Vitamin B5 (Pantothenic acid) - Quantitative, Serum

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Vitamin B5 (Pantothenic Acid) - Quantitative Serum Test Information Guide

Why is it done?
- Test Purpose: Measures the serum concentration of pantothenic acid (vitamin B5) to assess nutritional status and identify deficiency states. This test quantifies the water-soluble vitamin essential for energy metabolism, synthesis of coenzyme A, and fatty acid synthesis.
- Primary Indications: Evaluation of unexplained neuropathy or burning feet syndrome; investigation of chronic fatigue or weakness; assessment of malabsorption disorders; screening for nutritional deficiency in patients with severe dietary restrictions; evaluation of pantothenic acid responsive dermatitis; monitoring patients receiving long-term parenteral nutrition.
- Typical Clinical Scenarios: When metabolic dysfunction is suspected; during comprehensive nutritional assessment; in patients with gastrointestinal disorders affecting nutrient absorption; in cases of drug interactions that deplete vitamin B5; when evaluating complications of alcoholism; assessment of post-surgical nutritional status.
Normal Range
- Reference Range Values: Normal serum pantothenic acid levels: 1.5 - 4.0 μg/dL (micrograms per deciliter) or approximately 0.34 - 0.88 μmol/L (micromoles per liter). Some laboratories report ranges of 1.0 - 3.5 μg/dL depending on methodology and reference population.
- Units of Measurement: Results are reported in μg/dL (micrograms per deciliter) or μmol/L (micromoles per liter). Conversion factor: 1 μg/dL = 0.227 μmol/L.
- Result Interpretation: Normal Result: Serum pantothenic acid levels within the reference range indicate adequate nutritional status and sufficient B5 availability for metabolic processes. Borderline Low: Levels approaching but not below the lower limit may suggest marginal deficiency. Low Result: Values below 1.0 - 1.5 μg/dL indicate pantothenic acid deficiency. Elevated Result: Levels above 4.0 μg/dL are relatively uncommon and rarely clinically significant, as excess water-soluble vitamin is typically excreted.
- Normal vs Abnormal Meaning: Normal values reflect adequate dietary intake and absorption of pantothenic acid, ensuring normal metabolic function and coenzyme A synthesis. Abnormal (low) values indicate insufficient B5 supply, potentially compromising energy metabolism, immune function, and neurological health.
Interpretation
- Low Pantothenic Acid Levels (<1.0 μg/dL): Indicates vitamin B5 deficiency, which may manifest as burning feet syndrome, paresthesias, fatigue, insomnia, and peripheral neuropathy. Associated with inadequate dietary intake, malabsorption disorders (celiac disease, Crohn's disease), chronic diarrhea, or increased metabolic demand. May develop in patients on prolonged antibiotic therapy that alters gut flora synthesis of B5.
- Normal Range Levels (1.5-4.0 μg/dL): Indicates adequate B5 status with sufficient stores for metabolic requirements. Patient's symptoms, if present, are unlikely attributable to pantothenic acid deficiency and warrant investigation of alternative etiologies.
- Elevated Levels (>4.0 μg/dL): Uncommon finding with minimal clinical significance. May occur with recent excessive supplementation or rare cases of impaired renal clearance. Generally does not require intervention as excess pantothenic acid is water-soluble and readily excreted.
- Factors Affecting Results: Dietary intake variations (vegetarians may have lower levels); malabsorption disorders significantly reduce serum levels; chronic alcoholism impairs absorption and increases utilization; medications (antimicrobials, immunosuppressants); recent supplementation may transiently elevate levels; pregnancy and lactation increase requirements; certain genetic polymorphisms in B5 metabolism; collection time (serum separation timing affects stability); hemolysis interferes with accurate measurement.
- Clinical Significance of Patterns: Progressive decline in serial measurements suggests ongoing malabsorption or inadequate dietary replacement. Deficiency in context of normal B-complex levels may indicate selective absorption problem. Persistently low levels despite supplementation warrant investigation of malabsorption or increased losses.
Associated Organs
- Primary Organ Systems Involved: Gastrointestinal tract (primary site of absorption); nervous system (highly dependent on B5 for myelin formation and neurotransmitter synthesis); metabolic tissues (liver, mitochondria for energy production); adrenal glands (for steroid hormone synthesis); skin (for barrier function and healing).
- Diseases and Conditions Associated with Deficiency: Burning feet syndrome (paresthesia of lower extremities); peripheral neuropathy; chronic fatigue syndrome; immune dysfunction; dermatitis and skin conditions; adrenal insufficiency symptoms; hyperlipidemia; impaired wound healing; insomnia and mood disturbances; carpal tunnel syndrome; elevated lipid levels.
