Question: Based on the case study below, What is the rationale for B.D.’s Ferrous Sulfate? Case Study 4: Crohn Dis
Posted: Thu Mar 31, 2022 8:02 am
Question:
Based on the case study below, What is the
rationale for B.D.’s Ferrous Sulfate?
Case Study 4: Crohn Disease
SUBJECTIVE:
Patient’s Chief Complaint:
B.D. is a 27-year-old woman with an 8-year history of Crohn
Disease (CD). She presents with 6 days of abdominal pain, diarrhea,
dizziness, and weakness.
History of Present Illness (HPI):
B.D. reports initial abdominal pain and diarrhea began about 6
days ago. She thought her abdominal pain was improving until
yesterday; but, now she reports increased right quad pain that is
“intense” at times.
Past Medical History (PMH):
Crohn Disease diagnosed at age 19 after an onset of abdominal
pain, chronic diarrhea, weight loss, and admission for
dehydration.
Appendectomy at 7 years old.
Also takes venlafexine 75mg Daily for depression under good
control by PHQ-9
Family History (Fam Hx)
Father: HTN, Seasonal Allergies
Mother: Rheumatoid Arthritis
Social History:
Married 5 years with 2 children
Works as medical assistant in family practice office
No tobacco usage in home
ETOH: 2 or less glasses of red wine per week
Immunizations:
TdaP age 19
Annual influenza
Review of Systems (ROS):
Negative for (-): fevers, sore throat, mouth sores, headache,
visual changes, urinary frequency or pain, cough, shortness of
breath, chest pain, joint swelling or tenderness
Positive for (+): diarrhea, abdominal pain, nausea, dizziness
worsened when changing positions or with activity, and weight loss
of 5 pounds this week.
Medications:
Prednisone 10mg PO Daily
Venlafexine 75mg PO Daily
Ferrous Sulfate 325mg PO Daily
Cyanocobalamin 1000mcg IM monthly
Allergies:
Hydrocodone: Rash
OBJECTIVE:
Physical details
Specific abnormal findings in italics
Vital Signs:
BP: 152/88
HR: 89
RR: 22
T: 98.0 F
Ht: 5’ 2”
Wt: 106 pounds
General:
Neuro:
Alert, oriented. Speech clear. CN II-XII grossly
intact
Integumentary: Skin warm,
dry. Mucous membranes slightly
pale.
HEENT:
Fundoscopic examination normal
EOMI. PERRL. Tympanic membranes clear, intact.
Bilateral nares patent
Throat non-erythematous, moist. Uvula midline.
Neck and Lymph Nodes: Throat supple with no thyromegaly or
cervical lymphadenopathy.
No appreciable carotid bruit. No JVD.
Pulm:
Lungs CTA bilaterally. No accessory usage.
Heart:
Regular rate, S1 and S2 on auscultation. No gallops or friction
rubs
Abdomen: BS
hyperactive in LUQ. BS hypoactive in lower quads.
Soft, no rigidity. Mild guarding of RLQ upon
palpation.
No hepatic or splenomegaly.
Genital / Rectum: Good sphincter
tone. Hemoccult Heme-positive
Musculoskeletal: Full ROM with
good strength
Neuromuscular tone intact
Grips equal 5/5 strength
Extremities:
Nails unremarkable for disease
No C/C/E (Clubbing, Cyanosis, Edema)
Laboratory and Test Results:
Lab
Test
6 months
ago
Current
Hemoglobin
13.2
g/dL 11.4
g/dL
Hematocrit
41%
32%
ESR
23
mm/Hr 32
mm/Hr
Sodium
138
mEq/L
142 mEq/L
Chloride
102
mEq/L
106 mEq/L
Potassium
3.8 mEq/L
4.1 mEq/L
Calcium
9.1
mg/dL
8.6 mg/dL
Total Protein
6.7 g/dL
3.3 g/dL
CO2
28
mmol/L
34 mmol/L
BUN
20
mg/dL
36 mmol/L
Creatinine
0.9
mmol/L
1.0 mmol/L
Glucose
95
mg/dL
109 mg/dL
Abdominal CT:
Distal ileum displays significant inflammation and skip
lesions. No free air or fistulas appreciated.
