1. Essential Micronutrients Flashcards
• Basis of hematopoiesis and neuro growth and development
○ Array of essential micro nutrients: ____
○ Macro: proteins, carbs, fat
• Micro nutrients are the small molecules that are used as cofactors
for a variety of enzymatic rxns
• Or a component of an essential substance
○ Example: Iron Hg
○ Example: Zn synthesize DNA
vitamins and minerals
Vitamin A • Comes in two dietary forms • Vitamin A from \_\_\_\_ sources • Provitamin A carotenoid from \_\_\_\_ – α-carotene – β-carotene – β-cryptoxanthin • Other carotenoids not converted to vitamin A
• Comes in two main dietary forms
○ Animal sources ‐ vegans and vegetarians are fucked
• ____ is the most common organ that provide this source, very rich source
○ Plants
• Comes to us from animals as vitamin A
• Plant source comes as a precursor called carotenoids
○ ____ is most well recognized
• One of the primarily used that can be a precursor to vitamin A
• High abundance in ____ colored fruits and vegetables
animal plant liver b-carotene red/orange
Vitamin A • \_\_\_\_ soluble retinoid • Solubilized into \_\_\_\_ in intestine • Absorbed in \_\_\_\_ • Vitamin A > retinol > retinal > \_\_\_\_ • Most Vitamin A stored in liver \_\_\_\_ cells
• All B vitamins are ____ soluble
• All the other lettered are fat soluble (including vitamin A)
○ Similar pattern of absorption
○ Once digested and converted to vitamin A they are incorporated into
micelles
○ ____ are used to cross plasma membranes
• Different parts of the intestine absorb different nutrients
○ Most absorbed in the duodenum, some in ileum, few in the jejunum
• Most fat soluble absorbed in the ____
• Once absorbed they get converted eventually to an end product called
retinoic acid
○ This is what works within the cell as the ____ form
○ Array of enzymatic actions most importantly ____
• Cofactor for promoting DNA transcription
Drug: for ____
○ Retinoic acid
○ Topically potent
○ Pro ____ function
Storage:
○ Stored in the body, we don’t ____ it
○ Stored in the liver in Ito cells (BS1 last year, first lecture)
fat micelles duodenum retinoic acid Ito
water micelles duodenum biologic DNA transcription acne transcrption synthesize
Vitamin A deficiency • Most common cause of \_\_\_\_ in 3rd world • \_\_\_\_ blindness • Dry \_\_\_\_, eyes and hair • Hyperkeratosis of skin and mucosa – \_\_\_\_ • Angular \_\_\_\_ • Immune dysfunction – Increased infection
Vitamin toxicity is not as commonly seen as deficiency
In this part of the world it is not commonly seen
○ Most common cause of third world blindness
Night blindness / ocular and vision problems
Dry skin, eyes, hair
○ Hair might fall out
○ Retinoic acid plays a roll in transcription, the cells that are rapidly turning over give rise to these
____ of the oral mucosa
○ Hyperkeratosis reflective Hyerkeratosis of the ____
○ can cause blindness as well
○ Damage to conjunctiva
○ Keratomalacia
Angular cheilitis is common to all ____
○ Fungal infection at the commissures of the lips
Immune dysfunction
○ Many immune states
○ Roll in immune development ‐ development of ____
blindness night skin keratomalacia chelitis
leukoplakias
oral mucosa
defieincies
lymphocytes
Hypervitaminosis A • \_\_\_\_ • Bone pain and fracture • \_\_\_\_ complications • Liver damage • Disrupts \_\_\_\_ of other vitamins
Hypercarotenemia
• Non-____
• Excessive ____
• Pigmentation of ____ NOT mucosa > differentiates from jaundice
Excessive vitamin A, not a big problem in this part of the world
○ Happens if you eat foods only excessively rich in vitamin A Too much causes an array of systemic problems
○ Complications are common to many excessive toxicity so just learn it for all the vitamins
Hypercarotenemia ‐ what is more common
○ Non‐toxic state
• Not real complications beyond the change in skin color
○ High b‐carotene ingestion
• Lots of carrots
○ Become orange (see picture)
○ Ddx: ____
• Difference: even mucosal tissues turn yellow in jaundice • Here only the skin
toxic
neurologic
metabolism
toxic
b-carotene
skin
jaundice
B complex vitamins • B1 = \_\_\_\_ • B2 = Riboflavin • B3 = \_\_\_\_ • B5 = Pantothenic acid • B6 = \_\_\_\_ • B7 = Biotin • B9 = \_\_\_\_ • B12 = Cobalamin All water soluble vitamins absorbed in intestine via \_\_\_\_ transport
