ARJ
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A 67-year-old man has had numbness and tingling in the hands and feet for 3 weeks. He lives in a homeless shelter and is well fed. He has been treated for pulmonary tuberculosis for 5 months with isoniazid, rifampin, ethambutol, and pyrazinamide. He is compliant with his medication regimen but continues to abuse alcohol. His temperature is 37 C (98.6 F), blood pressure is 134/74 mm Hg, pulse is 69/min, and respirations are 19/min. He is well nourished but depressed and irritable. There is decreased sensation to pain and touch in the hands and feet in a stocking-glove distribution. Which of the following is the most likely nutritional deficiency?
A ) Folic acid
B ) Niacin
C ) Vitamin A
D ) Vitamin B1 (thiamine)
E ) Vitamin B2 (riboflavin)
F ) Vitamin B6
G ) Vitamin B12 (cyanocobalamin)
H ) Vitamin C
I ) Vitamin D
J ) Vitamin E
K ) Vitamin K
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| ibraheem
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F) Vit. B6.
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| chemamr
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F
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| frontal
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I'd go with B-6 (pyridoxine) too. While alcohol abuse makes the deficiency possible, as it does the deficiency of certain other vitamins, isoniazid increases the likelihood of pyridoxine deficieny alone.
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| kabu
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F
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| DrS
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F
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| ARJ
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The Classic sign of B6 deficiency is increased irritability, convulsions, and peripheral neuritis. Although convulsion is not present.........
Also the patient is on isoniazid therapy
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| abc888
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D
- Thiamine (vitamin B-1) deficiency
- Dry beriberi is characterized by severe burning dysesthesias (feet more than hands), weakness and wasting (distal more than proximal), trophic changes (shiny skin, hair loss), and acrodistal sensory loss in a graded fashion typical of dying back polyneuropathies.
- Some patients do not become symptomatic, possibly because they are absorbing thiamine produced by bacteria in the large intestine. However, one half become symptomatic by 7 weeks; by 15 weeks, axonal changes start to appear histologically.
- The neuropathy begins with fatigue and loss of sensation, pain, and heaviness in the legs. Then, pretibial edema develops, along with glove-and-stocking paresthesias and difficulty with tasks such as climbing stairs and standing on 1 leg.
- If the thiamine deficiency is long standing, muscles on the dorsum of the feet atrophy and paralysis can ensue.
- Difficulty with talking or swallowing may also be noted.
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| abc888
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Pyridoxine (vitamin B-6) deficiency
- The presentation includes seborrheic dermatitis, cheilosis, glossitis, nausea, vomiting, weakness, and dizziness.
- Neurologic examination shows decreased proprioception and vibration sense with spared pain and temperature sensations; normal strength; decreased or absent Achilles reflex and decreased patellar reflex.
- Ataxia, if present, is sensory.
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| doyoudig
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B6 for sure
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| dr in trouble
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B6
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| Ivonne
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F
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| liliaeliz
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F) vit. B6
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| judy
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it is vitamin B1
http://www.wrongdiagnosis.com/p/peripheral_neurop...
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| cirus
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B6 due to INH
alcohol mainly causes folate not vit B12 def
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