A 52-year-old woman presented to the clinic for ongoing fatigue and weight loss during the last 6 weeks

A 52-year-old woman presented to the clinic for ongoing fatigue and weight loss during the last 6 weeks. She thinks she’s loss at least “10 pounds”. For the past week and a half, she’s noted some progressing ‘muscle cramping’ tetany, as well as ‘tingling’ sensation around her mouth and lower extremities. She’s also noted some intermittent colicky abdominal pain. On your exam, you noted a positive Chvostek’s sign. PMH: 20-year history of Crohn’s disease. She also tells you that she is a practicing vegan.

Primary Diagnosis

Vitamin D Deficiency: Vitamin D deficiency is a result of the body’s inability to absorb and maintain sufficient Vitamin D levels (Krela-Kaźmierczak et al., 2015). It can be caused by lifestyle choices (diet), environment (lack of sunlight), or underlying disease processes (Crohn’s) (Krela-Kaźmierczak et al., 2015). A vegan diet of eating plant sources puts a person at risk for Vitamin D deficiency because plants do not contain the vitamin (Krela-Kaźmierczak et al., 2015). Without UVB radiation from sunlight, the 7-dehydrocholesterol found on the skin cannot convert to the previtamin D3 (Krela-Kaźmierczak et al., 2015). Intestinal mucosa inflammation and lesions interfere and inhibit digestion and absorption of lipids, therefore, Vitamin D (Krela-Kaźmierczak et al., 2015). Signs and symptoms of Vitamin D deficiency include a positive Chvostek’s sign (twitching of the facial nerve when stimulated), bone pain, abdominal pain, fatigue, and a tingling nerve sensation (Krela-Kaźmierczak et al., 2015). The patient has a positive Chvostek’s sign. This occurs in hypocalcemia, which can be caused by Vitamin D deficiency. Her history of Crohn’s disease and vegan diet also highlight the possibility that her body has been in a constant malnourished state, which is causing her weight loss. Her hypocalcemic state, considering her age, also puts her at risk for osteoporosis (Krela-Kaźmierczak et al., 2015).

Differential Diagnoses

1. Hypoparathyroidism: Hypoparathyroidism is a result of low parathyroid hormone (PTH) that causes a low calcium level in the blood (Abate & Clarke, 2017). PTH plays an important role in calcium balance by mobilizing calcium from the skeleton and with calcium absorption through synthesis of calcitriol (1,25-dihydroxyvitamin D) (Abate & Clarke, 2017). This absorption and synthesis cannot occur if there is not a sufficient Vitamin D level. Common causes of hypoparathyroid levels include thyroid surgery, hypomagnesemia, and genetics (Abate & Clarke, 2017). Symptoms include muscle aches and spasms, tingling, fatigue, dry skin, and brittle nails (Abate & Clarke, 2017).

2. Hypomagnesemia: Hypomagnesemia is defined as a low level of magnesium in the blood (Pham et al., 2014). Magnesium has an enzymatic function that affects membrane cell function, which affects glucose metabolism as well as other electrolyte balances, including calcium (Pham et al., 2014). Having a low magnesium level can be directly correlated with a low calcium level. Inadequate absorption or letting too much go are common causes (Pham et al., 2014). Clinical manifestations include neuromuscular hyperexcitability that can range from tremors to neuropsychiatric disturbances to coma (Pham et al., 2014). In reference to the heart, it can cause arrhythmias, torsades de pointe, enhances digoxin sensitivity, and sudden death (Pham et al., 2014). The patient’s diet and disease process place her at a high risk for hypomagnesemia.

3. Malnutrition: The body can be found in a malnourished state when there are not sufficient dietary vitamins and nutrients consumed or absorbed to support a healthy state of being or due to an underlying disease process (Shashidhar, 2017). Micronutrient deficiencies can cause fatigue from having low iron, goiter development from low iodine, hypocalcemia from low Vitamin D, and night blindness from low Vitamin A (Shashidhar, 2017). Clinical signs include weight gain, fatigue, irritability, decreased subcutaneous tissue, edema, abdominal distention, and mental impairment (Shashidhar, 2017). The patient’s disease process along with her diet choice and recent weight loss places her at risk for malnutrition.

Potential Treatment Plan

Vitamin D supplementation is recommended in people who have confirmed Vitamin D deficiency (Gani & How, 2015). Oral Vitamin D supplements are available in Vitamin D3 (cholecalciferol) or Vitamin D2 (ergocalciferol) forms (Gani & How, 2015). All patients should maintain a daily calcium intake of 1300mg, since the combination of Vitamin D and calcium prevent fractures (Gani & How, 2015). Once a regimen is initiated, a three-month follow-up is required to check serum 25(OH)D concentration (Gani & How, 2015).

