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Answer 3
  1. Vitamin A (retinol) deficiency. The patient has untreated pancreatic exocrine insufficiency caused by steatorrhea. Although these patients can malabsorb many vitamins and minerals, fat-soluble vitamin deficiencies (vitamins A, D, E, and K) are often prominent. The case patient has difficulty seeing in low-light conditions (ie, night blindness), which is likely due to vitamin A (retinol) deficiency. Vitamin D deficiency can cause osteopenia, muscle weakness, and/or deep bony pains, and vitamin E deficiency can result in peripheral neuropathy and hemolysis. Vitamin K deficiency often manifests as easy bruising and a prolonged clotting time, and vitamin C deficiency can result in gingival inflammation with associated bleeding and scurvy. The case patient should be treated with vitamin supplementation and pancreatic enzyme replacement therapy to replace the zymogens the patient’s pancreas can no longer produce.

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