A chronic alcoholic presenting with bleeding gums and petechiae is more likely to have deficiency of:
Ans: B (Vitamin C) Ref: Harrison's Principles of Internal Medicine, 18th edExplanation:Principal Clinical Findings of Vitamin MalnutritionNutrientClinical FindingDietary Level per Day Associated with Overt Deficiency in AdultsContributing Factors to DeficiencyThiamine* Beriberi* Neuropathy* Muscle weakness* Wasting* Cardiomegaly* Edema* Ophthalmoplegia* Confabulation<0.3 mg/1000 kcalAlcoholism,chronic diuretic use hyperemesisRiboflavin* Magenta tongue* Angular stomatitis* Seborrhea* Cheilosis<0.6 mg Niacin* Pellagra* Pigmented rash of sun-exposed areas* Bright red tongue* Diarrhea* Apathy* Memory toss* Disorientation<9.0 niacin equivalentsAlcoholismVitamin B6 deficiency Riboflavin deficiency Tryptophan deficiencyVitaminB6* Seborrhea* Glossitis* Convulsions* Neuropathy* Depression* Confusion* Microcytic anemia: <0.2 mgAlcoholismIsoniazidFolate* Megaloblastic anemia* Atrophic glossitis* Depression* | Homocysteine<100 mcg/dAlcoholism.Sulfasalazine PyrimethamineTriamtereneVitaminB12* Megaloblastic anemia* Loss of vibratory and position sense* Abnormal gait* Dementia* Impotence* Loss of bladder and bowel control* | Homocysteine* |Methylmalonic acid<1.0 mcg/dGastric atrophy (pernicious anemia) terminal ileal disease, strict vegetarianism, acid- reducing drugs (e.g., H2. blockers)Vitami n C* Scurvy* Petechias* Ecchymosis* Coiled hairs* Inflamed and bleed, ng gums* Joint effusion* Poor wound healing<10 mg/dSmokingAlcoholismVitamin A* Xerophthalmia* Night blindness* Bitot's spots* Follicular hyperkeratosis* Impaired embryonic development* Immune dysfunction<300 mcg/dFat malabsorption.InfectionMeaslesAlcoholismProtein-energymalnutritionVitamin D* Rickets* Skeletal deformation* Rachitic rosary* Bowed legs* Osteomalacia<2 0 mcg/dAging, lack of sunlight exposure, fat malabsorption, deeply pigmented skinVitamin E* Peripheral neuropathy* Spinocerebellar ataxia* Skeletal muscle atrophy* RetinopathyNot described unless underlying contributing factor is presentOccurs only with fat malabsorption or genetic abnormalities of vitamin E metabolism/transportVitamin K* Elevated prothrombin time* Bleeding<10 mcg/dFat malabsorption, fiver disease, antibiotic use
Vitamin B12
Vitamin C
Thiamine
Pyridoxine
Nutrition