Nutritional Emergencies
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 6 May 2018
⏱️ 10 minutes
🧾️ Download transcript
Summary
Consider In High Risk Patients
* Alcoholics* GI disorders* Eating disorders* Starvation/poor diet* Extremes of age
Thiamine (B1) deficiency
* Causes damage to neurons and cardiac myocytes* Manifestations* Dry beriberi* Neuropathy* Paresthesias* Wernicke’s encephalopathy* Ophthalmoplegia* Ataxia* Altered mental status* Korsakoff syndrome* Ophthalmoplegia, ataxia, altered mental status* PLUS* Confabulation* Memory loss* Wet beriberi* Heart failure from cardiac damage* Treatment* High dose thiamine
Niacin (B3) Deficiency
* “Pellagra”* Clinical Triad* Diarrhea* Dementia* Dermatitis* Scaly rash* Neck* Dorsum of hands* Treatment* Vitamin B3
Folate (B9) Deficiency
* Megaloblastic anemia* Treatment* Folate
B12 Deficiency
* Classically occurs in vegans (in addition to the previous high risk groups)* Manifestations* Megaloblastic anemia* PLUS* Neurologic complaints* Subacute combined (posterior and lateral column) degeneration of spinal cord* Posterior columns* Impaired vibratory sensation and propioception* Lateral columns* Sensory loss* Motor weakness
Additional Reading
* Thiamine Deficiency: Pearls and Pitfalls (emDOCs)
Transcript
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| 0:00.0 | Hello, men students. My name is Zach Golson and thank you for downloading this week's |
| 0:07.0 | episode of the EM Clerkship Podcast. What I want to talk about this week is nutrition. Not like how I have a |
| 0:18.8 | nutritious diet, which I definitely don't. |
| 0:20.9 | What I want to talk about are the disorders that we like never think about that really do affect people with bad nutrition. |
| 0:30.1 | Alcoholics, eating disorder patients, old people, poor people with GI disorders. |
| 0:35.3 | I have seen several of these cases during residency. They are out there, |
| 0:40.0 | especially with our patients. We probably should know more about this than anybody else. They are |
| 0:45.1 | dangerous. And when you reasonably put this in your differential, it makes you sound like you're |
| 0:50.5 | really thinking through stuff. I think it makes you sound like a good student. |
| 0:55.2 | Today, we are going to cover the royal family |
| 0:58.7 | of nutritional deficiencies. |
| 1:01.6 | And this family's name are the Bs, the B vitamins. |
| 1:06.6 | Sure, we know that iron deficiency can cause anemia |
| 1:10.0 | and vitamin D deficiency causes osteoporosis, |
| 1:13.4 | vitamin C causes scurvy, obvious, big players, primary care type stuff. But the players in |
| 1:20.6 | emergency medicine aren't those ones. They're the Bs. B1, B3, B9, B12. They're like the |
| 1:27.4 | Illuminati of nutritional disorders. |
| 1:29.9 | You know they're out there, but they're more widespread and more sneaky and more dangerous |
| 1:34.2 | than even you realize. |
| 1:35.9 | And that's what we're going to talk about today. |
| 1:39.2 | The top five nasty nutritional disorders. |
| 1:44.6 | Dry Berry Berry and Wernicke-Korsikov, |
... |
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