All water soluble absorbed in intestine via passive transport (except food level active transport)
○ Caveat: if you are taking multivitamins with ____ doses that is how you absorb them through passive transport
○ Small quantities in the diet is through ____ transport
• Nutrient level sources
• Food level sources digested absorbed through active transport Need to know the B number and names
thiamin niacin pyridoxine folate passive
high
active
B complex vitamins
____: high doses absorbed ____: nutritional doses into the food
○ Requires energy
passive
active
Thiamin (B1)
- Required for ____ metabolism
- Nutritional sources (low dose) absorbed via ____ transport
- Pharmacologic (high) dose absorbed by ____ transport
- Minimal storage
All the vitamins are required for metabolism ○ Many are in the ____ cycle pathway
This does not get stored in the body
○ taken up converted to ____: functionally active form of thiamine
• cofactor to biologic pathways
• ____ required for conversion Abs, converted, little stored
○ Once it is used its used
energy active passive krebs thiamine pyrophosphate ATP
Know where it is used
Functional form: thiamine pyrophosphate is used in four places
○ ____: Converts ribose 5 phosphate to glyceraldehyde 3 phosphate (precursor to the Kreb cycle)
○ Catabolize ____
• This catabolism helps synthesis ____ in the citric acid
Citric acid cycle thiamine pyrophosphate comes in twice
○ ____: Converting pyruvate to acetly coa (decarboxylate)
○ ____: Alpha‐ketogluterate to succinyl coA
pentose phosphate AA acetyl CoA pyruvate dehydrogenase alpha-ketoglutarate dehydrogenase
Thiamin (B1) Deficiency state called \_\_\_\_ – \_\_\_\_ manifestations – \_\_\_\_ complications – \_\_\_\_ syndrome
Risk factors – Insufficient \_\_\_\_ intake – Chronic alcoholism – \_\_\_\_ / AIDS – Diabetes mellitus – Medications eg \_\_\_\_
Deficiency for one of two reasons
○ From a third world country in a deficient state
○ ____
Phenotype is the same: Berberi
○ Body wide rash
○ ____: Stays depressed in the skin
These patients are at risk for Wernicke‐Korsakoff syndrome
○ Two phenotypes that occur in the same context
○ Wernicke: ____
• Neurologic complications much like patients with menigitis, or prion disease
• Gate changes, ____
○ Korsakoff: ____ over time
• Start forgetting
• Confabulating: makes up ____ stories out of the blue
Unique: alcoholism can cause Berberi
○ Alcoholism does not typically cause the other disease states Medication ‐ Furosimide:
○ ____
○ Usage can cause B1 deficiency is used excessively Tx: replenishing the B1
○ ____ usage
No real complications associated with excessive B1 because it is not stored
beriberi
mucocutaneous
cardiovascular
wernicke korsakoff
dietary
HIV
furosemide
alcoholism
peddle edema
encephalopathy
tremors amnesia bizarre diuretic multivitamin
Riboflavin (B2) • Essential component of two coenzymes – Flavin \_\_\_\_ – Flavin \_\_\_\_ • Required for \_\_\_\_ production • \_\_\_\_ / drug / steroid metabolism • Regulates metabolism of other \_\_\_\_ vitamins
Component of two important coenzymes
○ FMN: Flavin mononucleotide
○ FAD: flavin adenine dinucleotide
○ Need to recall both of these from the ____ cycle
○ Beyond that these are used in other pathways including ____
Required for energy production
○ Macromolecules metabolism (fat and steroids)
○ Metabolism steroid
B2 plays a role in regulating other vitamins
○ A, folic acid, and B 12
○ synergistic
• Some of the phenotypes are common to most of the vitamins Know where they come in the pathway
○ FAD: converts ____ to a byproduct needed to synthesize DNA
○ FMN: together to convert ____ to excretable form in the
urine
○ Work ____ with one another
mononucleotide adenine dinucleotide energy fat B
kreb
DNA synthesis
folic acid
synergistically
Riboflavin (B2)
• Absorbed in \_\_\_\_ • \_\_\_\_ storage • \_\_\_\_ molecule – Fluoresces when exposed to \_\_\_\_ light • \_\_\_\_ = deficiency
Not stored to any great extent
At high levels this molecule is fluorescent
If you suspect toxicity state, test the urine and it will phosphoresce ____ under UV light
