Clinical Cases Of Vitamins

Question 1

Scurvy in adults

Answer 1

1) Bleeding gums and petechial hemorrhage on skin.
2) Swollen gums with slight bleeding
3) ecchymosis

Scurvy is due to deficiency of Vit C which is important for collagen fibres formation.
Important for conversion of proline and lysine into hydroxyproline and hydroxylysine.

Question 2

Scurvy in children

Answer 2

Legpain, lethargy, pallor, perifollicular hemorrhage and ecchymosis.
X ray of lower limb shows metaphyseal changes. Swollen and bleeding gums also seen.

Formation of collagen is affected resulting in weakning of blood vessels.

Deficiency of vitamin C causes decreased absorption of iron from GIT causing hypochromic microcytic anemia.

Question 3

Wernicke korsakoff syndrome B1 deficiency

Answer 3

Forgetfulness , muscle weakness , poor appetite, tremors in hand , nystagmus, unsteady gait
Alcohol consumption

Severe deficiency results in GOA
global confusion, opthalmoplegia and ataxia.

Question 4

Wet beriberi

Answer 4

Pitting pedal edema, main diet is rice and family cannot afford vegetables and fruits
Thiamine is important is PDH and alpha ketoglutarate dehydrogenase.

Dry beriberi characterised by neuromuscular symptoms, muscular atrophy, emaciation and peripheral neuropathy.

Wet beriberi is characterised by CVS involvement with failure of right side of heart , breathlessness and edema.

Deficiency common in chronic malnutrition and alcoholics.

Question 5

Vitamin B2 deficiency (Riboflavin)

Answer 5

Ulceration of mouth
Swollen painful tongue
Dry lips and multiple ulceration
Photophobia
Circumcorneal vascularisation

FAD and FMN are coenzyme forms of Vitamin B2.

Question 6

Vitamin B3 deficiency-pellagra (Niacin)

Answer 6

Dry scaly lesions on neck and dorsum of hands.
Excess consumption of maize

Pellagra is characterised is dermatitis, diarrhea and dementia.

Casal necklace is given to lesion around neck.

Tryptophan amino acid is used to produce nicotinic acid.

Pellagra occurs due to Niacin or vit. B12 deficiency.

Question 7

Vitamin B6 deficiency (pyridoxine)

Answer 7

Tingling and numbness in peripheries
Patient of pulmonary tuberculosis and is on treatment from months.

Pyridoxal phosphate is conenzyme form of pyridoxine

Xanthurenic acid is assessed in urine of patient.

Question 8

Vitamin B7 or biotin deficiency in raw egg consumption

Answer 8

Loss of hair and lesions around mouth,
Tingling sensation on nose , eyes and peripheries
Consumption of raw eggs.

Egg yolk is rich biotin and egg albumin has avidin which binds with 4 biotin to form a complex which fails to be reabsorbed in GIT.

Coenzyme form of biotin is biocytin.

Question 9

Vitamin B12 deficiency

Answer 9

In vegans
Megaloblastic anemia with hypersegmented neutrophils.

Found in animal sources and deficiency common in vegetarians.

B12 is absorbed from ileum and intrinsic factor secreted from stomach is important for its absorption by parietal cells.

In case of neurology
Difficulty in walking, lack of taking care of himself.

Knuckles hyperpigmentation is also seen .

Question 10

Vitamin B9 or folic acid deficiency called as folate trap.

Answer 10

Consumption of anticonvulsant drugs
FIGLU present in urine
Deficiency of B9 and B12
Peripheral smear shows megaloblastic cells.