Board Review: Acute Signs
A 50 year old male presents with 4 weeks of diarrhea and associated abdominal pain described as cramping. He reports multiple episodes of pale, loose and malodorous stools daily. He recently went fishing. His vitals are as followed: 70 bpm, BP: 125/80, RR 18, PO2: 98%. Temp 37.2. What vitamin deficiency would you worry about in this patient?
Answer: D. This patient is presenting with signs and symptoms consistent with giardiasis. Patients can have malabsorption and steatorrhea, and chronic infection can result in deficiency of fat soluble vitamins A, D, E, and K. Malabsorption can also lead to deficiency in Vitamin B12 and folate.
Giardiasis is the most common cause of parasitic diarrheal infection in the US and is transmitted by fecal-oral route. It is associated with streams and daycares. Classic symptoms include, colicky abdominal pain and pale, loose, malodorous stools. Treatment is metronidazole.
Singh KD, Bhasin DK, Rana SV, et al. Effect of Giardia lamblia on duodenal disaccharidase levels in humans. Trop Gastroenterol 2000; 21:174.
Bjoernsen, L. P., & Ebinger, A. (2016). Chapter 159 Foodborne and Waterborne Diseases In Tintialli's Emergency Medicine: A Comprehensive Study Guide (8th ed). New York, NY: McGraw-Hill Education.