Fat-Soluble Vitamin Deficiencies

You are a Nutritionist seeing a family today that has been referred to you for a consult.   Address the questions after reading the patient’s brief history below:  

Caleb is a 2-year-old male.  He has been crawling all over the place, but has only started being able to support his own weight and trying to walk within the last month.  In fact, his mother notes that he has a lot of difficulty supporting himself and his legs appear bowed.  His parents are vegan and are also strict with his intake as well.  The majority of his nutrients come from fruits and vegetables.   His mother notes that Caleb was exclusively breastfed as a baby and drinks soy milk, though doesn’t really seem to like it so he doesn’t take much in.  Lately, he’s been less active, seeming tired, and at his most recent pediatrician visit the physician’s assistant noted that Caleb is not reaching his growth milestones.  

What symptoms does Caleb present that are worrisome, and why?

Why is it important to know that Caleb was exclusively breastfed as a baby?

Based on the information provided, for what vitamin deficiency is Caleb most at risk? 

Based on your answer to the previous question, what is the potential result(s) of this vitamin deficiency in children? 

What would you recommend to Caleb’s parents in support of their little boy’s optimal health given his current physical evaluation?  Why are those your recommendations?

Lucia is a 73-year-old woman who prefers her vegetables very well cooked – she has esophageal dysphagia and needs her vegetables to be on the softer side in order to swallow them effectively.  Because of her dysphagia, she doesn’t eat much meat but when she does, she makes sure it is very lean and that it has as little fat as possible.  Additionally, she’s allergic to nuts so can’t consume them. Lucia has recently been experiencing some other GI tract issues (abdominal cramping and bloating, diarrhea) for the past year, and was diagnosed with Crohn’s disease a few months ago.  To add to her ailments, Lucia has also been struggling with her vision and was diagnosed with cataracts.  Overall, she has been feeling very weak and more fatigued than usual, so she visited the doctor to get a blood test and make sure everything is okay. 

What symptoms does Lucia present with that are potentially worrisome?

What is Crohn’s disease, what symptoms does it cause, and how would it relate to a nutrient deficiency?

Based on the information provided, for what vitamin deficiency is Lucia likely deficient?  Explain how you determined this.

Lucia’s doctor wants to do a blood smear to nail down her deficiency.  How/why would a blood smear be specifically helpful in this case?

Baby Anika was born via an uncomplicated vaginal delivery home birth vaginal. Mother and baby were reported to have an uneventful first few weeks at home. Breastfeeding was going well, and Anika was growing as expected. However, Anika began to develop severe bleeding from her umbilical stump and her parents were unable to stop the bleeding, so had to take her to the emergency department. Anika’s parents reported no family history of hemophilia and reported no issues with feeding intolerance, bruising, or changes in urination, stools, or activity. After a blood panel, Anika’s results returned normal with no concerns. However, the bleeding remained an issue. After multiple rounds of various treatments, Anika’s healthcare team suggested she may have a vitamin deficiency that’s leading to her bleeding.

Based on the information, for what vitamin is Anika likely deficient?

Explain how this vitamin deficiency could result in uncontrollable bleeding? Describe important mechanisms this vitamin is involved in.

At birth, Anika’s parents declined any vaccinations or injections. Why might it be particularly important for a baby to receive a vitamin injection at birth? Explain at least two reasons why babies are “at a disadvantage” when it comes to this vitamin.