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The Nutrition-Focused History and Physical Examination (NFPE) in Malnutrition
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Mouth symptoms include oral pain, tongue pain, gum pain, tooth pain, difficulty chewing and inadequate saliva production. Just as with a patient who has an altered sense of taste and smell, a patient with unpleasant mouth symptoms will have diminished oral intake. The subconscious association of pain or discomfort with eating will detract from the desire to eat. Attempting to eat despite the symptoms will create a negative experience that will certainly detract from further consumption. These symptoms may be the result of lip cracking, mouth lesions, loose teeth, gum disease, tongue disease, soft/hard palate defects or inadequate saliva production. I try to ask quickly about each of these if a patient has mouth symptoms so that I can better understand the source.
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Published in Baylor University Medical Center Proceedings, 2018
The final piece of the pellagra puzzle was set in place by researchers at the University of Wisconsin and announced modestly 22 years later and 8 years after Goldberger had died. Dr. Conrad A. Elvehjem and his colleagues reported their breakthrough in a letter to the editor of the September 1937 issue of the Journal of the American Chemical Society. Elvehjem stated that they had found it “most interesting” that “black tongue was caused by a deficiency of nicotinic acid” (niacin). Physicians by now were curing pellagra with liver extract. They learned that rats on a diet deficient in the “P-P factor,” as Goldberger had understood it could be, were stimulated to grow with nicotinamide and nicotinic acid, both substances synthesized from liver extract. Because there was no rodent equivalent of pellagra, the scientists began working with dogs. After inducing black-tongue disease using a diet developed by Goldberger—yellow corn, casing, cottonseed oil, and mineral supplements—Elvehjem and Koehn in the Department of Agricultural Chemistry at the University of Wisconsin confirmed that nicotinic acid affected the canines dramatically. Dogs that got a single dose were hungry; with their improved appetite, they grew and the black tongue lesions disappeared.