Posted: July 14th, 2022

FNES 264 VITAMIN CASE STUDIES

FNES 264 VITAMIN CASE STUDIES
Be sure to answer all questions. Answers must be complete and referenced using APA or AMA reference style. You should have footnotes within your answers and a reference list at the end with full citations. (5 points)
A five-year-old female with typical development initially presented with a rash of red dots, some purple splotches and bone pain in both lower extremities. She also has bleeding gums on occasion. Diet history shows at the age of 1 year she transitioned from infant formula to milk and cereal snacks. She never accepted baby food. Since she began regular food her diet has consisted of cereal snacks, one type of cracker and the occasional banana. Other than that occasional banana, she never eats fruit, vegetables or meats. She drinks whole milk, water and rarely soda. She refuses to taste new foods or drinks.
What vitamin deficiency may be present? (5 points)
Provide at least one physiological manifestation and one dietary factor that led to your conclusion. (6 points)
What recommendations would you make that are realistic for this patient to treat this deficiency? (5 points)

A 48-year-old homeless man presented to the ER and was admitted to the hospital. He was confused, agitated and unable to give any history. He was very thin with a BMI of 14.2, and had striking abnormalities in his eyes and skin. After a few days he was able to provide a brief history that included heavy alcohol use, poor diet and self-neglect. He did not have money to buy food, often skipped meals and did not have the means to access a balanced diet for years.
Though many may be present, what vitamin deficiency do you suspect contributed to his agitation, confusion and eye abnormalities? (4 points)
What factor in his history also led you to this conclusion? (4 points)
What medical diagnosis may be given related to this vitamin deficiency? (4 points)
The patient was noted to have a high blood lactic acid level. Provide an explanation regarding this vitamin’s function as to why the level was high. (6 points)

A 28-year-old male presents to the ER after he experienced severe dizziness, fell and broke his arm. He mentions to the doctor he has also been very weak and appears pale. Blood tests reveal he has hemolytic anemia, which is the lysis of red blood cells.
What vitamin deficiency may have caused his hemolytic anemia? (5 points)
How may a toxicity of this same vitamin affect blood clotting? (5 points)
A 14-year-old boy first presented to his doctors with fatigue and was found to have a vitamin B12 deficiency. He received injections and dietary counseling. The next year he began to have vision disturbances but doctors did not find a clear cause. After two years he suffered worsening eyesight and eventual blindness. Upon interviewing him about his diet, it was found that since elementary school he would not eat certain textures of foods. His diet was mainly French fries, Pringles, white bread and sometimes ham.
What vitamin deficiency may he have? (5 points)
What factors in his medical and diet history led to your conclusion? (6 points)
A 64-year-old woman wants to speak to a dietitian about the use of vitamin supplements to reduce her risk of a heart attack. She has been managing dyslipidemia and hypertension for years but was recently admitted to a local hospital for Assessment of chest pain. After undergoing a stent placement, she was instructed to remain compliant with her medications and encouraged to pursue lifestyle modification. However, she wants to know whether, in addition to losing weight and modifying her diet as instructed by her physician, a vitamin supplement, especially niacin, can promote heart health.
What information can you provide for the use of vitamin supplements to prevent and treat cardiovascular disease? (10 points)

A 57-year-old male presents to his doctor with marked fatigue, diarrhea and a sore, swollen tongue. He also states he has been experiencing a tingling feeling in his toes and a feeling of clumsiness. Blood tests reveal and elevated MCV and homocysteine.
What vitamin deficiency do you suspect? (5 points)
What factors led you to this conclusion? (5 points)
What lab value would you recommend to confirm this deficiency? (5 points)

A college student is extremely stressed, tired and run down. He sees a commercial for “Miracle Vitamin” promising to boost energy and decrease stress. Being promised a quick fix, he decides to go to the vitamin store to purchase the product. In the store, a salesman introduces himself as a nutritionist and shows him the “Miracle Vitamin” on the shelf. The product costs $40 for a bottle of 50 pills though he sees other vitamin supplements being offered for much less. When he questions the salesman, he states that “Miracle Vitamin” is worth the price because it is all natural. He also points out the % Daily Values on the supplement label and shows it contains over 500 % for vitamin A, D, folic acid and niacin as well as some others. When the college student asks if this is too much, the salesman reassures him that any excess vitamin will be excreted in his urine and it is better to take more vitamins than not enough. The student is convinced and despite his limited budget, he purchases the supplement.
Discuss three things that concern you with this scenario. Be sure to provide your rationale as to why you are concerned. (15 points)

