Water-Soluble Vitamin Deficiencies

Today your patient is Cai, a 52-year-old factory worker. He has been admitted to the hospital and presents with muscle weakness that has been affecting his ability to perform his job requirements. During his examination, you also note some inflammation of his mouth. As you ask Cai questions, he is a bit confused.  You inquire about drug and alcohol use, and he states that he isn’t drinking now, but he does have a history of alcohol abuse. He reports that he has lost quite a bit of weight in the last six months, and his dietary intake has been poor. He eats a lot of fast food, though his appetite has been poor.  He was laid off a year ago but he is back to work part-time. You order further testing to help determine the cause for his symptoms.

Based on the information provided, what possible vitamin deficiency(ies) do Cai’s signs and symptoms suggest?  Explain how you came to this conclusion.  

If you had multiple vitamins in mind, which one is the likely diagnosis?

What could be the cause of this probable vitamin deficiency (specific to Cai)?

What might be another sign(s) that you could expect to report upon examination of Cai, or a symptoms that you would expect Cai to complain of?

What specific diagnosis best fits Cai’s sign/symptoms?

Based on the information provided, what vitamin(s), if any, would you recommend supplementing?

What food(s) would provide the most significant source of the vitamin missing in his diet?

Jules lives in a low-income household so she and her family typically eat a vegetarian diet since they can’t afford many meat products. Her typical meals include whole grains and leafy foods, but no dairy products or seafood. Jules has been struggling lately and has turned to alcohol as a coping mechanism, making her diet even worse. She enjoys drinking outside in the sunshine but has been noticing her skin is inflamed and itchy and it gets worse in the sun. But that’s not all – she met a man at the supermarket and wanted to give him her phone number, but she couldn’t remember it. Strange, right?

Based on the information, for what nutrient is Jules likely deficient? What made you choose this nutrient?

What disorder does Jules likely have given her vitamin deficiency?

When Jules went to the doctor, they screened her for Hartnup disorder?  Why would that be the case?  What is Hartnup disorder?

Franny is a 38-year-old nurse.  She is in her first 3 weeks of pregnancy and lately has been experiencing fatigue, weakness, and recurring headaches.  She visits her primary care doctor, and he orders a blood test.  A complete blood count (CBC) test showed that the blood cells were large and immature.

What do the large and immature blood cells likely indicate?

Is there a vitamin(s) for which Franny could be deficient?  Explain your rationale.

Could this deficiency potentially impact her pregnancy? Explain in specific detail.