Water soluble vitamins

Question 1

6 m/o breastfed infant with vomiting, opthalmoplegia and congestive heart failure.

Answer 1

Thiamine, B1 deficiency (beriberi). Mom is probably deficient.

Question 2

5y/o child who only eats burgers, milk, who limps and refuses to walk. Also has a rash.

Answer 2

Vitamin C deficiency resulting in scurvy. Not walking due to joint pain. May not present with the gum bleeding, petichiae, etc.

Question 3

Alcoholic, found down with altered mental status, anemia.

Answer 3

Thiamine or B12 or folate deficiency. Some combination is likely.

Question 4

15 m/o breastfed infant w/ failure to thrive, no longer walking, mom has dietary “limitations”

Answer 4

This could be rickets, but Vitamin D is not water soluble.

This can be a presentation of B12 deficiency. If mom is a strict vegan, baby can be low.

Question 5

Obese adolescent who refuses to walk. Has had bariatric surgery. Falls down.

Answer 5

B12 or thiamine.

Both could be present in a bariatric patient.

Question 6

Adult of low SES with chronic diarrhea/malabsorption, rash on arms, hands neck.

Answer 6

Pellagra (niacin deficiency).

Question 7

What are the B vitamins?

Answer 7

Thiamin (B1)
Riboflavin (B2)
Niacin (B3)

**These are found in whole grains, and fortified in processed grains. All release energy.

Question 8

What is the precursor for niacin (eg what can stand in for replacement of niacin?)

Answer 8

Tryptophan

Question 9

What is B1 deficiency?

Answer 9

Thiamine deficiency. Beriberi - nervous and cardiovascular effects

Dry: neuropathy, food drop, muscle atrophy
or
Wet: edema, circulatory collapse, CHF
or
Cerebral: Wernicke-Korsakoff

Question 10

What populations, aside from alcoholics, are at risk from thiamine deficiency?

Answer 10

Post-bariatric surgery

Anorexia nervosa

Question 11

What is the classic presentation of riboflavin deficiency?

Answer 11

B2 deficiency (dairy, milk)

Cracking and dryness at the corner of the mouth.

Question 12

What is the classic presentation of Niacin deficiency?

Answer 12

B3. Pellagra.

Question 13

What are the classic signs of pellagra?

Answer 13

4 Ds. 
Diarrhea
Dermatitis
Dementia
Death

Question 14

Signs and symptoms of folate deficiency?

Answer 14

Macrocytic anemia
Hypersegmented neutrophils
Elevated homocysteine

Question 15

B12 deficiency looks exactly like folate deficiency except for…..

Answer 15

neurologic deficits.