Treatment Modalities For Iron Deficiency Discussion

Treatment Modalities For Iron Deficiency Discussion

Case 2 Response

Response to Lizzie

Hi Lizzie,

I agree with your diagnosis; Anemia, unspecified (D64.9), possibly due to lead exposure” The normal hemoglobin levels for a child range from 11.9 -15.0 g/dl. The patient in the scenario presented with a hemoglobin count of 10.7 g/dl, which implied mild anemia. Chronic lead poisoning often suppresses the ability to produce hemoglobin through interference with the steps involved in enzymatic heme synthesis. The resultant effect is reduced blood cells, increasing the likelihood of anemia (Hsieh et al., 2017)Treatment Modalities For Iron Deficiency Discussion. Iron deficiency may arise through the absorption of lead, resulting in further escalation of the anemia.

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Treatment modalities for iron deficiency anemia include measures that enhance stores in the body. Such measures include consuming iron-rich diets, such as iron-enriched cereals, legumes, liver, and leafy green vegetables such as spinach, pasta, whole-wheat bread, beef, pork, and rice. Another method is to utilize iron supplements to reduce the impact and progression of mild or moderate iron-deficiency anemia. Children provide 3mg/kg/day of iron supplements but for those weighing over 40kg, give Ferro-liquid 40ml/day (Victorian Pediatric Clinical Network, n.d.)Treatment Modalities For Iron Deficiency Discussion. Parents or guardians should be educated that the medication causes teeth discolorations and calls for using a straw while consuming the drug. Additionally, the child should be encouraged to brush using baking soda after consuming the supplements.

Response to Lisabeth

Hi Lisabeth,

After going through your diagnosis of severe persistent asthma, uncomplicated (J45.50) compared to my diagnosis of asthma with allergic rhinitis (J45.909), it made me realize that I should start treatment with step 3 per stepwise approach. Step 3 is moderate persistent, characterized by symptoms occurring daily. When inhaled SABA is utilized daily, it may have some limitations. It is recommended to start with low dose ICS + LABA or medium-dose ICS and LABA, or alternative low dose ICS + LTRA, theophylline (Burns et al., 2017). Furthermore, suppose the patient is not doing well with treatment of step 3. In that case, it also recommends referral to a specialist (an advance to step 4) for further follow-up investigations and management. I like your plan that starts ICS, Cetirizine 5 mg, and Montelukast 4 mg. The treatment plan is detailed and takes a step-by-step approach which is well stated. Another critical factor to consider is patient education on the right way to use the SABA powder inhaler, which is crucial for optimizing its performance. It is also vital that the patient avoids allergic triggers that may trigger their condition Treatment Modalities For Iron Deficiency Discussion.

Response to Carla

Hi Carla

I agree with your diagnosis of ADHD. This child meets the criteria for ADHD, such as difficulty remaining still at home and school. She is constantly running around, has difficulty sustaining attention while doing certain things, and is continuously disruptive in behavior in the classroom and with other children. I also agree with your behavior therapy plan because it has been utilized and proved through research to be effective in treating ADHD, primarily when delivered through the parents. Behavior therapy improves the child’s self-esteem, self-control, and behavior. As much as a psychologist has already diagnosed the patient, it is critical to educate the parent/guardian on how to look after this 5-year-old child by encouraging positive behaviors while discouraging negative ones (Magnus et al., 2017)Treatment Modalities For Iron Deficiency Discussion. This approach reduces the child’s tendency to be involved in negative behaviors, which are healthy for development and co-existence in the community or family.

References

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (2017). Pediatric primary care (6th ed.). Elsevier Health Sciences.

Hsieh, N., Chung, S., Chen, S., Chen, W., Cheng, Y., Lin, Y., You, S., & Liao, C. (2017). Anemia risk concerning lead exposure in lead-related manufacturing. BMC Public Health, 17(1). https://doi.org/10.1186/s12889-017-4315-7

Magnus, W., Nazir, S., Anilkumar, A. C., & Shaban, K. (2017). Attention deficit hyperactivity disorder (ADHD). https://europepmc.org/article/med/28722868

Victorian Pediatric Clinical Network. (n.d.). Iron deficiency. The Royal Children’s Hospital Melbourne. Retrieved June 21, 2022, from https://www.rch.org.au/clinicalguide/guideline_index/Iron_deficiency/#:~:text=3%20%2D%206%20mg%2Fkg%2F,been%20corrected%20to%20replenish%20stores Treatment Modalities For Iron Deficiency Discussion

First, write response to Lizzie per her plan which is anemia. I wrote my draft opinion, so you can use it for your edition.

Second, repones is Lisabeth about her Asthma plan. I also wrote a response to her. Please add or edit what I wrote for her.

Third, response to Carla about ADHD. I wrote some but I didn’t have time to get you reference. There are more reference for you to use for 5 ye old child with ADHD. You can have 1 or 2 references

Lizzie wrote:

Assessment:

This is a 5-year-old female without ANY previous immunization that is brought to the office by her grandmother. Her grandmother is now her legal guardian. She is anemic with Hgb level of 10.7 g/dL and her blood lead level is borderline at 10 mcg/dL. Until recently, her diet was mostly junk food and soda which grandma has now eliminated. She is a full-term baby with no drug or alcohol exposure during pregnancy who is fully covered by the state’s Medicaid health insurance at this time Treatment Modalities For Iron Deficiency Discussion.

