Folic acid diarrhea

Toxicities are GI (stomatitis, diarrhea, nausea, vomiting), hematologic (thrombocytopenia, leukopenia), pulmonary (fibrosis, pneumonitis), and hepatic (elevated enzymes, rare cirrhosis). Concomitant folic acid may reduce some adverse effects without loss of efficacy. Liver injury tests (aspartate aminotransferase or alanine aminotransferase) should be monitored periodically, but a liver biopsy is recommended during therapy only in patients with persistently elevated hepatic enzymes. MTX is teratogenic, and patients should use contraception and discontinue the drug if conception is planned. 

Patients with folic acid deficiency may have diarrhea and nausea, but the principal symptoms are weakness and easy fatigability due to megaloblastic anemia arising from impaired cell division in the bone marrow. 

Folic acid deficiency symptoms include megaloblastic anemia, glossitis, diarrhea, and weight loss. The requirement for this vitamin increases during pregnancy and lactation. 

Dietary deticiencies of folic acid are most frequently associated wilh anemias imacroeylic, megaloblastic, and pernicious), glossitis, diarrhea, gastrointestinal lesions, intestinal malabsorption, and sprue. 

Folic acid (Vitamin B9) Yeast, liver, green vegetables, some fruits Anaemia leading to weakness, tiredness, sore tongue, diarrhea, irritability, headache, heart palpitations. 

Gastrointestinal adverse effects (stomatitis, anorexia, abdominal pain, dyspepsia, nausea, vomiting, diarrhea, and weight loss) are very common, particularly after oral administration of methotrexate (up to 50%), and often require dosage adjustment (3). Folic acid supplementation reduces the incidence of several gastrointestinal adverse effects. 

Tropical sprue is a malabsorptive disease thought to be generated by specific t)q)es of infections. The disease involves diarrhea and is associated with the malabsorption of folate. Hence, its treatment may involve supplements of folic acid. 

Folic acid Megaloblastic anemia, diarrhea, glossitis Serum folate Decreased with increased cellular/tissue turnover (pregnancy, malignancy, hemolytic anemia) masks neurologic complications of vitamin B12 deficiency decreases risks of neural tube defects... 

The sole use of folic acid is as a nutrient in animal bodies. It is used in the synthesis of methionine, an amino acid used in the formation of proteins and nucleic acids. A deficiency of folic acid can produce various symptoms, including ulcers in the stomach and mouth, slowed growth, and diarrhea. It also results in a medical condition known as megaloblastic anemia, in which a person s body produces red blood cells that are larger than normal. 

There is an increased risk of diarrhea in patients taking misoprostol with the m nesium-containing antacids. Sulfasalazine may increase the risk of toxicity of oral hypoglycemic dru, zidovudine, methotrexate, and phenytoin. There is an increased risk of crys-talluria when sulfasalazine is administered with medienamine. A decrease in the absorption of iron and folic acid may occur when these ents are administered with sulfasalazine. When bismuth subsalicylate is administered witli aspirin-containing dru, there is an increased risk of salicylate toxicity. There is an increased risk of toxicity of valproic acid and methotrexate and decreased effectiven s of the corticosteroids when these agents are administered with bismuth subsalicylate. 

Megaloblastic anemia in young adults should always arouse suspicion of idiopathic steatorrhea, even if there is no diarrhea. This is particularly true if free hydrochloric acid is present in the gastric juice or if the response to Bu is slight or absent. Nieweg (1953) observed responses to Bi2 in two of his patients and a partial response in another. Two responded to folic acid. 

Mucosal lesions (Fig. 1), nausea, and diarrhea are also consequences of MTX therapy. At doses of 15 to 25 mg used for arthritis, nausea has been reported by 40% to 60% of patients and diarrhea over 10% of the time (94,95). Stomatitis had also been reported in over 10% of cases from another series (96). This appears to be dose related, with no difference between placebos for any of these effects in a randomized trial of MTX for sarcoidosis (35). However, in a larger series of sarcoidosis, some sarcoidosis patients did discontinue MTX because of nausea (8,97). The hematologic and G1 toxicity of MTX can be minimized by the use of low-dose folic acid supplement (1-mg folic acid per day) (98) without affecting the efficacy of MTX. MTX leads to decreased homocysteine levels that can be reversed with folic acid supplementation (99). 

Patients should be asked about nausea, diarrhea, and stomatitis. If present, these usually respond to dose reduction and the addition of Tmg folic acid (98). This does not appear to affect the drag s anti-inflammatory propaties (118). 

Sprue. Folic acid is effective in the treatment of sprue, a gastrointestinal disease characterized by intestinal lesions, malabsorption of food, diarrhea, stools containing large amounts of fat, macrocytic anemia, and general malnutrition. 

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