Nutrition Case Studies
In this activity, you will be pretending to be doctors. The following cases are patients
who are suffering from nutrient deficiencies or toxicities. We will only be considering
vitamins and minerals for these exercises; we will not be considering carbs, fats, proteins,
toxins, or infectious disease. You will read the symptoms for each patient, then try to
figure out the vitamin/mineral toxicity or deficiency the patient is suffering from. Use
your textbook, supplemental lectures and the Required Links provided on the Reading
Guides main page. I wrote these based on your text and the Required Links; so, use
them!!! I did not use any sources that are not available to you.
But wait, there’s more! In order to figure out WHICH vitamin or mineral is the problem,
and whether it is a deficiency or toxicity, you will need to know a little bit about each
patient’s lifestyle. For example, certain nutrient deficiencies are more common in
alcoholics. If you suspect one of those nutrients (like folate or thiamin, for example), you
would want to ask the patient “how much alcohol do you drink?”.
This is where you all need to work together. Each of you will be receiving lifestyle
“hints” for one or two of the patients in your class email. You will be responsible for
answering questions that are addressed to your patient in the discussion room. So, for
example, let’s say you receive a hint about Mr. Peabody. His hint says that he is a strict
macrobiotic; and that’s all it says. Another student in the discussion forum posts the
question: “Mr. Peabody, how much alcohol do you drink?” Since there was no mention
of alcohol in the hint, you can simply answer, “not much,” or “none,” or “only
moderately,” etc. But, if somebody asked you, “Mr. Peabody, do you follow any kind of
special or restricted diet?” you would answer, “yes, I am a strict macrobiotic.”
Of course, each of you will want to ask questions about the other patients for whom you
did not receive a hint. So, for example, maybe you got Mr. Peabody’s hint, but you did
not get Mrs. Featherbottom’s hint. You will want to ask Mrs. Featherbottom some
relevant questions in the discussion forum, and another student will answer for her. For
example, perhaps you suspect that she has a nutrient toxicity. You would want to ask,
“Mrs. Featherbottom, do you take any supplements?” If she says “yes,” you would want
to ask “Is there a specific reason you are taking them; do you know if you are taking a
megadose?” This will help you figure out which nutrient she is supplementing, and if it
is too much.
What I suggest is that you first narrow down each case to 2-4 possible nutrient problems.
Then, use the text and links to figure out what is different about lifestyle related to them.
For example, folate and B12 deficiencies are very similar; but, lifestyles that lead to them
are typically quite different: a folate deficiency would be more likely from a lack of fresh
plant foods, while a B12 deficiency would come from not eating any animal foods. So,
ask questions that will help you narrow down the possibilities.
Each patient has only ONE problem- to keep it simpler for our purposes. While in real
life, a person suffering from one deficiency may be likely to suffer from others, each of
our patients is only suffering from ONE vitamin or mineral deficiency or toxicity. So, an
answer for Mrs. Featherbottom might be: she is suffering from a vitamin D toxicity.
When you answer the questions, I will ask you not only what the problem is, but also
how you came to that conclusion. I expect you to include information from the
discussions; that is, I expect you to talk about the lifestyle information from discussions
that helped you make your decision.
1. Vernon, a 27 year old male, calls and asks if you can fit some time in for him
today; he’s experiencing some “weird stuff” and doesn’t want to overreact by
going to the ER, but he thinks it might be important. You ask him to describe the
symptoms over the phone so that he can get to the ER immediately if it sounds
like a real emergency. The man says he’s been nauseous and feels “flushed” and
hot and is sweating like crazy. The thing that really freaked him out was that his
vision seems blurred.
2. Sally, a 28-year-old woman, comes to you complaining of the following
symptoms: a reduced appetite and reduced sense of smell and taste, as well as
nausea and diarrhea. In addition, she feels like she gets sick more than her friends
and cuts take a long time to heal. During the exam, there is a loss of power and
soon you realize that your patient cannot see you in the dim light.
3. Tabitha, a young child, is rushed to the emergency room, exhibiting symptoms of
shock and liver failure. She has been vomiting, and has a very rapid heartbeat and
weak pulse.
4. Henna, a 35 year old woman comes to you, a psychiatrist, complaining of being
depressed, tired and irritable. She also has frequent headaches. Lately she’s
noticed some numbness, tingling in her hands and feet, and muscle weakness that
makes walking difficult. She thinks these physical symptoms are probably
psychosomatic and a result of her general depression, but wants to know if there
could be something “real” to it. She also has an odd lesion, but again, thinks her
general depression makes her more susceptible to injury
5. While working in an extremely impoverished area of the world where the primary
(and some days, the only substantial) food source is corn, you are approached by
Mary, a young woman who has the largest, reddest tongue you’ve ever seen. You
agree to examine her because she complains of other symptoms. During the
examination, you notice a rash that is particularly prominent on the areas of her
body most often exposed to sun, her neckline and hands. The woman also
complains of feeling depressed and apathetic, suffering from memory loss, and
having frequent diarrhea. *note: there is no hint for this case study.
