- Diagnosis
- Etiology
- Pathology
- Management & Treatment
- Epidemiology
- Prevention
- Complications
- Prognosis
- Clinical Case Studies
- Study Questions
Nonspecific symptoms including edema of mucous membranes, angular stomatitis, glossitis, and seborrheic dermatitis (eg, nose, scrotum)
Wet beriberi (high-output cardiac failure), dry beriberi (peripheral neuropathy), Wernicke-Korsakoff syndrome (eye movement disorders, ataxia and impaired memory)
| Nutrient | Therapy |
|---|---|
| Vitamin B12 | 1000 μg IM x 6 doses to replenish stores, then 1000 μg IM monthly |
| Vitamin Ea | 800–1200 mg PO qd |
| Vitamin Ka | 10 mg IV × 1 |
| 1–2 mg PO qd or 1–2 mg IV weekly in chronic malabsorption | |
| Thiamineb | 300 mg IV qd × 3 days, followed by 10 mg PO qd until recovery |
| Niacin | 100–200 mg PO tid for 5 days |
| Pyridoxine | 50 mg PO qd, 100–200 mg PO qd if deficiency related to medications |
| Zincb,c | 60 mg PO bid |
Riboflavin deficiency leads to mouth ulcers (stomatitis), cheilosis (dry, scaly lips), scaly skin (seborrhea), and photophobia.
Riboflavin deficiency leads to mouth ulcers (stomatitis), cheilosis (dry, scaly lips), scaly skin (seborrhea), and photophobia.
Content 9
Complications of Injecting Drug Use
- Local problems—Abscess (Figures 240-2
and 240-3; Abscess), cellulitis, septic thrombophlebitis, local induration, necrotizing fasciitis, gas gangrene, pyomyositis, mycotic aneurysm, compartmental syndromes, and foreign bodies (e.g., broken needle parts) in local areas.2A 32-year-old woman with type 1 diabetes developed large abscesses all over her body secondary to injection of cocaine and heroin. Her back shows the large scars remaining after the healing of these abscesses. (Courtesy of Richard P. Usatine, MD.)
- IDUs are at higher risk of getting methicillin-resistant Staphylococcus aureus(MRSA) skin infections that the patient may think are spider bites (Figure 240-4).
- Some IDUs give up trying to inject into their veins and put the cocaine directly into the skin. This causes local skin necrosis that produces round atrophic scars (Figure 240-5).
- IDUs are at risk for contracting systemic infections, including HIV and hepatitis B or hepatitis C.
- Injecting drug users are at risk of endocarditis, osteomyelitis (Figures 240-6and 240-7), and an abscess of the epidural region. These infections can lead to long hospitalizations for intravenous antibiotics. The endocarditis that occurs in IDUs involves the right-sided heart valves (see Chapter 50, Bacterial Endocarditis).2 They are also at risk of septic emboli to the lungs, group A β-hemolytic streptococcal septicemia, septic arthritis, and candidal and other fungal infections.
Content 3
A 29-year-old woman with vitiligo develops numbness in her feet with decreased vibratory sense and megaloblastic anemia. She most likely has what condition? Pernicious anemia, the most common cause of vitamin B 12 deficiency. Pernicious anemia can be associated with autoimmune disorders such as vitiligo, hypothyroidism, and hypoadrenalism. Removal of the ileum and parasitic infection with the tapeworm Diphyllobothrium latum are rare causes of B 12 deficiency.