Fat Soluble vitamins

Question 1

Describe the laboratory findings of deficiency and insufficiency of vitamin D.

Question 2

Describe the laboratory findings of deficiency and insufficiency of vitamin D.

Question 3

Vit A biochemical function

Answer 3

major photo-chemical for vision
-retinal signaling
maintenance of conjunctiva and cornea

Question 4

Vit D biochemical function

Answer 4

Hormone
immune function- cytokine production, antimicrobial peptide generation in M0’s
regulates cell growth and differntiation
maintain intra and extra cellular calcium
increase intestinal absorption of calcium and phosphate
increase bone mineralization

Question 5

Vit E biochemical function

Answer 5

antioxidant (protects RBC’s and membranes from free radical damage
can enhance anticoag effects of warfarin

Question 6

vit K biochemical function

Answer 6

carboxylation of clotting factor proteins 2 7 9 10

Question 7

Vit D major physiologic metabolic roles

Answer 7

conversion of dehydrocholesterol–>cholecalciferol D3 in the skin (through uv light)

absorbed through chylomicrons (requires fat absorption)

D2 or D3 is hydroxylated in the liver
-25OH-VitD level reflects body stores
25-OH-Vit D is hydroxylatedin the kidney to active form
1,25 OH Vit D

Question 8

Vit A major dietary sources

Answer 8

preformed retinal palmitate- animal sources
-liver, dairy, egg yolk, fish oil
Precursor Beta carotene
-deep yellow green orange vegetables
-spinach carrots, broccoli pumpkin

Question 9

Vit D major dietary sources

Answer 9

milk, formula, fish liver oils, fatty fish, egg yolk

D2- plant algae, yeast + UV
D3- more potent larger AUC than D2, similar peak plasma

Question 10

Vit E major dietary sources

Answer 10

polyunsaturated fat rich vegetable oils, corn nuts, wheat germ, whole grains

Question 11

Vit K major dietary sources

Answer 11

leafy greens brocolli, fruits, seeds, beef liver

synthesis by intestinal bacteria

Question 12

Vit A characteristic deficiency findings.

Answer 12

xerophthalmia (dry eyes)
Bitots spots- foamy wipe cloudy patch on sclera–>
nigh blindness—>
total blindness

immune impairment- dysregulation, large cause of mortality worldwide, vit A tx with measles reduces morbidity and mortality

Question 13

Vit D characteristic deficiency findings.

Question 14

Vit E characteristic deficiency findings.

Answer 14

Risk- malnirishment prematurity fat malsorption/short gut

loss of DTRs, loss of coordination, loss of vibration and position sense, neuropathy, opthalmoplegia

hemolytic anemia, acanthocytosis, muscle weakness, posterior column and spinocerebellar demyelination
-neurological presentation may be similar to vit B12, but with out high MCV anemia, HYpersegmented neutrophils, or increase serum MMA levels

Question 15

Vit K characteristic deficiency findings.

Answer 15

prolonged coag time
hemorrhagic disease of the newborn
-pupura, GI bleeds, CNS bleeds

risk- poor placental transport in newborns
-fat malabsorption
-chronic antibiotics
prevention- need IM injection

Question 16

2. Identify circumstances in which risk of vitamin deficiency or toxicity is high.

Answer 16

A-low intake, low protein intake, low fat intake, fat malabsorption
D- low sun exposure, fat malabsorption, breastfed doesnt have vit D, obesity, liver or renal disease–> cant covert to 1,25-OH (need calcitriol)

400 IU for babies who are breast fed

Question 17

Identify circumstances and clinical features of toxicity of vitamins A,

Answer 17

not from too much beta carotene; only with preformed Vit A

Sx’s- vomiting, increased ICP, HA, bone pain, osteopenia/porosis, liver damage hepatitis–> fibrosis–>
death, birth defects (accutane)

lab tests- serum (very specific for total body amount)
- negative acute phase reactant, so it decreases with inflammation

Question 18

Identify circumstances and clinical features of toxicity of D

Answer 18

hypercalcemia
-vomiting, seizures, nephrocalcinosis, vascular and soft tissue calcinosis

Risk- Sarcoidosis, greater than 10,000 IU/d in children or during pregnancy
50-100,00 IU daily in adults

