Exam 3 Vitamins

Question 1

Vitamin A Function

Answer 1

2 diet sources:
preformed (retinyl palmitate) - liver, dairy, eggs
precursor (ß-caretene) - leafy greens
Rentia differentiation

Question 2

Vitamin A as treatment

Answer 2

Wrinkles/acne
Measles
AML

Question 3

Vitamin A deficiency

Answer 3

Night blindness
Xerophtalmia
Immune ineffectiveness
Labs WNL due to liver stores, decrease with APR

Question 4

Vitamin A toxicity

Answer 4

Preformed (retinyl palmitate) only
n/v, HA, increased ICP, bone pain/osteoporosis
Liver damage
Birth defects

Question 5

Vitamin D function

Answer 5

Hormone with PM and nuclear receptors
Maintains Ca homeostasis
Innate immune function
Fish, egg, fortified milk and formula
Plant = D2, Animal = D3

Question 6

Vitamin D deficiency and values

Answer 6

Osteoporosis
Rickets
<20, 21-29, >30 ng/mL

Question 7

Vitamin D metabolism

Answer 7

Two hydroxylation reactions:

1. Liver -> 25-OH D3 = storage
2. Kidney -> 1-25-OH2 D3 (calcitriol) = active

Question 8

Vitamin D toxicity

Answer 8

Risk with chronic granulomatous disease (ex sarcoid)
Calcifications
Seizures

Question 9

Vitamin E function

Answer 9

Antioxidant
Cell membrane stabilizer
Polyunsaturated vegetable oils, wheat germ

Question 10

Vitamin E deficiency

Answer 10

Hemolytic anemia
Loss of DTRs, loss of proprioception
Ataxia, neuropathy, opthalmoplegia
Often irreversible neurodegeneration

Question 11

Vitamin E toxicity

Answer 11

No evidence for megadoses

Risk of coagulopathy (Vit K inhibition)

Question 12

Vitamin K function

Answer 12

Carboxylation of factors 2, 7, 9, 10
Leafy vegetables
All newborns receive IM injection

Question 13

Vitamin K deficiency

Answer 13

Prolonged coagulation times

Hemorrhagic disease of the newborn

Question 14

Who’s at risk? ADEK

Answer 14

A: Similar for all deficiency - low intake
D: Lack of sunlight, excess sunscreen
E: Fat malabsorption syndromes, short gut
K: Newborns

Question 15

Name the B vitamins

Answer 15

B1: Thaimine
B2: Riboflavin
B3: Niacin
B6: Pyridoxine
B9: Folate
B12: Cobalamin

Question 16

B1 Deficency

Answer 16

Wernicke-Korsakoff syndrome: AMS, ophthalmoplegia, ataxia
Dry beriberi: symmetrical muscle wasting, foot drop
Wet beriberi: edema and CHF

Question 17

B1 at risk populations

Answer 17

Alcoholics
Refeeding anorexia patients
Bariatric surgery

Question 18

B2 deficiency

Answer 18

Mouth findings:
Cheilosis (dry cracked lips)
Angular stomatitis

Question 19

B3 function

Answer 19

NAD derived from niacin
Derived from tryptophan
Synth requires B6 and B12

Question 20

B3 deficiency

Answer 20

Pellagra:

diarrhea, dermatitis (sun exposed), dementia, death

Question 21

B3 at risk populations

Answer 21

Where corn is major source of calories

Alcoholics, general malnutrition

Question 22

Energy releasing B vitamins

Answer 22

B1
B2
B3

Question 23

Hematopoietic B vitamins

Answer 23

B9

B12

Question 24

B9 functions

Answer 24

good 1 carbon group transfer
also does CH3, CH2 and others
Converted to THF via dihydrofolate reducatase

Question 25

B9 sources

Answer 25

"Foliage" green leafy veggies Whole grains - easily destroyed with prolonged cooking "Fortified" whole grains in 1999

Question 26

B9 deficiency

Answer 26

``` Macrocytic anemia, hypersegemnted neutrophils Increased homocysteine Neural tube defects MTHFR gene mutations can cause Don't treat until rule out B12 def ```

Question 27

B9 at risk populations

Answer 27

Pregnant mothers Infants to deficient mothers Meds: dilantin, sulfasalazine

Question 28

B12 functions and sources

Answer 28

Reform THF (methionine synthesis) Lipid (Co-A and Odd chain) and CHO metabolism From animal products

Question 29

B12 at risk populations

Answer 29

Decreased intrinsic factor (autoimmune,pernicous anemia) Gastric atrophy Breastfed infants with vegan mother Vegetarians, vegans

Question 30

B12 deficiency

Answer 30

Usually takes long time to present (large stores) Macrocytic anemia, hypersegmented neutrophils Neurological disturbances, ataxia Blood effects reversible, neuro effects irreversible

Question 31

B6 functions

Answer 31

PLP formation: 1. Cysteine synthesis 2. Transamination

Question 32

B6 deficiency

Answer 32

Anemia Seizures Glossitis Associated with ESRD, Isoniazid use

Question 33

B6, B9, B12 fun facts

Answer 33

B6 - toxic, PLP B9 - Material levels don't reflect breast milk B12 - large storage pool