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Slide Notes

The purpose of this deck is to emphasize the importance of addressing all symptoms of chronic alcoholics in the ED.

It is important that they are treated as real patients with real disease, not just "frequent fliers" looking for a free sandwhich!

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The following deck comes courtesy of EMRAP.org - September 2016: Volume 16, Issue 9 | www.emrap.org
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20/20: EM Alcoholic Vitamin Defiencies

Published on Sep 23, 2016

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PRESENTATION OUTLINE

1.

EM Alcoholic Vitamin Defiencies

"If you see it, you can treat it"
The purpose of this deck is to emphasize the importance of addressing all symptoms of chronic alcoholics in the ED.

It is important that they are treated as real patients with real disease, not just "frequent fliers" looking for a free sandwhich!

------
The following deck comes courtesy of EMRAP.org - September 2016: Volume 16, Issue 9 | www.emrap.org
2.

#1 - Classic presentation

  • Stumbling, continuous falling
  • Difficulty seeing, esp at night
  • Dry, scaly skin
Photo by Martin Gommel
3.

Vitamin A deficiency

Photo by puliarf
4.

Liver = 90% Vit A storage
Deficiency = Nyctolopia, xerosis cutis, keratomalacia

Photo by puliarf
5.

Tx - Vit.A deficiency

100k U IM q1d x 3d -> 50k U IM q1d x 14 d -> 20k U PO q1d x 2mo
Photo by puliarf
6.

#2 - classic presentation

  • Stumbling, falls
  • Confusion
  • Eyes cannot look laterally
Photo by Martin Gommel
7.

Vit B1 (thiamine) deficiency

*Wernicke's Encephalopathy*
Photo by mag3737
8.

"Eyes, Whys, Thighs' : Wernicke's = Ophthalmoplegia, Confusion, Abnormal gait
Caution – only 1/3 patients with WE present with all 3

Photo by mag3737
9.

Tx - Vit. B1 (thiamine) deficiency

500mg Thiamine IV q8h x 3d (+ meals)
Photo by mag3737
10.

#3 - Classic presentation

  • Bizzare Behavior
  • Red rash on hands, face
  • Swollen tongue
  • Diarrhea
Photo by Martin Gommel
11.

Vit. B3 (niacin) deficiency

Pellagra ("Devil's Blisters")
Photo by Crossett Library Bennington College
12.

3D's = Diarrhea, Dermatitis, Delirium

Photo by Crossett Library Bennington College
13.

Tx - Vit. B3 (niacin) deficiency

50-100mg Niacinamide oral q6h x 3-4d
Photo by Crossett Library Bennington College
14.

#3 - classic presentation

  • Weak, fatigued
  • Small amount blood in saliva
  • Non-blanching spots on extremities
Photo by Martin Gommel
15.

vit. C defiency

*SCURVY*
Photo by Free Grunge Textures - www.freestock.ca
16.

Scurvy rare - only severe malnourished (alcoholics)
Key - bleeding gums, petechiae, hemarthrosis

Photo by Free Grunge Textures - www.freestock.ca
17.

Tx - vit. C defiency

200-1000mg PO daily (body can’t absorb more than this)
Photo by Free Grunge Textures - www.freestock.ca
18.

#4 - classic presentation

  • Confusion
  • Irritated
  • Sweating
  • Tachycardic
  • Tachypneic
Photo by Martin Gommel
19.

hypoglycemia

Photo by sixpackshack
20.

Don't always assume head trauma
"FSG-pre-HCT"

Photo by sixpackshack
21.

Tx - hypoglycemia

Thiamine + Amp D50 (only 200cal) + meal! (Banana Bag = Expensive urine)
Photo by sixpackshack
22.

SUMMARY

  • A - "Can't get the A if you can't see'
  • B1 - "eyes, whys, thighs'
  • B3 - 3D's
  • C - "When you C bleeds, think C"
  • Glucose - "FSG-PRE-HCT"
23.

Untitled Slide

David Cisewski

http://dhc0626@gmail.com