nutritional deficiency cases Flashcards
Failure to thrive, macrocytic anemia, hypotonic, poor head control, areflexic, tremor, staeatorhea, mother areflexic, and has burning sensation in mouth
b12 def
anemia, periorbital edema, fatigue, pale rash only drinks milk at 18 months, picky eater, eats cardbaord and paper
Zinc and Fe deficiency
where do kids get most of their zinc and iron?
red meat. High vegetable diets because phytate will sequester those trace elements
14 y/o M autistic, fell off the bus
cloudiness in pt’s eyes x 1 wk
keeping eyes mostly closed
Diet:
Pringles & Ritz crackers (only x months)
No supplements
ROS: recent diarrhea (resolved)
Anthropometry:
Height/age: 8th %ile
Weight/age:
Vit A deficiency
and many other vitamin and mineral deficiencies
including zinc
16 y.o. girl severe underweight
history of weight loss.
always feeling cold. Lack of weight gain for at least 6 months, but aware of being thin before that. Complains of “stomach aches” often, mostly RLQ; s/t peri-umbilical; lasts few minutes; relieved w/ stooling; stools – hard & runny; s/t “thin”; no straining; + urgency s/t; has seen blood – few days ago; not sure how often or how long. Pain described as crampy – 7/8 out of 10, but doesn’t last long; 3x/day gets abd pain. No joint c/o; no mouth sores; no peri-anal sores; no heart burn sxs.
Growth Hx: no past growth data available
Diet/Nutrition Hx:
Feeding behavior: school lunch – eats but often gets abd pain with eating
Feeding tolerance: no foods worse than othes (including fatty foods)
Feeding variety: favorite foods: eats what mom prepares; fried catfish; mom cooks meats, burgers, steaks
Milk/formula intake: Ensure shake (360 kcal/can) – 1-2 cans/d; tried x 2-3 mo (w/ or w/o rest of meal); most days 1 can; drinks 2% milk – will drink w/ cereal in a.m. +/- at night. No lactose intolerance – mom says they drink milk regularly and a lot;
Recall:
Breakfast today: ham and cheese on an Eng. Muffin, water
Morning snack 10-11 a.m.: pop-tart and water
3-4 p.m: McGriddle (pancake, sausage, egg, and cheese)- whole thing
7:45 p.m: mac and cheese and 3 chicken wings; lemonade 8 oz.
9 a.m. yesterday – got up and had breakfast. Doesn’t feel hungry but doesn’t have to force herself to eat.
PMH: born at 38 weeks with BW 5 lb 7 oz Illnesses: none Hospitalizations and Surgeries: none Medications: no meds, no MVI Development: Meeting milestones: less energy recently, hyper in past; A’s and B’s for grades, in pre-college high school. Family Hx: Pat GMOC has cancer (unknown site); DM & CVD in pat side; mat- HTN; no Fhx of GI dz; kidney, etc; no thyroid problems; mom recalls also being small (thin), but not this thin. Mom typically in 100-110 in young adulthood. Couldn’t gain weight even w/trying to eat more until recent years. Mother’s height 5’8” (slender, but not extremely so); Father’s height 5’8”.
Social Hx:
No sports; grade to be in 11th , in pre-college hs.s; participates in student “voice committee”; no missed school; at home: 1 adult (mom) + 5 kids + mat brother (21 yr old); 17, pt, 15, 13, 7 yr. All healthy; mom self-employed as massage therapist and works at home. No new stresses; dad involved recently – lived in Delaware until past month. Previously very little contact. Pt. reports that it seems “weird” to have him back “b/c he waited a long time”, but denied major stress. Travel hx neg; no unusual pets, no known TB exposure.
Review of Systems: no HA, no rash, bruise; no CNS; periods at 14 yr; now less than monthly (approx. q o month) and light blood loss since not gaining wt; always feels cold; has prob w/ sleep b/c has to get up to go to bathroom (urine or stool); no skin or hair changes; vomits if eats too much (about 2x/wk) s/t self-induced others spontaneous; no blood in emesis; denies pain/”heart burn”.
Vital Signs: BP 90/63 | Pulse 106| Temp 95.5 (Tympanic)
Anthropometric Data:
Ht: 158 cm | Wt 26.4 kg
Wt for age percentile: LLQ; no mass palpable
GU/Anus: normal T4-5; no perianal lesions; rectal exam: normal sphincter tone; vault w/ soft stool; grossly bloody stool
Musculoskeletal: minimal SQ fat; severe generalized wasting; no clubbing; no edema; jt’s non-tender & FROM; cold
Skin: no lesions, rashes; ? pallor, but as noted conjunctiva pale
Lymph: no LAD; Neuro: grossly intact and DTR’s 1 +/=
Crohns
Progressive weakness & unable to walk
16 yr old male Down Syndrome, T1DM & Celiac Disease
Past year, progressively worsening gait, initially starting with difficulty walking & choosing to scoot or sit instead of walk; then unable to stand w/o support; lost 15 lb/past 6 mo
Continuing to eat well, varied diet
Diet – not gluten free; stools daily soft, no diarrhea; no MVI
BMI 15.3
Thin, non-ambulatory, alert/cooperative
Skin: + Pallor, hyperpigmentation +fine mac-pap rash over upper extremities & trunk
DTR’s ~ absent; bradykinesia; (+Trousseau & Chvostek)
LABS: BMP, glucose, MMA Homocysteine, B3, Vit E, 25 OH Vit D, CBC
microcytic anemia
B3- rash Vit E Vit D Ca2+- hypocalcemia Fe- low
Down syndrome-impaired ability for self reporting, developmental delays T1D Celiacs- duodenum No MVI BMI 15.3
