A 40 year-old alcoholic man is admitted to the hospital for upper gastrointestinal bleeding. He is intoxicated and complains of fatigue. He had a hemarthrosis evacuated 6 months ago and has been lost to follow-up since then. He takes no medications. Laboratory data show platelets of 400,000, INR of 1.0. He has a diffuse hemorrhagic eruption on his legs. The recommended treatment for this patient’s underlying disorder is :-
- Niacin
- Thiamine
- Vitamin C
- Vitamin K
View Explanation
From further history and physical examination. it becomes appaient that INs upper G bleeding is from gingival membranes.
LEG ERUPTIONS Perifollicular hemorrhagic rash of scurvy (vitamin C deficiency).
Scurvy COMMON IN
(1) Alcoholics
(2) The elderly who consume <10 mg/d of vitamin C.
In addition to nonspecific symptoms of fatigue. these patients also have impaired ability to form mature connective tissue and can bleed into various sites including the skin and gingiva.
A normal INR excludes symptomatic vitamin K deficiency.
Thiamine, niacin, and folate deficiencies are also seen in patients with alcohilism.
Thiamine deficiency = penpheral neuropathy (beri-beri).
Folate deficiency = rnacrocytic anemia and thrombocytopenia.
Niacin deficiency causes pellagra. which is characterized by glossitis and a pigmented, scaling rash that may be particularly noticeable in sun exposed areas