Schillings Formula

1. Give PO ⁵⁷Co(Cyanocobalamin) capsule - approximately 0.1μCi
2. One to two hours post dose administer 1000U stable B₁₂ IM
3. Have the patient collect a 24 hour urine
4. When the 24 hour urine arrives refrigerate it for several hours to reduce the temperature and smell
5. Measure the volume
6. Pipette 4 mL of urine and place into a test tube for counting
7. Count the urine for at least 15 minutes and as much as 30 minutes - remember your counting statistics!
8. Count the background for the same amount of time as the sample
9. Apply your data to the above information
10. Normal vs. Abnormal results
    1. Mallinckrodt package insert says, "0 to 3 percent is pernicious anemia or some other condition preventing absorption of the B12
    2. 3 to 5 percent is questionable
    3. Greater than 5% is normal
    4. Other literature indicates that normal is between 8 to 10 percent

Schillings II

1. Is done when Schillings I is considered abnormal
2. When administering the dose of ⁵⁷Co-B₁₂ also administer, PO intrinsic factor
3. Continue with the application of steps 2 - 9
4. If this is abnormal go to Schillings III

Schillings III

1. Administer IV antibiotic therapy for 7 to 10 days
2. This will destroy bacteria in the GI track that may be preventing the absorption of B₁₂
3. After therapy repeat Schillings one and include the administration of intrinsic factor

Comments

1. Urine Collection must be done over a 24 hours period
2. Why is 100(%) not used in the formula? 100 (%) and correction factor is 100.
3. Make sure you know the difference between Schillings I, II, III
4. Understand the Schilling's Procedure includes
   1. Reason for the injection of stable B12
   2. Application of intrinsic factor
   3. Use of IV antibiotics

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