FNES 264 VITAMIN CASE STUDIES
Be sure to answer all questions. Answers must be complete and referenced using APA or AMA reference style. You should have footnotes within your answers and a reference list at the end with full citations. (5 points)
1. A five-year-old female with typical development initially presented with a rash of red dots, some purple splotches, and bone pain in both lower extremities. She also has bleeding gums on occasion. Diet history shows at the age of 1 year, she transitioned from infant formula to milk and cereal snacks. She never accepted baby food. Since she began regular food, her diet has consisted of cereal snacks, one type of cracker, and the occasional banana. Other than that occasional banana, she never eats fruit, vegetables, or meats. She drinks whole milk, water, and rarely soda. She refuses to taste new foods or drinks.

What vitamin deficiency may be present? (5 points)
Vitamin C deficiency may be present that is typically characterized with the symptoms she exhibited that is red dots, some purple splotches, and bone pain in the lower extremities

Provide at least one physiological manifestation and one dietary factor that led to your conclusion. (6 points)
When the body is Vitamin C deficient, the small blood vessels become fragile to cause the small bright red spots. Bleeding gums are also a sign of deficiency in Vitamin C. Vitamin C is also fundamental in bone formation. Its deficiency increases the risk of weak and brittle bones hence the bone pains she is experiencing (Julson, 2018).
Vitamin C is mainly obtained from breast milk, infant formula, fruits such as citrus fruits, strawberries, and cantaloupe together with vegetables such as potatoes and cabbage. However, the child’s diet is missing these essential sources of Vitamin C since she stopped taking infant formula at an early stage and does not eat any fruits or vegetables.

What recommendations would you make that are realistic for this patient to treat this deficiency? (5 points)
Since the child is a picky eater, the patient could be put on Vitamin C supplements available as oral supplements. The child’s pediatrician should guide in the right Vitamin C supplements for the child. The parent or guardian could also try to introduce smoothies to the child’s diet, which are made of the essential fruits and vegetables needed for Vitamin C. The smoothies that may have a taste that is not preferred, then natural sweeteners should be included. The smoothies should be introduced in small servings regularly until the child is used to the eating plan.

2. A 48-year-old homeless man presented to the ER and was admitted to the hospital. He was confused, agitated, and unable to give any history. He was very thin with a BMI of 14.2 and had striking abnormalities in his eyes and skin. After a few days, he provided a brief history that included heavy alcohol use, poor diet, and self-neglect. He did not have money to buy food, often skipped meals, and did not have the means to access a balanced diet for years.

Though many may be present, what vitamin deficiency do you suspect contributed to his agitation, confusion, and eye abnormalities? (4 points)
Vitamin B1 deficiency could have led to agitation, confusion, and eye abnormalities.

What factor in his history also led you to this conclusion? (4 points)
Vitamin B1 or thiamin deficiency potentially causes delirium and the fatal brain dysfunction called Wernicke encephalopathy (Beikheiser, 2018). The primary symptoms of these conditions include confusion. Vision problems; hence the eye abnormalities have also been related to Wernicke encephalopathy, which has been linked to Vitamin B1 deficiency. In addition, an irritable mood that consists of agitation has also been linked to thiamin deficiency.

What may medical diagnosis be given related to this vitamin deficiency? (4 points)
The diagnosis for Vitamin B1 deficiency includes delirium, delusional disorder, eye abnormalities, and severe underweight due to the BMI of 14.2. A BMI of less than 15 demonstrates severe underweight related to the lack of taking proper meals or even skipping them due to lacking the money to buy them. In addition, the patient exhibited symptoms such as being very thin, skin and eye challenges, memory loss, confusion, and agitation that show a high likelihood of thiamin deficiency or beriberi.

