Life threatening nutritional deficiencies in a dialysis patient

Abstract

Nutritional deficiencies are very common among the patient on chronic hemodialysis. But they can be easily overlooked or misdiagnosed. Deficiencies of trace elements and phosphorous is rare among this patient population but if neglected can lead to catastrophic effects. We describe a case report of a patient with ESRD recently started on outpatient maintenance hemodialysis, who presented with life threatening muscular weakness with respiratory failure requiring prolonged mechanical ventilation. On initial workup, it was unclear what the cause of her weakness was, however, further investigations showed undetectable phosphorous levels as well as very low levels of trace elements. Replacement of these compounds to normal levels led to marked improvement in the clinical picture. On further evaluation, the patient was also found to be profoundly depressed with poor appetite even prior to initiation of hemodialysis. This case report highlights the importance of early diagnosis of depression and malnutrition in patients on chronic hemodialysis, as severe depression can contribute to malnutrition and life threatening deficiencies of organic as well as inorganic compounds, which may cause life threatening complications as evidenced in this patient.

Hypophosphatemia in critically ill adults and children – A systematic review

“…Sixteen case reports reported symptoms of muscle weakness in hypophosphatemic patients. Serum phosphate levels varying between 0.1-0.6 mmol/l were associated with general weakness [69][70][71][72][73], decreased muscle tone and muscle strength [74,75], paralysis [76], flaccid quadriparesis [77,78], absent tendon reflexes [74,76], rhabdomyolysis [79], ataxia [69], dyspnea [71,80], decreased vital capacity [70] and acute respiratory failure [69,70,[72][73][74][75][76][77][78][79][81][82][83][84] in 16 case reports in toto. Clinical improvement was related to phosphate repletion in all cases.…”

Genome-Wide Association Analysis To Delineate High-Quality Snps For Seed Micronutrient Density In Chickpea (Cicer Arietinum L.)

“…Their de ciency leads to physiological disorders like tissue hypoxia, anaemia, acrimal dermatitis, hypogonadism, etc. Copper plays important role in the metabolism in both plants and animals 31 . Its de ciency in the human diet causes several abnormalities in the important life processes like collagen and elastin biosynthesis, iron mobilization, wound healing etc 32 .…”

Genome-wide association analysis to delineate high-quality SNPs for seed micronutrient density in chickpea (Cicer arietinum L.)

“…Their deficiency leads to physiological disorders such as tissue hypoxia, anemia, acrimal dermatitis, and hypogonadism. Copper plays an important role in metabolism in both plants and animals 39 . Its deficiency in the human diet causes several abnormalities in important life processes, such as collagen and elastin biosynthesis, iron mobilization, and wound healing 40 .…”