Suspected Aspiration of Vitamin B12 Spray in Adult Male

Case at a Glance

A 37-year-old male presented with concerns about possible aspiration of vitamin B12 spray into his respiratory tract, experiencing persistent foreign body sensation and mild respiratory symptoms.

Patient's Story

The patient reported using a high-dose methylcobalamin B12 liquid spray the previous evening when he felt some of the liquid entered his trachea rather than being swallowed normally. Notably, he did not experience the typical immediate coughing reflex that usually occurs with aspiration. He attempted manual coughing to clear the sensation without apparent success. The patient described a persistent foreign body sensation in his windpipe and lungs during breathing, which was most pronounced in the first 1-2 hours post-incident. The sensation gradually diminished but persisted intermittently, particularly when lying down. By the following morning, he continued to experience subtle respiratory sensations during certain phases of breathing, described as a mild, transient urge to cough that occurred primarily during late expiration or early inspiration.

Initial Assessment

Patient presented with anxiety regarding potential aspiration pneumonitis. He was concerned about the composition of the vitamin spray (described as mostly watery with slight oily consistency) and its potential for bacterial contamination after prolonged room temperature storage. The patient had self-administered two sprays of the product. Vital signs were stable, and the patient appeared well without acute distress.

The Diagnostic Journey

Clinical evaluation focused on ruling out aspiration pneumonitis. The patient's lack of immediate coughing reflex raised questions about the actual occurrence of aspiration. Physical examination of the chest and respiratory assessment were performed to evaluate for signs of pulmonary involvement. The patient's symptoms were primarily subjective sensations without objective findings of respiratory compromise.

Final Diagnosis

Suspected minimal aspiration of vitamin B12 spray with possible laryngeal irritation. No evidence of aspiration pneumonitis or pneumonia at time of evaluation.

Treatment Plan

Conservative management with observation was recommended. Patient education provided regarding the typical timeline for aspiration-related complications (usually developing within 24-72 hours if they occur). The patient was advised to monitor for symptoms such as fever, productive cough, shortness of breath, or chest pain. Reassurance was provided that the small volume aspirated and the composition of the vitamin spray made significant complications unlikely.

Outcome and Follow-up

Patient was advised to seek medical attention if respiratory symptoms worsened or if signs of infection developed. Follow-up was scheduled as needed based on symptom progression. The persistent mild sensations were likely related to laryngeal irritation rather than pulmonary aspiration, with expected resolution over several days.