Medical Emergencies · single question
A patient presents with fatigue, pallor, and a beefy red tongue. They have chronic kidney disease (CKD). Which nutritional deficiency is MOST likely?
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Correct answer: C. B12 deficiency
Patients with chronic kidney disease (CKD) are at high risk for vitamin B12 deficiency due to: impaired B12 absorption (uremic gastritis), dietary restriction, and malnutrition common in CKD patients on dialysis. B12 deficiency causes megaloblastic anemia (large, immature red cells) AND a characteristic beefy red (atrophic) tongue (glossitis). CKD also causes iron-deficiency anemia from blood loss during dialysis, but the beefy red tongue specifically points to B12.
- A. ❌ Folate deficiency also causes megaloblastic anemia with glossitis but is less specifically associated with CKD.
- B. ❌ Iron deficiency anemia causes pallor and glossitis but characteristically an atrophic pale tongue, not 'beefy red.'
- C. ✅ CORRECT – B12 deficiency causes megaloblastic anemia + beefy red glossitis; commonly associated with CKD due to impaired absorption.
- D. ❌ Vitamin C deficiency (scurvy) causes bleeding gingiva and poor wound healing — not beefy red glossitis.
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