Question 19

Identify circumstances and clinical features of toxicity of E

Answer 19

coagulopathy (inhibit vit K clotting factors)

Question 20

Vit A biochemical function

Answer 20

major photo-chemical for vision
-retinal signaling
maintenance of conjunctiva and cornea

Question 21

Vit D biochemical function

Answer 21

Hormone
immune function- cytokine production, antimicrobial peptide generation in M0’s
regulates cell growth and differntiation
maintain intra and extra cellular calcium
increase intestinal absorption of calcium and phosphate
increase bone mineralization

Question 22

Vit E biochemical function

Answer 22

antioxidant (protects RBC’s and membranes from free radical damage
can enhance anticoag effects of warfarin

Question 23

vit K biochemical function

Answer 23

carboxylation of clotting factor proteins 2 7 9 10

Question 24

Vit D major physiologic metabolic roles

Answer 24

conversion of dehydrocholesterol–>cholecalciferol D3 in the skin (through uv light)

absorbed through chylomicrons (requires fat absorption)

D2 or D3 is hydroxylated in the liver
-25OH-VitD level reflects body stores
25-OH-Vit D is hydroxylatedin the kidney to active form
1,25 OH Vit D

Question 25

Vit A major dietary sources

Answer 25

preformed retinal palmitate- animal sources
-liver, dairy, egg yolk, fish oil
Precursor Beta carotene
-deep yellow green orange vegetables
-spinach carrots, broccoli pumpkin

Question 26

Vit D major dietary sources

Answer 26

milk, formula, fish liver oils, fatty fish, egg yolk

D2- plant algae, yeast + UV
D3- more potent larger AUC than D2, similar peak plasma

Question 27

Vit E major dietary sources

Answer 27

polyunsaturated fat rich vegetable oils, corn nuts, wheat germ, whole grains

Question 28

Vit K major dietary sources

Answer 28

leafy greens brocolli, fruits, seeds, beef liver

synthesis by intestinal bacteria

Question 29

Vit A characteristic deficiency findings.

Answer 29

xerophthalmia (dry eyes)
Bitots spots- foamy wipe cloudy patch on sclera–>
nigh blindness—>
total blindness

immune impairment- dysregulation, large cause of mortality worldwide, vit A tx with measles reduces morbidity and mortality

Question 30

Vit D characteristic deficiency findings.

Question 31

Vit E characteristic deficiency findings.

Answer 31

Risk- malnirishment prematurity fat malsorption/short gut

loss of DTRs, loss of coordination, loss of vibration and position sense, neuropathy, opthalmoplegia

hemolytic anemia, acanthocytosis, muscle weakness, posterior column and spinocerebellar demyelination
-neurological presentation may be similar to vit B12, but with out high MCV anemia, HYpersegmented neutrophils, or increase serum MMA levels

Question 32

Vit K characteristic deficiency findings.

Answer 32

prolonged coag time
hemorrhagic disease of the newborn
-pupura, GI bleeds, CNS bleeds

risk- poor placental transport in newborns
-fat malabsorption
-chronic antibiotics
prevention- need IM injection

Question 33

2. Identify circumstances in which risk of vitamin deficiency or toxicity is high.

Answer 33

A-low intake, low protein intake, low fat intake, fat malabsorption
D- low sun exposure, fat malabsorption, breastfed doesnt have vit D, obesity, liver or renal disease–> cant covert to 1,25-OH (need calcitriol)

400 IU for babies who are breast fed

Question 34

Identify circumstances and clinical features of toxicity of vitamins A,

Answer 34

not from too much beta carotene; only with preformed Vit A

Sx’s- vomiting, increased ICP, HA, bone pain, osteopenia/porosis, liver damage hepatitis–> fibrosis–>
death, birth defects (accutane)

lab tests- serum (very specific for total body amount)
- negative acute phase reactant, so it decreases with inflammation

Question 35

Identify circumstances and clinical features of toxicity of D

Answer 35

hypercalcemia
-vomiting, seizures, nephrocalcinosis, vascular and soft tissue calcinosis

Risk- Sarcoidosis, greater than 10,000 IU/d in children or during pregnancy
50-100,00 IU daily in adults

Question 36

Identify circumstances and clinical features of toxicity of E

Answer 36

coagulopathy (inhibit vit K clotting factors)