FAT SOLUBLE VITAMINS

Question 1

which water soluble vitamin is stored

Answer 1

B12

Question 2

Fat soluble vitamins

- require what for absorption?

Answer 2

dietary fat

Question 3

Do fat soluble vitamins require blood transport?

Answer 3

yes and no

Question 4

Function of vitamin A

Answer 4

photochemical for vision
- retinal signaling
maintenance of conjunctiva and cornea

Question 5

Vitamin A - 2 types of food sources

Answer 5

1. preformed retinyl palmitate from animal sources (liver, dairy, egg yolk, fish oil)
2. Precursor beta-carotene (deep yellow and green veggies)

Question 6

Vit A deficiency

Answer 6

Eyes: xerophthalmia - corneal dryness ; Bitot’s Spots ; Night Blindness ; total blindness

Epithelium: linings flat, dry, and keratinized

Immune Impairment - dysregulation ; effect depends on infectious agent ;

Question 7

VitA immune impairment treatment?

Answer 7

Treatment of deficiency decreases all cause child mortality 23-34% in developing world

VitA treatment with measles reduces morbidity and mortality

Question 8

VitA risk of deficiency

Answer 8

low vitA intake - poor diet (e.g. autistic with restricted diet)
PEM
Low fat intake (<5%kcal)
Fat malabsorption - liver disease / pancreatic insufficiency

Question 9

VitA toxicity from?

Answer 9

Not precursor beta carotene

ONLY preformed retinyl palmitate (e.g. cod liver oil)

Question 10

VitA toxicity symptoms

Answer 10

Vomiting
Increased ICP
Bone pain / osteopenia
liver damage 
death 
birth defects

Question 11

VitA - labs

Answer 11

serum retinol level - remains normal until liver store exhausted
decreased with inflammation - negative acute phase reactant

Question 12

Vit D function

Answer 12

Hormone

• plasma membrane and nuclear receptors in range of tissues
• maintains IC and EC calcium
• -> via intestinal absorption of Ca and P, renal reabsorption, and mobilization from bone
• Immune function
• innate -> antimicrobial peptide generation in macrophages
• adaptive -> modulation of cytokines

Regulates cell growth and differentiation

Question 13

Sources of vitD

Answer 13

conversion in skin
UVB light
Dehydrocholesterol –> cholecalciferol D3

dietary
- fish liver oil, fatty fish, egg yolk, fortified milk and formula

Question 14

VitD metabolism

Absorption?

Answer 14

absorption via chylomicrons - requires fat

Question 15

VitD metabolism

Hydroxylation?

Answer 15

D2 or D3 + OH in liver

25 OH VitD - level reflects body stores

25 OH VitD hyroxylated in Kidney to active form 1,25 OH VitD (Calcitriol)

Question 16

VitD deficiency

definition

Answer 16

Deficiency 25OH VitD <20ng/mL

Question 17

VitD Deficiency

syndrome

Answer 17

Childhood rickets (<11ng/mL)
Failure of calcification 
wide metaphyses: wrists
bone pain 
bowed legs 
fractures

adult osteoporosis

Question 18

VitD risk for deficiency

Answer 18

low sun exposure
- dark pigment 
low intake
fat malabsorption 
breastfed infant --> supplement 
obesity (fat sequestration)
liver / renal disease (X-OH)
- need calcitriol Rx supplement

Question 19

Vit D supplementation

Answer 19

Breastfed (400 IU D3)

Children (EAR 400; RDA 600)

Adults (600 IU ; 800 IU>70 yr)

Question 20

VitD tox

Answer 20

hypercalcemia

vomiting / seizures / nephrocalcinosis / vascular and soft tissue calcinosis

Question 21

risk for VitD tox?

Answer 21

sarcoidosis (granulomas activate D)
>10,000 iu/d in child or preg
>50-100,000iu in adult >3wk

Question 22

VitE function

Answer 22

antioxidant
scavenge free radicals
stabilize membranes

Question 23

VitE source

Answer 23

polyunsaturated fat rich veggie oils (sunflower) corn, nuts, wheat germ

Question 24

VitE deficiency

Answer 24

neurologic degeneration that is IRREVERSIBLE
Loss of DTRs and coordination

hemolytic anemia

Question 25

VitE deficiency risk

Answer 25

malnourished premature fat malabsorption short gut

Question 26

VitE tox

Answer 26

relatively low | coagulopathy - very large doses inhibit vitK dependent clotting factors

Question 27

VitK | function

Answer 27

carboxylation of clotting factors (e.g. prothrombin gamma carboxyglutamate)

Question 28

VitK source

Answer 28

leafy greens, broccoli, fruits, seeds, beef liver synthesis by intestinal bacteria

Question 29

VitK deficiency

Answer 29

prolonged coagulation time | Hemorrhagic disease of newborn (purpura / gi bleed / cns bleed)

Question 30

Risk for VitK deficiency

Answer 30

newborn fat malabsorption chronic antibiotics

Question 31

VitK deficiency prevention

Answer 31

newborns all 0.5-1.0mg IM once

Question 32

VitA deficiency finding

Answer 32

eyes epithelium infections

Question 33

VitaminA deficiency risk

Answer 33

poor or extreme low fat diet

Question 34

Vitamin D deficiency finding

Answer 34

rickes osteopenia malacia

Question 35

Vitamin D deficiency risk

Answer 35

``` low sun dark pigment obesity breast feeding liver/kidney disease (calcitriol supplement) ```

Question 36

Vitamin E deficiency finding

Answer 36

neurologic | anemia

Question 37

VitE deficiency risk

Answer 37

prematurity

Question 38

VitK deficiency finding

Answer 38

impaired clotting

Question 39

VitK deficiency risk

Answer 39

newborn antibiotics poor diet