References

Abate, E. G., & Clarke, B. L. (2017). Review of hypoparathyroidism. Frontiers in Endocrinology, 7, 172. doi:10.3389/fendo.2016.00172

Gani, L. U., & How, C. H. (2015). PILL Series. Vitamin D deficiency. Singapore Medical Journal, 56(8), 433–437. doi:10.11622/smedj.2015119

Krela-Kaźmierczak, I., Szymczak, A., Łykowska-Szuber, L., Eder, P., Stawczyk-Eder, K., Klimczak, K., … Horst-Sikorska, W. (2015). The importance of vitamin D in the pathology of bone metabolism in inflammatory bowel diseases. Archives of Medical Science : AMS, 11(5), 1028–1032. doi:10.5114/aoms.2015.54858

Pham, P. C., Pham, P. A., Pham, S. V., Pham, P. T., Pham, P. M., & Pham, P. T. (2014). Hypomagnesemia: a clinical perspective. International Journal of Nephrology and Renovascular Disease, 7, 219–230. doi:10.2147/IJNRD.S42054

Shashidhar, H. (2017, July 19). Malnutrition. Medscape. Retrieved from https://emedicine.medscape.com/article/985140-overview

 

Get 20% Discount on This Paper
Pages (550 words)
Approximate price: -

Try it now!

Get 20% Discount on This Paper

We'll send you the first draft for approval by at
Total price:
$0.00

How it works?

Follow these simple steps to get your paper done

Place your order

Fill in the order form and provide all details of your assignment.

Proceed with the payment

Choose the payment system that suits you most.

Receive the final file

Once your paper is ready, we will email it to you.

Our Services

Ace Writing Center has stood as the world’s leading custom essay writing services providers. Once you enter all the details in the order form under the place order button, the rest is up to us.

Essays

Essay Writing Services

At Ace Writing Center, Nowadays, students normally have extremely busy schedules. You will note that some of them have to take on some evening or weekend jobs in order to get some income that can help them to sustain in college or in the university. This can deny them a chance to write all the essays given. Others usually get bombarded with a lot of work by their lecturers. This can still delay such students from working on all their essays. However, some of them usually try to work on all these essays but end up delivering their work late. This can prevent them from graduating since most lecturers are strict on deadlines. If you want to write a business essay, the wise way is to hire an outstanding essay writing service like us, so that you can get the best results. If you are keen, you will note that many companies usually overcharge their customers. Some of them are there only to make money. And in reality, they really don’t care to build a long term commitment with students. You should not choose such companies. You should take your time and choose a reliable company to work with. Ace Writing Center is the ultimate solution for you. We have been offering our writing service for more than 7 years. This is a clear indication that you will get quality essay writing service. We have a wide range of writers who can work on any business essay that you might have. We believe in doing extensive research so that we can provide quality work to all our clients. .

Admissions

Admission and Business Papers

Have you ever had to write an admission essay for college? The majority of students face the same issues when applying to a university or college and many in such situations decide they need professional help to cope with this matter. They get in a situation when the deadline keeps coming closer but lack motivation to start because they are just not sure if their writing skills are strong enough. We have a solution for you! Ace Writing Center is the best admission essay writing service with a large professional team and years of experience in providing high-quality papers to students of all levels and faculties. The mission of our team is to help students make their dreams of entering a good college come true and that’s what we offer!.

Editing

Editing and Proofreading

Sometimes all the words for your paper just flow out of your mind and into your fingers. You type quickly at your keyboard and there they are, your beautiful words right there on the screen. But you have no idea how to polish it up. You may be wishing there was a paper writing service that offered this type of writing service. Look no more! Here at Ace Writing Center, we offer you an editing and proofreading option that you can't find anywhere else..

Coursework

College Essay Writing

In case you are familiar Ace Writing Center, you know the way to distinguish a better company from a cheap one exactly. First of all, poor service website does not have a sufficient support. We think support team is an essential part of success; it has to answer all clients’ questions and be a connecting link between clients and their writers. On our web-service you will get answers about anything you need and your writer will receive all your instructions, assignments and requirements exactly and swiftly. A writing service that we run has got a flexible pricing system that will save you from senseless wastes and many bonus systems that let you sparing money for something important for you.

Open chat
1
Hello. Can we help you?