A patient with multiple enteric fistulae, after months of parenteral hyperalimentation, developed, severe depression accompanied by delirium, dermatitis, pallor, paresthesia, nausea, vomiting, anorexia, and headaches. His symptoms improved after treatment with parenteral biotin. Biotin-deficiency should be suspected in patients on hyperalimentation (without biotin supplementation) who develop similar symptoms.
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James L. Levenson (1983) studied this question.
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