fat soluble vitamins

Question 1

Compare water soluble vs fat soluble vitamins

Answer 1

water soluble: Not stored (except B12) but chronic intake affects tissue levels, highly absorbed, excreted via urine, low toxicity. Fat soluble: accumulates in body, requires absorption of dietary fat and carrier for transport in blood, potential for toxicity.

Question 2

Situations that place patient at risk for micronutrient deficiency

Answer 2

Inadequate intake or variety, increased requirements, increased metabolic demands, maldigestion or malabsorption, drug-nutrient or medical-treatment-nutrient interactions, requirement for pharmacologic doses.

Question 3

List fat soluble vitaminees

Answer 3

A, D, E, K

Question 4

List a non- B complex water soluble vitamin

Answer 4

Vitamin C

Question 5

List hematopoietic, B complex, water soluble vitamins

Answer 5

Folic acid, B-12

Question 6

List B complex, water soluble vitamins used in energy metabolism

Answer 6

thiamin, niacin, riboflavin, pantothenic acid

Question 7

are vitamins made in the body

Answer 7

NO, they are essential

Question 8

Vitamin A Function

Answer 8

Photochemical for vision (retinal signaling), Maintenance of conjunctiva and cornea

Question 9

Vitamin A risk of deficiency

Answer 9

Low intake, low fat intake (<5%), fat malabsorption (liver dz, low bile salts, pancreatic insufficiency), protein malnutrition

Question 10

Vitamin A toxicity

Answer 10

Only with preformed Vit A (retinyl palmitate) NOT beta-carotene. Symptoms: Vomiting, increased ICP, headache, bone pain, osteopenia/porosis, liver damage (hepatitis > fibrosis > failure), death, birth defects

Question 11

Vit A dietary sources

Answer 11

Preformed retinyl palmitate from animal sources -
Liver, dairy, egg yolk, fish oil. Precursor Beta-carotene - Deep yellow and green vegetables, Spinach, carrots, broccoli, pumpkinPreformed retinyl palmitate from animal sources -
Liver, dairy, egg yolk, fish oil. Precursor Beta-carotene - Deep yellow and green vegetables, Spinach, carrots, broccoli, pumpkin

Question 12

Vit A deficiency findings

Answer 12

Eyes: xerophthalmia (corneal dryness) Bitot’s Spots, night blindness > total blindness. Epithelium: linings flat, dry, and keratinized. Immune: dysregulation (Vit A treatment in kids with measles reduces morbidity and mortality)

Question 13

Vit D Function

Answer 13

Functions as a hormone 1. maintains intracellular & extracellular Ca++ (stimulates intestinal absorption Ca++and P, renal reabsorption of Ca++ and P, mobilization of Ca++ and P from bone). 2. innate immune function (generation of toxic radicals). 3. cellular growth and differentiation through nuclear and plasma membrane vitamin D receptors present in many types of cells.

Question 14

Vit D dietary sources

Answer 14

Precursor (dehydrocholesterol) in skin, converted to cholecalciferol (Vit D3) by UV light;Dietary sources: a) Natural: fish liver oils, fatty fish, egg yolks; b) fortified milk & formulas D3 from animal sources, c) D2 ergocalciferol from plant (algae) sources;

Question 15

compare activity of Diff Vit sources

Answer 15

Animal D3 activity 2-3x > D2 from plants

Question 16

Vitamin D metabolism

Answer 16

Absorbed via chylomicrons; Vitamin D2 or D3 hydroxylated in liver, to 25-hydroxy-cholecalciferol and then in kidney to 1,25-dihydroxy-cholecalciferol (calcitriol) = active form

Question 17

Define Vit D deficiency and insufficiency

Answer 17

Deficiency: 30ng/ml

Question 18

Vit D deficiency findings

Answer 18

1. Rickets (<11ng/ml Vit D): failure of calcification, wide metaphyses, bone pain, bowed legs, fractures. 2. adult osteoporosis. 3. Possibly autoimmune dz, neuromuscular, cardiovascular dz, cancer, mortality

Question 19

lab findings in Vit D deficiency

Answer 19

Decreased serum Ca and PO4, increased alk phosph. Decreased Vit D, and increased Parathyroid hormone

Question 20

Vit D risk of deficiency

Answer 20

Low sun exposure, dark pigment, low intake, fat malabsorption, breastfed infant, obesity (sequestration), liver or renal disease (need calcitrol for supplementation)

Question 21

Vit D toxicity

Answer 21

Hypercalcemia, vomiting, seizures, nephrocalcinosis, vascular and soft tissue calcinosis. People at risk include sarcoidosis (granulomas activate D), >10,000IU/d in child/pregnancy, 50-100,000 IU daily in adults >3 weeks

Question 22

Vit E Function

Answer 22

antioxidant, scavenges free radicals, stabilizes cell membranes

Question 23

Vit E dietary sources

Answer 23

Polyunsaturated fat rich vegetable oils (e.g. sunflower), corn, nuts, wheat germ, green leafy vegetables

Question 24

Vit E deficiency findings

Answer 24

Irreversible neuro degeneration- loss of DTRs, coordination, vibration/position sense, pus spinocerebellar ataxia, neuropathy, and ophthalmoplegia. Hemolytic anemia.

Question 25

Vit E deficiency risk

Answer 25

prematurity

Question 26

Vit E toxicity

Answer 26

Coagulopathy- large doses inhibit Vit K dependent clotting factors

Question 27

Vit K Function

Answer 27

carboxylation of clotting factor proteins (II prothrombin, VII, IX, X)

Question 28

Vit K dietary sources

Answer 28

leafy greens, brocolli, fruits, seeds, beef liver. Synthesis by Intestinal Bacteria

Question 29

Vit K deficiency findings

Answer 29

Prolonged coagulation time, hemorrhagic dz of newborn (purpura, GI bleeds, CNS bleeds)

Question 30

Vit K deficiency risk/ prevention

Answer 30

newborns with poor placental transport, fat malabsorption or chronic antibiotics. Prevent with 0.5-1mg IM Vit K in all newborns, once. Oral dosing has not been defined