- Gastrointestinal Disorders Affecting Levels: Celiac disease (impaired small intestinal absorption); Crohn's disease (mucosal inflammation and dysfunction); ulcerative colitis; short bowel syndrome; pancreatic insufficiency; bacterial overgrowth syndrome; irritable bowel syndrome; chronic diarrhea from any etiology; post-surgical malabsorption states.
- Neurological Complications: Distal symmetrical peripheral neuropathy; burning feet syndrome unresponsive to other interventions; impaired cognitive function; depression and mood disorders; sleep disturbances; demyelinating changes in severe chronic deficiency; compromised immune response to neurological infections.
- Metabolic and Endocrine Complications: Reduced energy production and ATP synthesis; impaired steroid hormone synthesis in adrenal glands; altered lipid metabolism with elevated cholesterol and triglycerides; impaired glucose metabolism; reduced capacity for stress response; compromised mitochondrial function throughout body.
Follow-up Tests
- Comprehensive B-Vitamin Panel: Testing for other B vitamins (B1, B2, B3, B6, B12, folate) to assess overall nutritional status. Deficiency of multiple B vitamins is common and requires comprehensive replacement strategy. Recommended when initial B5 deficiency is identified.
- Metabolic Function Tests: Lipid panel (triglycerides, total cholesterol, LDL, HDL) to assess lipid metabolism impairment; liver function tests to evaluate organ involvement; fasting glucose and HbA1c to screen for diabetes; comprehensive metabolic panel for electrolytes and kidney function.
- Gastrointestinal Assessment: Celiac serology (tTG-IgA, total IgA) if malabsorption suspected; fecal fat test for steatorrhea; small bowel imaging if Crohn's disease suspected; tissue transglutaminase testing; assessment of pancreatic sufficiency with 72-hour fecal chymotrypsin.
- Neurological Assessment: Electromyography (EMG) and nerve conduction studies (NCS) to confirm peripheral neuropathy; B12 and folate levels to exclude other causes of neuropathy; homocysteine level if neurological symptoms persist; metabolic screening to rule out diabetes and other metabolic causes.
- Immune and Inflammatory Markers: Complete blood count (CBC) to assess immune cell function; C-reactive protein and erythrocyte sedimentation rate to evaluate inflammation; immunoglobulin levels if recurrent infections present.
- Monitoring Frequency: Initial retest 4-8 weeks after starting supplementation to assess response; if deficiency confirmed, repeat testing every 2-3 months during treatment phase; once normalized, annual monitoring if risk factors persist; more frequent monitoring if symptoms don't resolve or malabsorption is ongoing.
- Additional Tests for Specific Presentations: For burning feet: comprehensive metabolic panel, TSH, B12, folate; for fatigue: iron studies, thyroid function, vitamin D, sleep study if indicated; for dermatitis: allergy testing, microbiology culture if infection suspected; for immune dysfunction: immunoglobulin levels, lymphocyte subset analysis.
Fasting Required?
- Fasting Requirement: No - Fasting is NOT required for this test. Serum pantothenic acid levels are unaffected by recent food intake.
- Patient Preparation Instructions: Patient may eat and drink normally before the blood draw; no special dietary restrictions required for this specific test; normal daily activities and routine can be maintained.
- Medication Considerations: Continue all regularly scheduled medications unless otherwise directed by physician; DO NOT discontinue B-vitamin supplements prior to testing as this may affect results and clinical interpretation; antimicrobial medications should be continued as prescribed; corticosteroids and immunosuppressants should be continued; inform laboratory of all supplements and medications being taken for result interpretation.
- Timing Recommendations: Test can be performed at any time of day; mid-morning blood draws are typically preferred for consistency; if monitoring supplementation response, test should be done at similar time to baseline for consistency; allow at least 4-8 weeks of supplementation before retest to assess therapeutic response.
- Sample Collection Special Requirements: Routine venipuncture into serum separator tube (SST) or standard serum tube; no special collection tube required; sample must be properly labeled with patient identifiers, collection date and time; serum must be separated from blood cells promptly (within 2 hours) to prevent degradation; refrigerate sample if delay in processing occurs; hemolyzed samples should be rejected as hemoglobin interferes with measurement.
- Pre-Test Instructions Summary: • No fasting required • Eat and drink normally • Continue all medications as prescribed • Continue B-vitamin supplementation if currently taking • Arrive well-hydrated to improve vein accessibility • Wear comfortable, loose-fitting sleeve that can be easily rolled up • Inform phlebotomist of any bleeding disorders or anticoagulant use • Keep appointment during regular business hours if possible • Allow 5-10 minutes for the blood draw appointment

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