DEXA Scan:
Spine
T-Score -1.9 Normal
Right Iliac
Crest T-Score
-1.5 Normal
Based on the case study below, What is the
rationale for B.D.’s Ferrous Sulfate?
Case Study 4: Crohn Disease
SUBJECTIVE:
Patient’s Chief Complaint:
B.D. is a 27-year-old woman with an 8-year history of Crohn
Disease (CD). She presents with 6 days of abdominal pain, diarrhea,
dizziness, and weakness.
History of Present Illness (HPI):
B.D. reports initial abdominal pain and diarrhea began about 6
days ago. She thought her abdominal pain was improving until
yesterday; but, now she reports increased right quad pain that is
“intense” at times.
Past Medical History (PMH):
Crohn Disease diagnosed at age 19 after an onset of abdominal
pain, chronic diarrhea, weight loss, and admission for
dehydration.
Appendectomy at 7 years old.
Also takes venlafexine 75mg Daily for depression under good
control by PHQ-9
Family History (Fam Hx)
Father: HTN, Seasonal Allergies
Mother: Rheumatoid Arthritis
Social History:
Married 5 years with 2 children
Works as medical assistant in family practice office
No tobacco usage in home
ETOH: 2 or less glasses of red wine per week
Immunizations:
TdaP age 19
Annual influenza
Review of Systems (ROS):
Negative for (-): fevers, sore throat, mouth sores, headache,
visual changes, urinary frequency or pain, cough, shortness of
breath, chest pain, joint swelling or tenderness
Positive for (+): diarrhea, abdominal pain, nausea, dizziness
worsened when changing positions or with activity, and weight loss
of 5 pounds this week.
Medications:
Prednisone 10mg PO Daily
Venlafexine 75mg PO Daily
Ferrous Sulfate 325mg PO Daily
Cyanocobalamin 1000mcg IM monthly
Allergies:
Hydrocodone: Rash
OBJECTIVE:
Physical details
Specific abnormal findings in italics
Vital Signs:
BP: 152/88
HR: 89
RR: 22
T: 98.0 F
Ht: 5’ 2”
Wt: 106 pounds
General:
Neuro:
Alert, oriented. Speech clear. CN II-XII grossly
intact
Integumentary: Skin warm,
dry. Mucous membranes slightly
pale.
HEENT:
Fundoscopic examination normal
EOMI. PERRL. Tympanic membranes clear, intact.
Bilateral nares patent
Throat non-erythematous, moist. Uvula midline.
Neck and Lymph Nodes: Throat supple with no thyromegaly or
cervical lymphadenopathy.
No appreciable carotid bruit. No JVD.
Pulm:
Lungs CTA bilaterally. No accessory usage.
Heart:
Regular rate, S1 and S2 on auscultation. No gallops or friction
rubs
Abdomen: BS
hyperactive in LUQ. BS hypoactive in lower quads.
Soft, no rigidity. Mild guarding of RLQ upon
palpation.
No hepatic or splenomegaly.
Genital / Rectum: Good sphincter
tone. Hemoccult Heme-positive
Musculoskeletal: Full ROM with
good strength
Neuromuscular tone intact
Grips equal 5/5 strength
Extremities:
Nails unremarkable for disease
No C/C/E (Clubbing, Cyanosis, Edema)
Laboratory and Test Results:
Lab
Test
6 months
ago
Current
Hemoglobin
13.2
g/dL 11.4
g/dL
Hematocrit
41%
32%
ESR
23
mm/Hr 32
mm/Hr
Sodium
138
mEq/L
142 mEq/L
Chloride
102
mEq/L
106 mEq/L
Potassium
3.8 mEq/L
4.1 mEq/L
Calcium
9.1
mg/dL
8.6 mg/dL
Total Protein
6.7 g/dL
3.3 g/dL
CO2
28
mmol/L
34 mmol/L
BUN
20
mg/dL
36 mmol/L
Creatinine
0.9
mmol/L
1.0 mmol/L
Glucose
95
mg/dL
109 mg/dL
Abdominal CT:
Distal ileum displays significant inflammation and skip
lesions. No free air or fistulas appreciated.
DEXA Scan:
Spine
T-Score -1.9 Normal
Right Iliac
Crest T-Score
-1.5 Normal