CINIII
Forum Senior
Topics: 34
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can anyone plz tell me what route of vitamins is needed for this.
A 55-year-old man comes in to your office complaining of diarrhea. He states that he has had a history of Crohn's disease for many years, and it has been particularly aggressive over the past two years. Five months ago, he underwent a small bowel resection (250 cm of bowel) for a severe relapse of Crohn's that was not responsive to medical therapy. Shortly after this past surgery, he states that he has been experiencing diarrhea. He has about five bowel movements per day and he describes them as bulky, light-colored, and foul-smelling. He describes a weight loss of 30 lb over the past five months with no change in appetite. He appears to be slightly wasted and has several superficial hematomas on the skin. Otherwise, the physical examination is unremarkable. Laboratory studies show: WBC 8,200/mm3, hemoglobulin 11.3 g/dL, hematocrit 33.7%, platelets 238,000/mm3, and a mean corpuscular volume 104 µm3. Chest x-ray shows clear lung fields. However, diffuse osteopenia is noted. Which of the following is the best way to treat this patient?
(A) Oral vitamin B12
(B) Oral vitamin B12 and oral vitamins A, D, E, and K
(C) Intramuscular (IM) vitamin B12 and oral vitamins A, D, E, and K
(D) IM vitamin B12 and vitamins A, D, E, and K
(E) IM vitamin B12, oral vitamins A, D, E, and K, and medium-chain triglycerides
Answer:
(E) IM vitamin B12, oral vitamins A, D, E, and K, and medium-chain triglycerides
Explanation:
This patient suffers from short bowel syndrome as a result of his small bowel resection. We can assume that during his surgery, much of the terminal ileum was resected because of the nature of his symptoms and laboratory findings. His macrocytic anemia suggests B12 deficiency, and his visible hematomas and osteopenia suggest deficiencies of vitamins K and D, respectively. Furthermore, the patient describes steatorrhea. All of these symptoms and signs are consistent with the loss of the terminal ileum because both B12 and bile salts are absorbed in the terminal ileum. This leads to B12 deficiency, and the loss of bile salts leads to fat malabsorption, steatorrhea, and with it, the malabsorption of fat-soluble vitamins. Because he lacks the ability to absorb enteric B12, it must be replaced intramuscularly. As for the fat-soluble vitamins, they may be given orally with supplemented medium-chain triglycerides, which do not require micellar solubilization.
i was thinking if the small intesting is not going to resorb vitamins,why dont we give it by im route?
thanks
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| Justice
Forum Fanatic
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CINIII wrote:
i was thinking if the small intesting is not going to resorb vitamins,why dont we give it by im route?
thanks
Well, I am not sure if parenteral forms of Vits ADE (many of them are still experimental drugs) would be recommended for use in this situation...
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| ssrpk
Forum Fanatic
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oral Vitamins A,D,E and K will be absorbed here along with medium chain triglycerides which do not require micelle formation
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