January Week 3: Vitamin Deficiencies
A 14 year old male presents with fatigue, pallor, and lightheadedness. He denies any changes in his diet, but has been vegetarian his entire life. You check a CBC, and note hemoglobin of 9 and MCV of 110.
1. What deficiencies would you consider? What other symptoms would help differentiate between the diagnoses?
A 1 month old infant born at 34 weeks gestational age is being exclusively breastfed, and is not on any medications.
2. What supplementation do you recommend for this patient and how much?
On a medical trip to Tanzania, you see a 10 year old girl with cough, congestion, and fever. On exam you also see foam-like patches on conjunctiva, as well as conjunctival and scleral xerosis without ulcerations. On further questioning, she admits to not be able to see at night.
3. What additional work-up would you do?
4. How would you treat this patient?
5. What can you tell the patient and her parents about her prognosis regarding her vision?
You are seeing an 13 month old girl in clinic because parents are concerned she is not starting to walk. She is at the 5th and 9th percentile for height and weight, respectively. You note she has a petechial rash on her arms and legs and swollen, red gums. Mother reports she has stopped giving formula and started giving milk, but usually heats it up first to kill the bacteria.
6. What is your most likely diagnosis?
7. What is the best way to confirm the diagnosis by laboratory studies?
A 2 year old boy is brought in by his mother. The family has recently moved here from Nigeria, and she is concerned about his poor growth and bowed legs. You suspect Vitamin D deficiency.
8. What are the risk factors for Vitamin D deficiency?
9. What laboratory or radiologic studies would you consider and what abnormalities would you expect to see?
Cases written by Dr. Ami Patel, PGY1