Man, 48, left permanently disabled due to three major deficiencies

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Vitamins and minerals that we acquire from food serve the primary purposes of providing energy and maintaining the body’s structure. Alcoholism, however, can limit the supply of these essential nutrients and lead to a host of complications. In one man’s case, drinking led to deficiencies so severe that he was left permanently disabled.

The BMJ Case Report is of a 48-year-old who was admitted to the hospital in an agitated state and extremely poor general condition.

The patient, who had no fixed abode, was thin at presentation with apparent anomalies in the eyes and skin and marked cognitive impairment.

The authors noted: “We report a case of an inadequate diet (caused by extreme self-neglect and alcohol excess) which led to chronic severe deficiencies of vitamin A, D and E.

“At presentation, the patient had widespread follicular hyperkeratosis of the skin, keratomalacia of both eyes and severe cognitive impairment.

“He responded well to treatment including high dose parenteral vitamins, but lasting impairments in his vision and cognition have caused permanent disability.”

Undernutrition associated with chronic alcohol consumption is well documented, with water-soluble vitamin deficiencies most commonly reported.

Based on the patient’s anomalies in his eyes and skin, and his history of alcoholism, a severe nutritional deficiency was immediately suspected.

As expected, test results showed a deficiency of vitamins A, D and E, as well as poor serum lipids due to poor nutrition.

Hyperkeratosis, which describes abnormal thinking of the outer layer of the skin, has an important link to vitamin A and vitamin C deficiencies.

In the patient’s case, treatment with vitamin A helped his skin return to normal condition within weeks.

his visual impairment, however, remained a massive source of disability.

Though the vast majority of complications linked to vitamin deficiencies respond well to treatment, early intervention offers the highest chances of a full recovery.

Inadequate dietary intake is the primary cause of vitamin deficiency in alcohol, other mechanisms may be involved.

Some cases are linked to the impaired metabolism, utilisation and absorption of vitamins by the body.

The National Institutes on Alcohol Abuse and Alcoholism explains: “For example, alcohol inhibits fat absorption and thereby impairs the absorption of the vitamins A, E and D that are normally absorbed along with dietary fats.

“Vitamin A deficiency can be associated with night blindness and vitamin D deficiency is associated with softening of the bones.”

The case study highlights the hidden dangers of chronic alcoholism, which affects an estimated eight million people in the UK.

Though the majority of health complications become apparent after decades of alcohol use, liver damage can be apparent after just a few years.

As the case study illustrates, nutritional deficiency in alcoholism has a range of psychiatric and physical implications, some of which may not resolve after treatment.

Fortunately, however, there is evidence that nutritional therapy to reverse the deficiencies can also quell cravings for alcohol.

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