Toxicity does not cause too many problems, neurologic, cardiovascular but no ____ complications associated with excessive B2
Deficiency state is pretty rare because so many sources
○ Ariboflavinosis
○ Manifestations are no different than B12, foliac acid cholitis
• Angular cheilitis, oral lesions, burning mouth
• Common to most of the vitamins
proximal small intestine minimal photosensitive UV ariboflavinosis
yellow-green
long-term
Riboflavin (B2) • Mucocutaneous lesions – \_\_\_\_ tongue • Anemia • Degeneration of \_\_\_\_ and CNS • Risk factors – \_\_\_\_ athletes – Vegan diet and/or minimal dairy – Treatment of neonatal \_\_\_\_
Deficiency tongue might turn magenta
○ Not pathognomonic but highly characteristics
The rest are all things we see in other deficiency states as well
○ Vegetarian or vegan you run the risk
○ B2 is primarily found in the ____
○ Fortified foods do have a good source of B2
○ Metabolized in the liver
magenta liver vegetarian jaundice liver
Niacin (B3) • Essential component of two coenzymes – Nicotinamide \_\_\_\_ – Nicotinamide \_\_\_\_ • Critical in most \_\_\_\_ pathways • Tissues with high \_\_\_\_ or high energy demands most susceptible to deficiency
Component of two coenzymes ○ NAD ○ NADP ○ \_\_\_\_ and \_\_\_\_ synthesis ‐ close to our heart • Only know the major: Kreb and DNA • But in a lot others
adenine dinucleotide dinucleotide phosphate turnover kreb DNA
Niacin (B3)
Mild deficiency
– Slows ____
Severe deficiency = \_\_\_\_ – Diarrhea – \_\_\_\_ – Dementia – \_\_\_\_
Deficiency is not common, we get B3 through an array of sources When it does happen it is very severe
○ Mild: minimal complications
• Lethargic
• Ddx: ____
• But no ____
○ Severe: pellagra
• Only used to describe severe niacin deficiency
• Experience four very commonly occurring manifestations D
• Diarrhea, dermatitis, dementia, death Get it from fortified foods like cereal
metabolism
pellagra
dermatitis
death
Pantothenic acid (B5)
• Required for biosynthesis of \_\_\_\_ • Synthesis and metabolism of – \_\_\_\_ – Fat – \_\_\_\_ • Deficiency state very rare
Critical cofactor of ____
○ Linked to yield: ____ used in the kreb cycle
Needed for synthesis of macromolecules, fat, carbs, proteins
○ Plus ____
Many sources we get this from, not a common deficiencies
coenzyme A
protein
carbohydrate
coenzyme A
acetyl CoA
DNA
Pyridoxine (B6) • Required for numerous enzymatic reactions • \_\_\_\_ metabolism • Gluconeogenesis and \_\_\_\_ • Hemoglobin formation • \_\_\_\_ function • Immunity
Unique vitamin, required for an entire array of enzymatic rxns
○ Producing ____: gluconeogenesis and glycogenolysis
○ Metabolizing protein
• ____ are lower on B6
○ Problems, additive beyond the diabetes
○ Diabetics metabolize ____ to yield energy to survive and sustain function
○ So if this is low in these patients it a double whammy
○ Required for gluconeogenesis and glycogenolysis
• Hemoglobin formation: At risk for ____
• Critical cofactor in brain development and function
protein
glycogenolysis
brain
glucose
diabetics
protein
anemia
Pyridoxine (B6) • Deficiency state is rare – \_\_\_\_ – Mucocutaneous lesions – \_\_\_\_ dysfunction – Seizures
• Risk factors – \_\_\_\_ disease – Inflammatory bowel disease – \_\_\_\_ – Chronic alcoholism
Rare, third world countries primarily speaking
• None of the features are unique to B6,
○ Common to B6, iron, B12, and folic acid
○ ____ Is the most severe manifestation
• Microcytic anemia
microcytic anemia
immune
chronic renal
rheumatoid arthritis
anemia
Biotin (B7)
- Coenzyme for ____ enzymes
- Synthesis of ____ acids
- Synthesis of ____ and valine
- ____
Coenzyme for carboxylase enzymes
○ Ex: left picture
○ ____ is used in the krebs cycle for glycolysis
• Fatty acid synthesis
• Synthesis of isoleucine and valine
○ Only vitamin that is used in ____ synthesis directly
carboxylase
fatty
isoleucine
gluconeogenesis
oxaloacetate
amino acid
Biotin (B7) • Deficiency very rare – \_\_\_\_ – Hair loss – \_\_\_\_ – Conjunctivitis – \_\_\_\_ complications • Risk factors – \_\_\_\_ – Inherited disease
Array of plant based sources
○ Do not see many deficiency states
• Not unique to this deficiency only
• Too much: not bad just passes through
brittle nails
dermatitis
neurological
pregnancy
