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Review Question - QID 104578

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QID 104578 (Type "104578" in App Search)
A 55-year-old man with a history of alcoholism presents for evaluation of a rash on his neck and arms. The patient frequently comes to the emergency department requesting pain medications and for acute intoxication. He endorses vomiting and diarrhea, recently. During the interview, the patient seems confused and is unable to recall any events leading to his presentation today. His temperature is 99.1°F (37.3°C), blood pressure is 122/81 mmHg, pulse is 111/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for the finding in Figure A. Which of the following is most likely deficient in this patient?
  • A

Biotin

70%

55/79

Niacin

18%

14/79

Riboflavin

6%

5/79

Vitamin A

1%

1/79

Vitamin K

4%

3/79

  • A

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This patient is presenting with dermatitis, diarrhea, and dementia which can be found in niacin deficiency.

Niacin (vitamin B3) is a vitamin that is found in a variety of foods. Niacin deficiency can be seen in patients with diets that largely consist of corn, in alcoholics, and in patients with malabsorption issues. The characteristic findings associated with niacin deficiency are glossitis (a smooth appearing tongue) and "the three D's": diarrhea, dermatitis, and dementia which can progress to death, if untreated. The treatment of pellagra is to administer niacin.

Figure A depicts the rough, hyperpigmented, and dry skin of dermatitis associated with pellagra.

Incorrect Answers:
Answer 1: Symptoms of biotin (vitamin B7) deficiency are non-specific but can include changes in mental status, anorexia, brittle hair, and myalgias. This is an uncommon nutritional deficiency.

Answer 3: Riboflavin (vitamin B2) deficiency is associated with a sore throat, angular cheilitis, stomatitis, and glossitis.

Answer 4: Vitamin A deficiency can present with dry skin and night blindness as well as Bitot spots on physical exam.

Answer 5: Vitamin K deficiency presents with easy bleeding/bruising as vitamin K is used to produce coagulation factors.

Bullet Summary:
Niacin deficiency presents with diarrhea, dementia, dermatitis, and death if untreated.

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