please help with this study case. thank

please help with this study case. thank you. JR is a 27 yo male graduate student who came to clinic today with c/o several loose stools daily. His PMHx is significant for a gunshot wound to his abdomen 5 years ago, requiring intestinal resection of ~50% of his small intestine (part of his jejunum and entire ileum were removed). He also had anastomosis (surgical re-attachment) of his proximal jejunum to the cecum of his colon. He has had no follow-up medical care since then. He states that he has at least 5 oily, foul smelling stools daily. Social Hx: Lives alone: Yes cigarettes: NO alcohol: 2 beers weekly coffee: 3 cups daily exercise: too weak and tired Weight Hx: Today’s wt: 125# wt 5 yrs ago: 165# (75 kg) IBW: 165.3# (75 kg) %IBW: 75%_ Height: 5’10” (177.8cm) BMI: 17.9_ Diet Hx: 3 meals, 2 snacks 24 hr recall BKFT (Diner- restaurant) 2 fried eggs, 3 sl bacon, 2 slices white toast with 2 tsp butter per slice 12 oz cranberry juice cocktail, 6 oz coffee, 4 teaspoons sugar Snack: jelly doughnut, 6 oz coffee, 4 tsp sugar Lunch: (Fast Food restaurant) large double cheeseburger, large order french fries, 12 oz chocolate milkshake Dinner (home) 8 oz baked ham with medium baked potato w/ 2 Tbsp butter + sour cream + cheese 2 dinner rolls w/ 2 Tbsp butter apple pie with 6 oz coffee and 4 tsp sugar Snack (home) 3 oz corn chips with 12 oz beer TOTAL: Kcalories: 4462 kcals Protein: 143g (13% of calories) Carbohydrates: 488 (44% calories) Fat: 204g (43% calories) Sat Fat: 85g Mono fat: 31 g PUFA: 6g Cholesterol: 852 Fiber: 5g Sodium: 7902 mg Calcium: 544 mg Review of systems: General: 27 yo male appears very thin wearing loose fitting clothing, weak with fatigue Appetite is good, eats twice as much as before surgery but still losing weight GI: 5 liquid bowel movements daily, foul smelling, oily, frothy EXAM: General: Very thin build Skin: flaky, ecchymoses, dry, scaly, patchy Nails: brittle, splitting Hair: dry, dull, pluckable Eyes: Pt reports difficulty driving at night due to poor night vision Head: Bilateral temporal wasting Mouth: red, shiny, inflamed tongue GI/ abdomen: Protuberant abdomen, bowel sounds, no hepatosplenomegaly Extremities: subcutaneous muscle wasting, skeletal muscle wasting Medications: none Labs: Cholesterol: 105 mg/dL desirable <200 mg/dL Calcium: 5.5 mg/dL 9-11 mg/dL Vitamin B12: 100 pg/mL 220-960 pg/mL Vitamin A: 3mg/dL 28-94 mg/dL 25(OH)D: 5 ng/mL 20-30 ng/mL Vitamin E: 3 mg/L 4.6-14.5 mg/L Prothrombin Time: PTT: 16 seconds <11-15 seconds Zinc: 300 mg/dL 550-1400 mg/dL Magnesium: 1.2 mg/dL 1.8-2.9 mg/dL Fecal fat (72 hrs) 28 g <6 g daily QUESTIONS: 1. Thinking about his condition, why might JR's skin be dry and flaky? Which nutrient deficiency would present with these symptoms? 2. Explain the likely reason that the divalent ions calcium, zinc and magnesium are low

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