The patient was noted to have a high blood lactic acid level. Provide an explanation regarding this vitamin’s function as to why the level was high. (6 points)
Thiamin functions as a fundamental cofactor in aerobic metabolism, and its deficiency does contribute to lactic acidosis. Lactic acidosis is the buildup of lactic acid in the bloodstream or, somewhat, the high blood lactic acid level. Thiamin is a water-soluble vitamin with minimal tissue storage. Therefore, when there is a minimal intake of thiamin, the stores will be consumed very fast. In addition, the vitamin is a cofactor to pyruvate dehydrogenase during aerobic metabolism as it facilitates the conversion of pyruvate to acetyl-CoA within the mitochondria (O’Donnell, 2017). The existence of a thiamin deficiency means that pyruvate becomes unable to enter the citric acid cycle and gets converted to lactate, which leads to lactic acidosis.

3. A 28-year-old male presents to the ER after he experienced severe dizziness, fell, and broke his arm. He mentions to the doctor he has also been very weak and appears pale. Blood tests reveal he has hemolytic anemia, which is the lysis of red blood cells.
What vitamin deficiency may have caused his hemolytic anemia? (5 points)
Vitamin E deficiency leads to hemolytic anemia since Vitamin E protects the red blood cell membrane from oxidative damage (Infant Nutrition and Feeding, n.d.).

How may the toxicity of this same vitamin affect blood clotting? (5 points)
When Vitamin E reaches its toxic levels, it interferes with Vitamin K’s activities, causing prolonged bleeding and clotting time (Infant Nutrition and Feeding, n.d.).
4. A 14-year-old boy first presented to his doctors with fatigue and was found to have a vitamin B12 deficiency. He received injections and dietary counseling. The following year he began to have vision disturbances, but doctors did not find a clear cause. After two years, he suffered worsening eyesight and eventual blindness. Upon interviewing him about his diet, it was found that he would not eat certain textures of foods since elementary school. His diet was mainly French fries, Pringles, white bread, and sometimes ham.

What vitamin deficiency may he have? (5 points)
Vitamin A deficiency relates to fatigue and vision disturbances such as worsening eyesight that eventually led to blindness.

What factors in his medical and diet history led to your conclusion? (6 points)
His diet lacks the essential food sources of vitamin A as he has only been eating French fries, pringles, white bread, and ham. The primary sources of Vitamin A liver, egg yolk, dark green, and deep yellow vegetables and fruits.
Also, the lack of vitamin A affects one’s vision since it causes the cornea to be very dry hence clouding in the eye’s front and visual loss. Furthermore, the deficiency in Vitamin A has also been seen to affect the retina that contributes to blindness which the boy eventually suffered.

5. A 64-year-old woman wants to speak to a dietitian about using vitamin supplements to reduce her risk of a heart attack. She has been managing dyslipidemia and hypertension for years but was recently admitted to a local hospital to evaluate chest pain. After undergoing a stent placement, she was instructed to remain compliant with her medications and encouraged to pursue lifestyle modification. However, she wants to know whether, in addition to losing weight and modifying her diet as instructed by her physician, a vitamin supplement, especially niacin, can promote heart health.

What information can you provide for the use of vitamin supplements to prevent and treat cardiovascular disease? (10 points)
Extensive research conducted through randomized controlled trials has demonstrated that there are no consistent benefits in using vitamin supplements to prevent and treat cardiovascular diseases. The results from the trials have demonstrated that vitamin supplements disappoint in preventing cardiovascular diseases, and hence their routine use is not supported. Furthermore, the use of complementary and alternative medicine therapies, which include the megadose vitamins, may even lead one to take them several times that are more than the prescribed daily allowance (Sultan et al., 2017). This has a direct and indirect negative impact on one’s health and, specifically the cardiovascular events. Typically, vitamins are required in minimal amounts, so the essential dietary ingredients will act as cofactors that facilitate the chemical reactions needed in maintaining body functions. Therefore, the consumption of a well-balanced diet will fulfill many of the body’s needs.
Also, the role of supplementation is mainly that of the patients who are deficient or at risk of the deficiency and those in particular subgroups, the intake of vitamin supplements is unlikely to be beneficial while being costly, and it could cause harm through the increased risk of cardiovascular diseases (Sultan et al., 2017).
6. A 57-year-old male presents to his doctor with marked fatigue, diarrhea, and a sore, swollen tongue. He also states he has been experiencing a tingling feeling in his toes and a feeling of clumsiness. Blood tests reveal elevated MCV and homocysteine.

