A 9-month-old infant, who has been fed cow’s milk exclusively for 4 months, is tachycardic and pale.
- Vitamin C
- Vitamin D
- Vitamin E
- Iron
- Vitamin K
Explanation:
Treatment for tuberculosis usually includes the medication isoniazid (INH), and INH competitively inhibits pyridoxine utilization. In most children, this does not result in clinical manifestations, but in individuals with a poor dietary intake of pyridoxine (eg, teenagers, vegetarians, and exclusively breast-fed infants) numbness and tingling of the hands and feet may develop.Treatment is replacement of pyridoxine.
Cow’s milk contains an insufficient quantity of iron to sustain normal RBC production. Therefore, children whose primary caloric source is cow’s milk are likely to develop iron-deficiency anemia, characterized by microcytosis and hypochromia on the peripheral smear
Hemorrhagic disease of the newborn is now rare, as the vast majority of newborns receive a vitamin K injection shortly after birth. Classic disease presents within the first week of life and is characterized by hematemesis, hematuria, umbilical stump and circumcision oozing, and purpura.
Vitamin C deficiency impairs wound healing. In its severe form, also termed scurvy, children can have diffuse tenderness, which is worse in the legs; evidence of hemorrhage; irritability; low-grade fever; swelling; tachypnea; and poor appetite. Diagnosis is based on clinical picture and radiographic findings; there are no definitive laboratory studies.
Vitamin A deficiency manifests first in visual changes, including night blindness. Deficiency can also cause drying of the conjunctivas and sclera. Skin is frequently dry. Poor growth and impaired cognition are also seen.
Vitamin D deficiency leads to rickets, a failure of bone mineralization, and the clinical picture described in the question. Vitamin D deficiency is usually not a problem in developed parts of the world. In addition to nutritional rickets, there are congenital forms of rickets. Despite vitamin D supplementation, these children can have permanent bony disfigurement.