Scribd
Upload
191 views5 pages

Folic Acid Deficiency

This document provides learning objectives and a case study about a 43-year-old woman presenting with vomiting, abdominal pain, fatigue, and weakness. Labs show macrocytic anemia secondary to folate deficiency. She has a history of alcohol use, fibromyalgia, celiac disease, hypothyroidism, and osteopenia. The assessment is acute pancreatitis from alcohol, dehydration, and folate deficiency anemia. The clinical pearl notes that unlike dietary folate, supplemented folic acid is absorbed even with GI abnormalities and will provide a therapeutic response despite alcohol or drug use.

Uploaded by

MOHANNAD
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
191 views5 pages

Folic Acid Deficiency

This document provides learning objectives and a case study about a 43-year-old woman presenting with vomiting, abdominal pain, fatigue, and weakness. Labs show macrocytic anemia secondary to folate deficiency. She has a history of alcohol use, fibromyalgia, celiac disease, hypothyroidism, and osteopenia. The assessment is acute pancreatitis from alcohol, dehydration, and folate deficiency anemia. The clinical pearl notes that unlike dietary folate, supplemented folic acid is absorbed even with GI abnormalities and will provide a therapeutic response despite alcohol or drug use.

Uploaded by

MOHANNAD
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 5

More 

Wine, Anyone? ……… Level I
Learning Objectives

After completing this case study, the reader should be able to:

Recognize the signs, symptoms, and laboratory abnormalities associated with folic acid deficiency.

Identify the confounding factors that may contribute to the development of folic acid deficiency (e.g., medications, concurrent disease states, and
dietary habits).

Recommend an appropriate treatment regimen to correct anemia resulting from folic acid deficiency.

Educate patients with folic acid deficiency regarding pharmacologic and nonpharmacologic interventions used to correct folic acid deficiency.

Describe appropriate monitoring parameters for initial and subsequent monitoring of folic acid deficiency.

Patient Presentation
Chief Complaint

“My stomach hurts and I have been throwing up today.”

HPI

Laura Jones is a 43­year­old woman with a 1­day history of vomiting and mild abdominal pain. The pain radiates down to the lower abdominal quadrants
bilaterally. She presents to the ED after experiencing some chest discomfort late in the day. She denies any fevers, chills, or similar pains in the past.
She also complains of loose stools and chronic fatigue for the past 2–3 months.

PMH

Fibromyalgia

Celiac disease

Hypothyroidism
Osteopenia

History of endometriosis

Placenta previa—s/p TAH–BSO

FH

Mother positive for lupus; sister with Crohn’s disease; negative for DM, CAD, CVA, CA

SH

Married; (+) alcohol—three to four glasses of wine per day, increased recently from one to two glasses after her mother­in­law moved in; (+) smoking
tobacco 0.5 ppd × 25 years, (–) recreational drug use; unemployed

Meds

Levothyroxine 100 mcg po daily

Estradiol 0.05 mg/24 h transdermal patch (Estraderm); replace twice weekly

All

Doxycycline—rash

ROS

(+) Generalized weakness; (–) dizziness; (–) weight gain or loss; (–) fever; (–) vision or hearing changes; (–) cough, chest pain, palpitations; (–)
shortness of breath; (+) nausea/vomiting, abdominal pain, loose stools; (–) rectal bleeding; (–) nocturia or dysuria; (+) bilateral lower extremity
weakness; (–) edema, rashes, or petechiae; (–) symptoms of depression or anxiety; (–) history of bleeding problems or VTE

Physical Examination
Gen

Caucasian female who appears generally ill, but nontoxic

VS

BP 135/90 mm Hg, P 82 bpm, RR 40, T 35.5°C
Skin

No petechiae, rashes, ecchymoses, or active lesions; decreased skin turgor

HEENT

Atraumatic/normocephalic; PERRLA, EOMI; conjunctivae pink, sclera white; TMs intact and reactive; nose is patent; tongue is large and erythematous;
dry mucous membranes

Neck/Lymph Nodes

Normal ROM; no JVD, adenopathy, thyromegaly, or bruits

Lung/Thorax

Lungs CTA bilaterally

CV

RRR; no murmurs, gallops, or rubs

Abd

Soft, nondistended, with midepigastric and right flank and right lower quadrant tenderness; (+) bowel sounds

Genit/Rect

Deferred

MS/Ext

Lower extremities warm with 2+ bipedal pulses; no clubbing, cyanosis, or edema

Neuro

CN II–XII grossly intact; decreased muscle strength 3/5 bilaterally in upper and lower extremities; DTRs throughout

Labs
 Favorite Table | Print

Na 138 mEq/L Hgb 12.6 g/dL AST 128 IU/L Folate


K 4.2 mEq/L Hct 37.2% ALT 52 IU/L    2.8 ng/mL
Cl 102 mEq/L RBC 3.78 × 106 /mm3 Alk phos B12  242 pg/mL
CO 2  21 mEq/L Plt 217 × 103 /mm3 142 IU/L
BUN 7 mg/dL WBC 6.3 × 103 /mm3 GGT 288 IU/L
SCr 0.52 mg/dL MCV 120.4 μm3 T. bili 2.1 mg/dL
Glu 89 mg/dL MCH 40.5 pg Alb 3.4 g/dL
Amylase 404 IU/L MCHC 33.6 g/dL TSH 2.06 mIU/L
Lipase 679 IU/L RDW 12.1% T4 , free 1.2 ng/dL

Assessment

Acute pancreatitis secondary to alcohol use

Dehydration

Macrocytic anemia secondary to folate deficiency

Clinical Pearl

Unlike dietary folate, supplemented folic acid (pteroylglutamic acid) is absorbed even with abnormal function of GI mucosal cells. Likewise, persistent
alcohol ingestion or the use of drugs affecting folic acid absorption, folate transport, or dihydrofolate reductase will not prevent a sufficient therapeutic
response to oral supplementation.

References

1. Arafah  BM. Increased need for thyroxine in women with hypothyroidism during estrogen therapy. N Engl J Med 2001;344:1743–1749.
CrossRef  [PubMed: 11396440] 
2. Malouf  R, Grimley Evans  J. Folic acid with or without vitamin B12 for the prevention and treatment of healthy elderly and demented people.
Cochrane Database Syst Rev 2008;(4):CD004514. doi: 10.1002/14651858.CD004514.pub2.

3. Snow  CF. Laboratory diagnosis of vitamin B12 and folate deficiency: a guide for the primary care physician. Arch Intern Med 1999;159:1289–1298.
CrossRef  [PubMed: 10386505

You might also like