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  #1  
Old 09-19-2012
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Default Alcoholism

Two days after admission, a 57-year-old man suddenly has a seizure.
He was undergoing evaluation for substernal chest pain. The nursing staff
noted that he seemed to be a little shaky since shortly after arrival on the
floor. He has no history of seizures and a stat CT of the head performed
during the postictal state was normal. Laboratory results had shown an
MCV of 101 (elevated) and his AST was mildly elevated (one and one-half
normal). In this patient, the most likely imbalance that would contribute to
this event would be:

a. Folate deficiency
b. Fasting hypoglycemia
c. Hypomagnesemia
d. Thiamine deficiency
e. Vitamin B12 deficiency

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[QUOTE=Fuser00;148416]Two days after admission, a 57-year-old man suddenly has a seizure.
He was undergoing evaluation for substernal chest pain. The nursing staff
noted that he seemed to be a little shaky since shortly after arrival on the
floor. He has no history of seizures and a stat CT of the head performed
during the postictal state was normal. Laboratory results had shown an
MCV of 101 (elevated) and his AST was mildly elevated (one and one-half
normal). In this patient, the most likely imbalance that would contribute to
this event would be:

a. Folate deficiency
b. Fasting hypoglycemia
c. Hypomagnesemia
d. Thiamine deficiency
e. Vitamin B12 deficiency

[/QUOTE
B would more appropriate as others might occur in alcoholic pt.
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  #3  
Old 09-19-2012
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Default my answer :)

e. Vitamin B12 deficiency
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e) Vit. B 12 deficiency

but thinking of more like non megaloblastic anemia
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Quote:
Originally Posted by venky2600 View Post
e) Vit. B 12 deficiency

but thinking of more like non megaloblastic anemia
Can vit. B12 deficiency cause seizure, i know it can cause memory loss and confusion but not sure to cause seizure
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I thought it was Folate dificiency. .
Vitamin B12 would be associated with neurological symptoms and abdominal bleeding in Alcoholics.

Help me I am confused.
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But then the MCV equal to 101 makes me think of megaloblastic anemia and makes Vit B12 deficiency a better choice.
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Originally Posted by Doc4Step1 View Post
But then the MCV equal to 101 makes me think of megaloblastic anemia and makes Vit B12 deficiency a better choice.
You are right as the pt has megaloblastic anemia which might be due to folate of vit.12 deficiency but non of them can result in seizue
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Quote:
Originally Posted by Anders View Post
Can vit. B12 deficiency cause seizure, i know it can cause memory loss and confusion but not sure to cause seizure
ya i totally forgot abt that...thanks for reminding me
then c) hypomagnesemia would be better answer....as increased MCv is mostly observed in alcoholics and also hypomagnesemia is most common in hospital settings
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I went with E) bc B12 deficiency increases level of homocysteine and that puts a pt at risk of MI. This pt presented with substernal chest pain + AST is elevated (true it's usually indicative for alcoholic liver disease but it's one of the first markers in heart failure/MI) so I went with this. I'm not sure if B12 deficiency can lead to a seizure.

hypomangesemia is also a good answer but since it's not related anyhow with a chest pain I picked B12.
A bit confused here..
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Quote:
Originally Posted by Casandra View Post
I went with E) bc B12 deficiency increases level of homocysteine and that puts a pt at risk of MI. This pt presented with substernal chest pain + AST is elevated (true it's usually indicative for alcoholic liver disease but it's one of the first markers in heart failure/MI) so I went with this. I'm not sure if B12 deficiency can lead to a seizure.

hypomangesemia is also a good answer but since it's not related anyhow with a chest pain I picked B12.
A bit confused here..
Nice explanation, as u said the pt. is alcoholic and these people are at a risk of hypoglycemia since they have impaired gluconeogensis
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Quote:
Originally Posted by Anders View Post
Nice explanation, as u said the pt. is alcoholic and these people are at a risk of hypoglycemia since they have impaired gluconeogensis
yes but would that explain seizures+chest pain or seizures only?
bc if we follow that path that you mention we should also chose thiamine deficiency...
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e. Vitamin B12 deficiency
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Quote:
Originally Posted by Casandra View Post
yes but would that explain seizures+chest pain or seizures only?
bc if we follow that path that you mention we should also chose thiamine deficiency...
Yup, all other options can be seen in this case . Let wait for the answer
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Quote:
Originally Posted by Fuser00 View Post
Two days after admission, a 57-year-old man suddenly has a seizure.
He was undergoing evaluation for substernal chest pain. The nursing staff
noted that he seemed to be a little shaky since shortly after arrival on the
floor. He has no history of seizures and a stat CT of the head performed
during the postictal state was normal. Laboratory results had shown an
MCV of 101 (elevated) and his AST was mildly elevated (one and one-half
normal). In this patient, the most likely imbalance that would contribute to
this event would be:

a. Folate deficiency
b. Fasting hypoglycemia
c. Hypomagnesemia
d. Thiamine deficiency
e. Vitamin B12 deficiency

Question asks cause of seizure... so
I'm stuck between B and C.
But because of the substernal pain I'll go with C. low Mg known to also to cause arrhythmias.
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ok, I think you are right that the question asks only about the reason of the seizure (they just mentioned the chest pain to justify his hospital stay). If so, then I have no doubt that
C) hypomagnesemia is the answer
Prolonged hypomagnesemia in alcoholics causes functional hypoparathyroidism -> low Ca2+ -> low seizure threshold.
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Correct Answer The asnwer is C

Nice explanations , Casandra posted the most precise explanation about Mg (decrease in chronic alcoholism) and its relation in decrease the treshold for seizures
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[QUOTE=Fuser00;148416]Two days after admission, a 57-year-old man suddenly has a seizure.
He was undergoing evaluation for substernal chest pain. The nursing staff
noted that he seemed to be a little shaky since shortly after arrival on the
floor. He has no history of seizures and a stat CT of the head performed
during the postictal state was normal. Laboratory results had shown an
MCV of 101 (elevated) and his AST was mildly elevated (one and one-half
normal). In this patient, the most likely imbalance that would contribute to
this event would be:

a. Folate deficiency
b. Fasting hypoglycemia
c. Hypomagnesemia
d. Thiamine deficiency
e. Vitamin B12 deficiency

[/QUOTE

option C I think is right one. since I dont think b12 def causing seizures( cause dementia). Alchoal cause low magnesium level. Low magnesium is a cause for Hypocalcemia. Hypocalcemia can ppt seizures. One may argue for Fasting Hypoglycemia to be right too.
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Alcohol withdrawal seizures are suspected because the man became shaky 2 days after admission in the hospital where he would not have access to alcoholic beverages, he has a macrocytosis consistent with folate deficiency due to alcoholism, and the diagnostic tests showed no underlying neurologic disease.
The consumption of alcohol leads to excessive loss of magnesium in the
urine and thus lowers seizure threshold. The AST level in general will
increase more in the face of alcohol usage than will the ALT. The bulk of
alcohol withdrawal seizures will occur within 5 days of the cessation of
alcohol consumption.
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