SUDDEN FOLIC ACID DEFICIENCY IN THE CRITICALLY III

Although people in good health need only about 50 micrograms of folic acid every day, the need for this important member of the vitamin B complex increases dramatically (seven to 20-fold) during bacterial infections and after loss of blood. Extra folic acid is used whenever new cells are formed in large numbers anywhere in the body.

Thus, when the bone marrow produces many extra white blood cells to fight an infection or forms many new red blood cells to make up for blood lost during surgery or hemorrhage, it suddenly uses much more folic acid than usual. If this increased need is not recognized and met, the patient will be unable to produce all the necessary white cells, red cells, and platelets, or to recover completely from a serious infection, even though transfusions and antibiotics are employed.

A report in Critical Care Medicine (8:500) points out that during a serious illness, the bone marrow uses up its folic acid stores so fast that it becomes deficient in this essential vitamin even though folic acid levels in the blood and other tissues remain normal.

It may not be possible for patients to obtain all the vitamins they need by mouth when they are seriously ill, and to facilitate recovery, daily injections of folic acid (10 milligrams) may be required. Another reason that folic acid in tablet form may not be recommended, the American Family Physician (32#4:290) reports, is that it may cause a deficiency of zinc. If present in the stomach to excess, it is thought, folic acid combines with all of the zinc contained in our food, thus rendering it insoluble and less easily absorbed.

Foods such as peanut butter, beans, nuts, liver, and green leafy vegetables are natural sources of folic acid.

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