Which vitamin deficiency is listed as a negative prognostic indicator for PLE?

• A. Hypovitaminosis D and ionized hypocalcemia
• B. Hypervitaminosis A
• C. Vitamin B12 sufficiency
• D. Vitamin E deficiency

Answer: (A)

Fat-soluble vitamin losses reflect the severity of intestinal disease in protein-losing enteropathy. Vitamin D deficiency is a key marker because it directly impairs calcium absorption, leading to ionized hypocalcemia. This combination signals more extensive malabsorption and a worse overall prognosis, so it is the best indicator among the options. Hypervitaminosis A is excess, not deficiency, and doesn’t indicate poor prognosis. Vitamin B12 sufficiency isn’t a negative indicator, and while vitamin E deficiency can occur with fat malabsorption, it isn’t as clearly linked to prognosis in this setting as vitamin D deficiency with low ionized calcium.