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Discussion Starter #1
A 56 year old homeless man came to the emergency department requesting narcotics to relieve the severe pain that he's experiencing in his lower back. He stated that the pain has been there for 15 years. Examination showed a wasted unkempt man with smell of Alcohol. Chest, cardiac, back, and neurological examinations are within normal limits. Abdominal palpation revealed enlarged liver and tender right upper quadrant.

Labs:
Hb 11 g/dL
MCV 112
Na 140 mEq/L, K 4 mEq/L, Cl 108 mEq/L,
BUN 6 mg/dL, Creatinine 0.9 mg/dL
AST 58 U/L (normal 7-27), ALT 20 U/L (normal 1-21)
Bilirubin 1.2 mg/dL (normal 0.1-1) Albumin 3.1 mg/dL (normal 3.5-5)

Which of the following is true regarding this patient presentation?
A- The liver enzyme pattern indicate a probable viral hepatitis
B- Folate deficiency is the likely cause of his anemia
C- B12 deficiency is the likely cause of his anemia
D- His back pain is likely to be due to metastatic cancer
E- He should be given narcotics for his back pain
 

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I think its B . cause
1. pt with chronic alcoholism develop folate deficiency ... causes macrocytic anemia with high MCV ....
2. Chronic alcoholism decrease bone growth and bone mass ... cause weak bone and easily fractures .....
3. Alcohol usually increase AST more than ALT ...
 

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Discussion Starter #3
I think its B . cause
1. pt with chronic alcoholism develop folate deficiency ... causes macrocytic anemia with high MCV ....
2. Chronic alcoholism decrease bone growth and bone mass ... cause weak bone and easily fractures .....
3. Alcohol usually increase AST more than ALT ...
But why not B12 deficiency !
 

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Cause in ques , neurologic examination is normal...
Most commonly patient with B12 deficiency develop peripheral neuropathy ...
 
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