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Folate
0%
0/12
Magnesium
Thiamine
42%
5/12
Vitamin A
58%
7/12
Vitamin D
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This patient is presenting with Bitot spots on physical exam which is suggestive of vitamin A deficiency. Vitamin A deficiency occurs because of poor intake or malabsorption. Night blindness and xerophthalmia (which refers to conjunctival and corneal dryness) are symptoms of vitamin A deficiency. In some cases, xerophthalmia may present with Bitot spots which are characterized by squamous metaplasia of the corneal epithelium (Figure A). Follicular hyperkeratosis is skin dryness caused by loss of sebaceous gland function combined with keratin buildup in the hair follicles, that occurs often on the shoulders, buttocks, and extensor surfaces. Follicular hyperkeratosis, as well as alopecia and frequent infections, are also seen with vitamin A deficiency. Figure/Illustration A demonstrates a Bitot spot (blue arrow) which is commonly seen in vitamin A deficiency. Figure/Illustration B demonstrates QT prolongation (with the QT segment between the red arrows) which could suggest hypocalcemia; however, it could also be due to many etiologies including medications. Incorrect Answers: Answer 1: Folate deficiency is common in alcoholics and presents with a megaloblastic anemia. Though this alcoholic is likely deficient in folate, there is no objective evidence to support this assertion. Answer 2: Magnesium can cause many abnormalities including QT prolongation, hypocalcemia (from impaired PTH release), and hypokalemia (from renal potassium wasting). Magnesium is commonly depleted in alcoholics. This patient's prolonged QT interval could be from many possible etiologies; however, there is no objective evidence of hypomagnesemia. Answer 3: Thiamine deficiency can cause Wernicke syndrome which presents with ataxia, ophthalmoplegia, and nystagmus. The treatment is administration of thiamine prior to administration of glucose. This patient's ataxic gait could be merely from his acute intoxication. Answer 5: Vitamin D deficiency can cause hypocalcemia and hypophosphatemia and can occur secondary to poor dietary intake, steatorrhea, and kidney failure. Hypocalcemia can cause QT prolongation; however, there are many possible causes of QT prolongation and this is a non-specific finding. Bullet Summary: Vitamin A deficiency presence with night blindness, xerophthalmia, and Bitot spots.
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