Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 13-07: Folic Acid Deficiency + Key Features Download Section PDF Listen +++ ++ Folic acid present in most fruits and vegetables (especially citrus fruits and green leafy vegetables) Daily requirements of 50–100 mcg/day usually met in the diet Total body stores of folate enough to supply requirements for 2–3 mo Most common cause of folate deficiency is inadequate dietary intake, which occurs in Alcoholics Anorectic patients Persons who do not eat fresh fruits and vegetables Those who overcook food Other causes Decreased absorption (tropical sprue; drugs, eg, phenytoin, sulfasalazine, trimethoprim-sulfamethoxazole) Increased requirement (chronic hemolytic anemia, pregnancy, exfoliative skin disease) Loss (dialysis) Inhibition of reduction to active form (methotrexate) + Clinical Findings Download Section PDF Listen +++ ++ Megaloblastic anemia, which may be severe Glossitis and vague GI disturbances (eg, anorexia, diarrhea) No neurologic abnormalities, unlike vitamin B12 deficiency + Diagnosis Download Section PDF Listen +++ ++ Megaloblastic anemia identical to that in vitamin B12 deficiency (eg, macro-ovalocytes, hypersegmented neutrophils (see Vitamin B12 Deficiency) Red blood cell folate level < 150 ng/mL Serum vitamin B12 level normal Distinguish from vitamin B12 deficiency as well as from pure anemia of liver disease (macrocytic anemia with target cells but no megaloblastic changes) + Treatment Download Section PDF Listen +++ ++ Folic acid, 1 mg orally once daily, for patients with folic acid deficiency or increased folic acid requirements Rapid improvement in sense of well-being, reticulocytosis in 5–7 days, and total correction of hematologic abnormalities within 2 months