Lecture 24: Nutritional Metabolic Disorders Flashcards
Lead poisoning
Presents differently in children (behavioral/IQ problems) vs adults (ab pain, constipation, wrist drop, encephalopathy, unusual taste in mouth, hypochromic, microcytic anemia)
Burton’s line
Discoloration of upper gum margin due to lead poisoning
Mercury poisoning
Encephalopathy, sensorimotor neuropathy, seizures, tremor
Arsenic and where it’s found
Encephalopathy, painful neuropathy, nausea, vomiting, diarrhea, renal failure, arrhythmias; warfare, murder, ground water
Thallium and where it was and is found
Vomiting, diarrhea, paresthesias (small fiber neuropathy), cognitive impairment; rat poison (since banned), shellfish near coal burning plants
Manganese and associated job
Psychiatric: confusion, irritability, compulsive behavior, then Parkinson’s disease symptoms BUT with increased reflexes (NOT like PD); associated with welders
Forms of malnutrition (4)
- Undernutrition; 2. Overnutrition; 3. Specific Deficiencies; 4. Imbalance
Malnutrition can be due to…what’s one specific one in the US?
GI causes; bariatric surgery
Marasmus
Balanced starvation often due to insufficient breast milk with wasting, mental changes, growth retardation
Kwashiorkor
Low protein w/ enough carbohydrates; encephalopathy, muscle wasting
Obesity specific definition
> 20% than desirable weight
Pickwickian Syndrome. What are lab tests?
Complication of obesity w/ severe cardiorespiratory distress & alveolar hypoventilation; polycythemia, hypoxemia, cyanosis, CHF & somnolence
Hypersomnia sleep apnea presents with…other effects?
Excessive daytime sleepiness; oxygen desaturation, arrhythmias
Neurological complications of DM (6). All due to…
Dementia, ischemic cranial nerves, peripheral neuropatihies, plexopathies (plexes become involved), bilndness, increased risk of stroke; strokes of blood vessels to nerves
Dietary excess: Vitamin A
Increased intracranial pressure
Dietary excess: Water
Encephalopathy (water intoxication)
Dietary excess: Protein
Hepatic encephalopathy
Dietary excess: Pyridoxine
Peripheral neuropathy
Dietary excess: Tryptophan (contaminated)
Neuropathy/myopathy
Dietary excess: Emetine, ipecac
Myopathy (related to anorexia)
What is the first step of alcohol withdrawal, followed by…
“Rum fits” (12-48 hours) –> DTs
What optic nerve effect is related to alcoholism?
Amblyopia (degenerative)
Serum alcohol levels and CNS toxicity
0.15 - 0.25 = slurred speech/ataxic gait, 0.3 = stupor, 0.4 = coma, 0.5 = death
Cental pontine myelinolysis and cause
Demyelinated pons –> severe paralysis, dysphagia, dysarthria (death); alcoholism, over correction of hyponatremia
Marchiafava-Bignami disease and cause
Demyelinated CC –> rapid psychosis, stupor, coma, death; alcoholism
Alcoholic cerebellar degeneration
Truncal ataxia w/ midline problems
Hepatic encephalopathy symptoms test
Dementia and ataxia; “Flapping tremor”
Why might alcoholics get subdural hematoma
Shrinking brain (stretching of bridging veins)
Thiamine deficiency: alcoholic vs pure
When due to alcohol, length dependent sensory or sensorimotor neuropathy;
pure thiamine deficiency polyneuropathy starts with weakness or numbness, rapid progression
Wernicke’s encephalopathy triad and associated conditions
Ataxia, ophthalmoplegia, confusion; impaired absorption (various gastric disorders or bariatric surgery) or poor intake of thiamine (as in alcoholism), HIV, hyperemesis gravidarum
Wernicke’s encephalopathy pathology
Lesions of medial thalamic nuclei, mammillary bodies, PAG, cerebellar vermis
Korsakoff’s pathology
Neuronal loss/gliosis, hemorrhage into mammillary bodies, thalamus (DM, anterior group)
How does Korsakoff’s develop? Presentation
Untreated Wernicke’s; memory loss (anterograde and retrograde) w/ confabulation, dementia, etc.
Pyridoxine deficiency
Various types, often presents in infancy as seizures, necessitates Pyridoxine supplementation
Cobalamine deficiency and other name
Can be related to diet (rare), congenital pernicious anemia, or NO abuse; combination of UMN and LMN problems due to demyelination, symptoms are symmetric and diffuse; subacute combined degernation of spinal cord
Cobalamine deficiency can cause…(disease name) and test
Posterolateral column disease (UMN disease); Romberg test
Vitamine E deficiency symptoms and causes
Progressive spinocerebellar syndrome and peripheral neuropathy w/ dry hair, baldness, muscle weakness, leg cramps; GI, pancreatic, hepatic disease
