case presentation n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
CASE PRESENTATION PowerPoint Presentation
Download Presentation
CASE PRESENTATION

Loading in 2 Seconds...

play fullscreen
1 / 57

CASE PRESENTATION - PowerPoint PPT Presentation


  • 227 Views
  • Uploaded on

CASE PRESENTATION. Mary Palomaki May 19, 2010. Chief Complaint. 16 month male with orange skin. History of Present Illness. Orange skin x 3 weeks Tugging on right ear Fever x 2 days, Tmax 102 PR Denies: change in activity, cough, runny nose, rash, vomit, diarrhea, travel, sick contacts

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

CASE PRESENTATION


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
    Presentation Transcript
    1. CASE PRESENTATION Mary Palomaki May 19, 2010

    2. Chief Complaint • 16 month male with orange skin

    3. History of Present Illness • Orange skin x 3 weeks • Tugging on right ear • Fever x 2 days, Tmax 102 PR • Denies: change in activity, cough, runny nose, rash, vomit, diarrhea, travel, sick contacts • Normal PO • Normal Stool • Normal in color, consistency • Normal UOP • Normal color

    4. Diet • 1 jar carrots/day • 1 jar mixed vegetables/day • Whole milk

    5. Birth History • Full Term • NSVD • No complications

    6. Past Medical History • Developmental Delay • Delayed Motor: Sit with support, no crawling, no walking • Delayed Speech: no words

    7. Family History • No thyroid disorders • No autoimmune disorders • No genetic disorders

    8. Vaccines • Delayed: No 1 year vaccines

    9. Physical Exam • VS: T: 101.3 HR: 120 RR 30 • O2Sat 100% RA • Gen: awake, alert • HEENT: NC, Perrl, EOMI, anicteric, mmm, oropharynx: no lesion, no erythema, R TM: + erythema, +bulging, L TM: dull • CV: S1, S2, no murmur

    10. Physical Exam 2 • Resp: b/l clear to ausculatation • ABD: BS+, soft, no distention, no HSM • Ext: FROM x 4, cap refill <2s • SKIN: orange/yellow tinged body, extremities, >>pigmentation palms, soles • GU: b/l descended testicles, normal phallus • Neuro: mild decreased tone, 2+ reflexes

    11. Differential Diagnosis

    12. Differential Diagnosis • Jaundice • Carotenemia • Excess ingestion/percutaneous absorption of chemicals • Quinacrine • Mepacrine • Dinitrophenol • Saffron • Tetryl • Picric acid • Inborn errors of metabolism

    13. Carotenemia • Increased number of carotinoids in the epidermis • Carotinoids are plant pigments • Act as antioxidants • Cell growth • Immune function • Carotene is hydrocarbon part of the carotinoid • Carotene from plants is primary dietary source of vitamin A

    14. Foods Rich in Carotene • Asparagus, broccoli, carrots, cucumbers, lettuce, spinach, squash, sweet potatoes, apples, oranges, peaches, prunes, tomatoes, yams, butter, egg yolk, milk, yellow corn • Baby foods and pureed foods allow greater absorption of carotene • Cell wall is broken during puree process, releasing carotene

    15. Carotene Metabolism Plant Cell Carotene Excretion via colon, epidermis In mucosal cells: B-carotene-->2 molecules retinol (Vitamin A metabolite) B-carotene 15, 15’dioxygenase

    16. Carotene • Accumulates in areas of concentrated sweat glands • Palms • Soles • Nasolabial folds • Is present in high concentration in breast milk

    17. Carotenemia • Mostly dietary • Associated with • Hypothyroidism • Diabetes Mellitus • Liver disease • Kidney disease • Anorexia Nervosa • Familial • Decrease amount of B-carotene 15, 15’dioxygenase

    18. Diabetes Mellitus • Most diabetics have elevated serum concentrations of B-carotene • Only 10% show skin color changes • Some diabetics have impaired conversion of B-carotene to retinol

    19. Hypothyroidism • Decreased conversion of carotene to Vitamin A • Hyperlipidemia and hypercholesterolemia exacerbate this effect

    20. Anorexia Nervosa • Altered lipid metabolism increases cholesterol levels, decreasing metabolism of carotene

    21. Carotene Absorption • Determined by type of food • Pureed foods • Manifest on skin 2 weeks after elevated serum levels of carotene

    22. History • Yellow/orange skin • No change in activity • No associated symptoms

    23. Diagnosis and Work Up • Clinical Diagnosis • No labs indicated

    24. Treatment • None • Anxious parents can be advised to avoid carotene containing foods

    25. Complications • None • Serum levels greater than three times the upper limit of normal do not cause hypervitaminosis A • Conversion of carotene to Vitamin A is slow

    26. NAME THAT DEFICIENCY/TOXICITY

    27. Pharyngeal ulcers • Impaired immunity • Megaloblastic anemia

    28. Folate deficiency

    29. Poor wound healing • Bleeding gums • Petechiae • Ecchymosis • arthralgia

    30. Vitamin C deficiency • (SKURVY)

    31. Pellagra--Niacin Deficiency • Diarrhea • Dermatitis • Dementia

    32. Anorexia • Dry/cracking skin • Hepatosplenomegaly • Long bone pain • Alopecia

    33. Vitamin A toxicity

    34. Bitot Spot

    35. Vitamin A Deficiency • Photophobia • Xerophthalmia • Keratomalacia • Epiphyseal bone formation • Defective tooth enamel • Retarded growth

    36. Fatigue • Anorexia • Irritability • Sometimes • Edema • Sometimes • No edema

    37. Beri-Beri(Thiamine) • Constipation • Headache • Insomnia • Polyneuritis • Elevated pyruvic • acid

    38. Photophobia, blurred vision

    39. Riboflavin (B2) deficiency • Burning, itching of eyes • Corneal vascularization • Poor growth • “Ariboflavinosis” • Phototherapy breaks down riboflavin • Careful with treatment of neonatal jaundice

    40. Patient eats diet of tomatoes and juice

    41. Lycopenemia • Lycopene found in tomatoes, beets, chili peppers • Turns skin reddish color, with excessive ingestion • Harmless condition • Resolves without treatment

    42. Oxaluria