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A Diagnostically Reasoned Case Study With Particular Emphasis on B₆ and Zinc Imbalance Directed by Clinical History and Nutrition Physical Examination Findings

The University of California Renal Center, San Francisco and The University of Arizona, Tucson

Mary Ann Kight, PhD, RD

The University of California Renal Center, San Francisco and The University of Arizona, Tucson

Rudolph Rodriguez, MD

The University of California Renal Center, San Francisco and The University of Arizona, Tucson

Steve Castillo, BA

The University of California Renal Center, San Francisco and The University of Arizona, Tucson

Despite a large body of literature documenting micronutrient requirements, vitamin and mineral imbalance remains an unappreciated player in altered body composition and functional integrity. The absence of routine biochemical determination of nutrient status contributes in part to the inability of the clinical staff to validate recognizable signs and symptoms of deficiency or toxicity. Disciplined use of Nutrition Physical Examination (NPE) procedures enables assessment of tissues known to reflect nutrient imbalance in a cost-effective way, which can assist clinical history taking and direct nutrition intervention. Macrophotography documenting lesions observed at baseline and after nutrient supplementation, along with laboratory monitoring, can ensure objective, advanced level, outcome-based nutrition therapy. This case illustrates use of the NPE and nutrition diagnostic reasoning in a relational manner to B₆ and zinc imbalance evidenced by (1) mild lip desquamation with ecchymotic-like lesions; (2) angular stomatitis; (3) seborrheic-like dermatitis of the scalp and eyebrows; (4) dry, flaky skin with sparse, wiry hair and scattered corkscrew and swan-neck hairs; and (5) somatic wasting with peripheral neuropathy.

Nutrition in Clinical Practice, Vol. 13, No. 1, 32-39 (1998)
DOI: 10.1177/088453369801300105


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