FTT

Question 1

1- Nonorganic FTT ( ∼ 90% of cases) :

Answer 1

Usually associated with: • Wrong feeding practices • Wrong preparation of formula feeds • Child neglect • Poor socioeconomic status • Intrauterine growth restriction • Prematurity and low birth weight

Question 2

B1, Thiamine

Answer 2

Deficiency
Be riberi
1- Wet—high	output	cardiac	failure
2- Dry—nervous	tissue	: Wernicke	encephalopathy	,
Korsakoff	syndrome
3- Infantile	beriberi:	cardiomegaly,	tachycardia,	cyanosis,	
aseptic	meningitis
Management
3-5	mg/day	PO	thiamine	for	6	weeks	
Toxicities
None	known

Question 3

B2, Riboflavin

Deficiency

Answer 3

Deficiency
• Glossitis,	cheilosis • photophobia,	lacrimation,	corneal	Vascularization • poor	growth
Management
3-10	mg/day	PO	riboflavin	
Toxicities
None	known

Question 4

B3, Niacin

Answer 4

Pellagra 3D
B3, Niacin
Deficiency
Pe llagra manifesting as: 1- Diarrhea 2- symmetric scaly dermatitis in sun exposed areas 3- neurologic symptoms of disorientation and delirium
Management
50-300 mg/day PO niacin
Toxicities
• Facial flushing • burning, tingling, and itching sensation on the arm , chest
, and face • cholestatic jaundice or hepatotoxicity

Question 5

B6, pyridoxine

Answer 5

Deficiency
• Irritability • Convulsions • Hypochromic anemia • Dermatitis around the eye, glossitis • Oxaluria • Pyridoxine-dependent epilepsy
Management
• 5-25 mg/day PO for deficiency states • 100 mg IM or IV for pyridoxine-dependent seizures
Toxicities
• Ataxia • Sensory neuropathy

Question 6

B7, Biotin

Answer 6

Deficiency
• Scaly periorificial dermatitis • Conjunctivitis • Alopecia • Lethargy, hypotonia • withdrawn behavior
Management
1-10 mg/day PO biotin

Question 7

B9, Folic acid

Answer 7

Deficiency
• Megaloblastic anemia • Growth retardation • Glossitis • Neural tube defects in progeny
Management
0.5-1 mg/day PO folic acid
Toxicities
• obscure and potentially delay the diagnosis of vitamin B12
deficiency • neurotoxicity

Question 8

B12, Cobalamin

IM

Answer 8

Deficiency
• Megaloblastic	anemia • Irritability • developmental	delay • developmental	regression • involuntary	movements • hyperpigmentation
Management
1,000	µg	IM	Vitamin	B12
Toxicities
None	reported

Question 9

Vitamin C, Ascorbic acid

Answer 9

Deficiency
Scu rvy	 • irritability,	 • tenderness	and	swelling	of	legs • bleeding	gums • petechiae,	ecchymoses • follicular	hyperkeratosis • poor	wound	healing
Gingival lesions Management
Toxicities
patients	and	hemochromatosis.
100-200	mg/day	PO	ascorbic	acid	for	 up	to	3	mo.
• abdominal	pain
• osmotic	diarrhea
• ↑	Risk	of	iron	toxicity	in	thalassemia

Question 10

Vitamin A

Answer 10

Deficiency
• Progressive loss of vision. • Night blindness is one of earliest signs of deficiency. • Xerophthalmia (dry eyes).
Management
A daily supplement of 1,500 μg of vitamin A is sufficient for treating latent vitamin A deficiency.
Toxicities
• Anorexia, slow growth, drying and cracking of skin,
enlargement of liver and spleen.

Question 11

Vitamin D

Answer 11

Deficiency
• Rickets in children • Osteomalacia in Adult • hypocalcemia can cause tetany and seizures
Management
Give vitamin D supplements
Toxicities
Hypercalcemia, which can cause emesis, anorexia, pancreatitis, hypertension, arrhythmias, CNS effects, polyuria, nephrolithiasis, renal failure

Question 12

Vitamin E

Answer 12

Deficiency
1. Red cell hemolysis in premature infants 2. posterior column and cerebellar dysfunction 3. pigmentary retinopathy
Management
• In neonates, the dose of vitamin E is 25-50 units/day for 1
week, followed by adequate dietary intake • In Children 1 unit/kg/day
Toxicities
Unknown

Question 13

Vitamin K

Answer 13

Deficiency
• Hemorrhagic manifestations
Management
• In Infants should receive 1 mg of parenteral vitamin K. • In adolescents should receive 2.5-10 mg of parenteral vitamin K.
Toxicities
• hemolytic anemia, jaundice, kernicterus, death

Question 14

Kwashiorkor

Answer 14

Kwashiorkor
Sever protein deficiency but normal caloric intake
Between the age of 6 months and 3 years of age.
Peripheral edema is present
Hair change common(sparse and easily pulled out)
Reduced subcutaneous fat
There is severe weight loss and poor appetite.
The thinning of muscles and limbs with flaky paint appearance on the skin.
Fatty liver common Worse prognosis
22

Question 15

Ma rasmus(PEM)

Answer 15

Ma rasmus(PEM)
S ever deficiency of all nutrients ad inadequate caloric intake
Between the age of 6 months and 1 year of age.
Peripheral edema is absent
Hair change absent
Absent Subcutaneous fat There is some weight loss and voracious feeder. The thinning of limbs with dry and wrinkled skin.
Fatty liver uncommon Better prognosis

Question 16

FTT physical examination:

Answer 16

1. Fall of in weight velocity.
2. Fall of in linear growth & head circumference.
3. Developmental delay.
4. Signs of malnutrition : thin child , wasted buttocks
   , thin hair. 5. Signs of neglect : dirt , unkempt , nappy rash ,
   unusual reaction to strangers. 6. Mental status changes in a child can indicate poor
   bonding or cerebral palsy. 7. Complete general examination , including all
   systems to detect any underlying disease.

Question 17

Investigation:
M ost affected infants and toddlers do not require any investigations and are managed based on history and physical examination

Answer 17

Investigations to be considered in a child with worrying signs or symptoms of disease:
1-complete blood count (CBC). 2-Iron studies. 3- Liver function tests. 4-urine analysis, urine culture, serum electrolytes. 5- Stool sample. 5-hormone function tests. 6-coeliac screen.