Vitamin Deficiency or Mineral Toxicity-Your Dx?

June 6, 2014

Crohn disease patients with short gut syndrome may require total parenteral nutrition to replace nutrients no longer absorbed. But the supplementation has its risks. Can you name the source of the symptoms in this case?

A 45-year-old woman with Crohn disease and short gut syndrome from multiple bowel resection presents with headache, a new onset tremor, and change in her gait. She has been dependent on total parenteral nutrition (TPN) for several years.

Which of the following could explain her symptoms?