Plan:

Anemia, unspecified (D64.9), possibly due to lead exposure.

Tx: Indicate a need to increase consumption of foods that are rich in iron, calcium, and Vit C. Such as fruits, nuts, green vegetables, milk, yogurt and proteins ( red meat). Check safety alert on her toys and ensure the house is lead-free ( paint and pipes).

Order a repeat lead exam, CBC with a differential, and CMP in 4 weeks. See child one week after for reevaluation.

Write response to Lizzie

Your post was…..appreciation

I agree with your diagnosis “Anemia, unspecified (D64.9), possibly due to lead exposure”

Child normal Hgb rage would be between 11.9 -15.0 g/dl. This pt is 10.7 which is implied to be mild anemia.
“Chronic lead poisoning inhibits the ability to produce hemoglobin by interfering with enzymatic steps in the heme synthesis pathway and diminishes red blood cells, thereby increasing risk of anemia [15]. The absorption of lead can cause iron deficiency and may further cause anemia.” Treatment Modalities For Iron Deficiency Discussion

Treatment for iron-deficiency anemia includes:

Iron supplements for Mild to moderate IDA – provide 3mg/kg/day such as for weight >40 kg give Ferro-Liquid 40 ml/day. So, we have to teach parent about this medication may stain teeth, drink through a straw to prevent teeth discoloration and consider brushing teeth with baking soda afterwards.
Iron-rich diet. Eating a diet with iron-rich foods can help treat iron-deficiency anemia. Good sources of iron include Iron-enriched cereals, breads, pasta, and rice. Meats, such as beef, pork, chicken, and fish. Leafy green, legumes, whole-wheat bread and rolls.

Hsieh, N., Chung, S., Chen, S., Chen, W., Cheng, Y., Lin, Y., You, S., & Liao, C. (2017). Anemia risk in relation to lead exposure in lead-related manufacturing. BMC Public Health, 17(1). https://doi.org/10.1186/s12889-017-4315-7 Treatment Modalities For Iron Deficiency Discussion

Lisabeth: Assessment and Plan

This is a 5-year-old female without ANY previous immunization that is brought to the office by her grandmother. Her grandmother is now her legal guardian. The patient has a history of asthma and daily inhaler usage, even twice daily, with a PEFR of 70%, placing her into the moderate persistent asthma category. Also, grandma reports allergies which require daily antihistamines usage due to her constant runny nose. A clear nasal discharge with inflamed nasal mucosa and dark circles under the eyes is noted on examination.

Severe persistent asthma, uncomplicated (J45.50)

The patient’s grandmother is reporting once or twice daily use of SABA rescue inhaler by the patient for symptom relief. This categorizes the patient’s asthma as severe persistent even in the relative lack of nighttime awakenings, lack of activity intolerance, and FEV of 70%. After ensuring that the patient and grandmother are using the dry-powder SABA inhaler properly and avoiding allergic triggers, instructions on the use of a peak flow meter and an easy to comprehend asthma action plan should be provided, which outlines proper steps to take in the case of a reduced functional capacity.
InitiateICS beclomethasone HFA 40 mcg/puff for 2 puffs daily and evaluate response in two weeks to determine titration or discontinuation.
Initiatenon-drowsy antihistamine Cetirizine 5 mg daily in the morning for allergic congestion and rhinorrhea.
InitiateMontelukast 4 mg chewable tablet before bedtime for asthma. Treatment Modalities For Iron Deficiency Discussion

RESPONSE TO LISABETH

Hi Li Lisabeth: This is what I wrote, you can add or edit

After reading your Dx of Severe persistent asthma, uncomplicated (J45.50) compared to my dx Asthma with allergic rhinitis (J45.909). It made me realized that I should start treatment with step 3 per stepwise approach.

Step 3 is moderate persistent: daily symptoms, daily use of inhaled SABA, some limitation, and FEV1 = / > 60%-80% predicted. It recommends starting low dose ICS + LABA or medium dose ICS and LABA, or alternative low dose ICS + LTRA, theophylline. And if patient is not doing well with treatment of step 3, it also recommends referral to specialist (which advance to step 4). I like your plan that start ICS, Cetirizine 5 mg, Montelukast 4 mg. Thus, I should add one more medication that is Montelukast 4 or 5 mg chewable in my treatment plan……….. Thank you for your detail plan of treatment

References

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (2017). Pediatric primary care (6th ed.). Elsevier Health Sciences.

Response to Calar about diagnosis of Attention-deficit hyperactivity disorder (ADHD)- F90.9

Mother states that the child cannot even sit still for half an hour to watch her favorite TV show. Treatment Modalities For Iron Deficiency Discussion

Plan

Behavior therapy and Referral to Pediatric Psychologist.

Children under 6 years of age, experts recommend that ADHD be treated with behavior therapy first, before trying medication.

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Hi Carla ,

I agree with your diagnosis “ADHD.” This child meet criteria for ADHD such as difficulty remaining still at home & school. She constantly running around, difficulty sustaining attention while doing certain things, constant disruptive behavior in the classroom and other children. I also agree with your plan “ behavior therapy” …….why and what for?

Per case study, child has been dx with psychologist already. However we still need to advise parent/guardian how to care for this 5 ye old child such as encourage positive behaviors and discourage negative ones for this child and….. with references Treatment Modalities For Iron Deficiency Discussion