6. Lucinda, an extremely thin young woman, comes to you complaining of the
following symptoms: diarrhea, confusion, general weakness and fatigue,
irratibility and frequent headache. While she’s talking, you notice that her tongue
is smooth and very red. You decide to do a blood work-up, which reveals that
many of her red blood cells are abnormally large and immature
7. Hank, a middle-aged man, comes to you complaining of fatigue and tingling in
his hands and feet. While he is talking, you notice that his tongue is very smooth
and red. You decide to do a blood work-up, which reveals that many of his red
blood cells are abnormally large and immature
8. Baron, a 50 year old man, comes to you complaining of a faint tingling sensation,
and frequent pain in his calf muscles. He also mentions that lately he’s been
feeling very tired and irritable. You noticed when he walked in that he had just a
bit of a limp or some sort of oddness in his gait (“ataxia”), and his eye movements
seem to be impaired. His wife mentions that Baron often has severe memory
lapses and is actually making up stories about his life that didn’t happen
(“confabulation”). A blood work-up did not show megaloblastic anemia.
9. Earnest, a 32-year-old male, comes to you with some strange symptoms. He has
been extremely fatigued lately. His wife had to help him into your office because
the pain in the joints of his legs is so bad he can barely walk. He has what he
describes as a rash on his legs, but upon inspection you realize that the "rash" is
actually small local hemorrhaging. You recognize this as a problem with the
integrity of blood vessel walls. On a hunch, you ask to look at his mouth, and
notice that his gums are bleeding slightly
10. While working in an impoverished area of the world, you see a young patient,
Hera, with bizarre looking, dry bumpy skin. This patient complains of dry eyes,
diarrhea, joint pain and “getting sick a lot.” During the exam, there is a loss of
power and soon you realize that your young patient cannot see you in the dim
light. a)Identify the nutrient deficiency/toxicity, b)explain how you came to that
conclusion. *Note, there is no hint that goes with this case.
11. Ethel, a 25-year old woman, comes to you complaining of pain in her pelvic area.
She mentions that over the past several weeks she has also lost her appetite, and
has felt nervous and nauseated for no apparent reason on several occasions. She
also reports excessive thirst and frequent urination, and is worried she may have
diabetes. Upon running some tests, you discover that the pelvic pain is caused by
kidney stones; in addition, Ethel has excessive amounts of protein in her urine and
elevated levels of urea in her blood.
12. Doris, a 25-year-old woman, complains of constant fatigue and occasional
tremors in her hands. While she is in your office, you notice the whites of her
eyes and her skin appear slightly yellowed, a sign of jaundice. Jaundice indicates
liver damage. A blood panel reveals that she is anemic; her white blood count is
low; and her copper level is low. An eye examination reveals that she has rustybrown rings around the edge of her irises. *There is no hint for this case.
13. Hawa, a 30-year old woman, comes to you complaining of fatigue, weakness, and
an inability to concentrate. She isn't sure if she should be visiting you or a
psychologist, because her symptoms are so vague she thinks they could be
psychosomatic. You do some blood work and urine tests anyway to rule out some
easily diagnosed infections like mononucleosis. Hawa does not show any signs of
infection, but her blood sample does show a high proportion of small, pale red
blood cells.
14. A young mother brings her 2 year old child, Duncan, in to see you. Duncan shows
significant signs of delayed speech and motor skills development. His growth also
appears stunted. The mother reports that Duncan has been evaluated for possible
genetic causes and none have been identified.
15. Trixie, a 3 year old child, is brought in by her mother for what she believes is an
intestinal ailment. Trixies's belly is weak and protruding. While you are
examining her (and finding no other signs of intestinal problems), you notice that
Trixies's legs are slightly bowed.
16. Walter, a 40-year old man, comes to see you. He says to you, "Doc, I've got a
lump in my throat." You, being the sensitive doctor, reply, "Well, Walter, I'm no
psychiatrist, but if you need to unload I'm here for you." Walter retorts "NO! Doc,
I mean, I really have a lump in my throat!" Sure enough, when he unzips his
jacket a huge lump protrudes from Walter's neck. *Note: there is no hint with this
case.
17. William, a 21-year-old college student male, comes to you complaining of
tiredness and weakness, heart palpitations (irregular heartbeats), and sharp pain in
his back. Upon examination, you discover an elevated blood pressure
(hypertension), which he claims is new. You also discover that he has kidney
stones, which is causing his back pain.