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  Folic Acid Deficiency

S/O

Assessment

Plan

Problem: S/O evidence

Etiology

Recommended Therapy

Goals/Monitoring Parameters

Patient Education

  

Subjective:

-Weakness

-Lethargy

-Cheilosis (chapping and fissuring of lips)

-Glossitis (tongue inflammation) 

 

Objectives:

Folate

MCV (macrocytic) Ţ

MCHC (homochromic or normochromic)

Reticulocytes

RDW (variation in size) Ţ

Hgb

Hct

 

 

1). Inadequate intake

-Alcohol abuse (interferes w/ absorption and activation of folate)

-Poor diet   

2).Increased demand

-Pregnancy & lactation

-Chronic hemodialysis

 

3). Malabsorption at the jejunum

-Jejunal resection

-Drugs: Phenytoin, Primidone, Oral contraceptives, cholestyramine, sulfonamides    

4).Altered metabolism

-Drugs (Inhibits DNA synthesis)Ś 6-thioguanine, azathioprine, 6-mercaptourine, methotrexate, trimethoprim, pyrimethamine, pentamidine

-Inborn Errors 

 

*Folate important for Cell division and for normal erythropoiesis

 

Minimum Daily Requirements: 50mcg/d

Recommended Daily intake: 200mcg/d

 Small body stores ľ 5-10mg;  Megloblastic anemia may occur within 3-4months.  

Folate (Folic Acid):  1mg PO QDx 4wks

 Folate 0.1mg as a nutritional supplement may be recommended for pts at risk for reoccurrence.

 

Goals:

Correct underlying cause

Restore folate levels

Relieve Symptoms

Restore Hgb, Hct

 

Monitor:

RBC morphologyŚnormal w/in 24-48hrs

Reticulocytes: peak at day 10

Hematologic normalized w/in 10days

AnemiaŚcorrected in 1-2 months

 

 

 

 

Take Daily

Avoid Alcohol

Regular Healthy Diet

Keep away from children