What vitamin deficiency do you suspect? (5 points)
Vitamin B12 Deficiency

What factors led you to this conclusion? (5 points)
Deficiency of Vitamin B 12 demonstrates symptoms such as fatigue, tongue inflammation hence the swelling, the tingling feeling felt in the toes, and the feeling of clumsiness. Also, the Vitamin B12 deficiency has been related to the elevated MCV (macrocytosis) and homocysteine. Vitamin B12 deficiency causes macrocytosis since DNA synthesis requires cyanocobalamin (vitamin B12) as a cofactor. Therefore, its deficiency leads to decreased DNA synthesis in the erythrocyte, leading to macrocytosis (Haltmayer et al., 2002). Also, the homocysteine metabolism is affected by Vitamin B12 as it is used as a cofactor. Therefore, its deficiency leads to the accumulation of homocysteine.

What lab value would you recommend to confirm this deficiency? (5 points)
An average level of Vitamin B12 in one’s bloodstream is generally between 190 and 950 picograms per millimeter. It is considered to be borderline for a rainy value between 200 to 300, and in case it goes below 200 pg/ml, it is considered low levels (Ratini, 2017).

7. A college student is highly stressed, tired, and run down. He sees a commercial for “Miracle Vitamin” promising to boost energy and decrease stress. Being promised a quick fix, he decides to go to the vitamin store to purchase the product. A salesman introduces himself as a nutritionist in the store and shows him the “Miracle Vitamin” on the shelf. The product costs $40 for a bottle of 50 pills though he sees other vitamin supplements being offered for much less. When he questions the salesman, he states that “Miracle Vitamin” is worth the price because it is all-natural. He also points out the % Daily Values on the supplement label and shows it contains over 500 % for vitamin A, D, folic acid, and niacin, as well as some others. When the college student asks if this is too much, the salesman reassures him that any excess vitamin will be excreted in his urine, and it is better to take more vitamins than not enough. The student is convinced, and despite his limited budget, he purchases the supplement.

Discuss three things that concern you with this scenario. Be sure to provide your rationale as to why you are concerned. (15 points)

1. The risk of excessive intake of vitamins could lead to adverse side effects that could easily result in death. In addition, the product states to be having over 500% of the various vitamins, which already is putting the patient at risk since some of these vitamins are not recommended to be taken in these excesses.
2. The vitamin supplements need to be administered by healthcare professionals such as pharmacists, who are the only parties allowed to market the product (Hamishehkar et al., 2016). However, in this case, the product has been sold by a salesman who does not provide critical information related to the product.
3. Also, the student was not diagnosed with a particular disease that is related to the identified symptoms. As a result, the student may be treating a wrong diagnosis which poses a considerable risk to his health.

References
Hamishehkar, H., Ranjdoost, F., Asgharian, P., Mahmoodpoor, A., & Sanaie, S. (2016). Vitamins, are they safe?. Advanced pharmaceutical bulletin, 6(4), 467.
Ratini, M. (2017, April 28). Vitamin B12 test & normal levels. WebMD. https://www.webmd.com/a-to-z-guides/vitamin-b12-test#
Haltmayer, M., Mueller, T., & Poelz, W. (2002). Erythrocyte means cellular volume and its relation to serum homocysteine, vitamin B12, and folate. Acta Medica Austriaca, 29(2), 57-60.
Sultan, S., Murarka, S., Jahangir, A., Mookadam, F., Tajik, A. J., & Jahangir, A. (2017). Vitamins for cardiovascular diseases: is the expense justified?. Cardiology in review, 25(6), 298-308.
Julson, E. (2018). Fifteen signs and symptoms of vitamin C deficiency. Healthline. https://www.healthline.com/nutrition/vitamin-c-deficiency-symptoms#TOC_TITLE_HDR_17
Berkheiser, K. (2018). 11 signs and symptoms of thiamine (Vitamin B1) deficiency. Healthline. https://www.healthline.com/nutrition/thiamine-deficiency-symptoms#TOC_TITLE_HDR_7
O’Donnell, K. (2017). Lactic Acidosis: A Lesser Known Side Effect of Thiamine Deficiency. PRACTICAL GASTROENTEROLOGY, 41(3), 24-31.
Infant Nutrition and Feeding. (n.d.). Appendix C: Nutrient Chart – Function, Deficiency and Toxicity Symptoms, and Major Food Sources. Retrieved from https://wicworks.fns.usda.gov/wicworks/Topics/FG/AppendixC_NutrientChart.pdf

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