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Step 1 > Nutrition Deficiencies > Flashcards

Nutrition Deficiencies Flashcards

1
Q

Function of Vit A

- Liver, leafy vegetables

A
  • Antioxidant
  • Visual pigment
  • Normal differentiation of epi cells into specialized tissue (pancreatic cells, mucus-secreting cells)
  • Prevents squamous metaplasia
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2
Q

What is Vit A used to treat?

A
  • Measles
  • AML subtype M3 (all-trans retinoic acid)
  • Severe cystic acne
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3
Q

Vit A Deficiency

A
  • NIGHT BLINDNESS (nyctalopia)
  • Dry, scaly skin (xerosis cutis)
  • Corneal degeneration (keratomalacia)
  • Bitot spots on conjunctiva
  • Immunosuppression
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4
Q

Acute Vit A Toxicity

A
  • N/v, vertigo, blurred vision
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5
Q

Chronic Vit A Toxicity

A
  • Alopecia, dry skin, hepatic toxicity, arthralgias, pseudotumor cerebri (papilledema)
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6
Q

Vitamin B1

A

Thiamine

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7
Q

Enzymes thiamine pyrophosphate (B1) is cofactor for:

A
  • Pyruvate dehydrogenase (glycolysis –> TCA)
  • alpha-KG dehydrogenase (TCA)
  • Transketolase (HMP shunt)
  • Branched chain ketoacid dehydrogenase
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8
Q

Vit B1 Deficiency

A
  • Impaired glucose breakdown –> ATP depletion worsened by glucose infusion (give thiamine before IV glucose)
  • Highly aerobic tissues (brain, heart) are affected first
  • Wenicke-Korsakoff
  • Beriberi
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9
Q

Who becomes Vit B1 deficient?

A

Malnutrition, alcoholism, countries where “polished rice” is staple

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10
Q

Dx of Vit B1 deficiency?

A

Increase in RBC transketolase activity following Vit B1 administration

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11
Q

Pyruvate dehydrogenase cofactors?

A

TPP, lipoic acid, CoA, FADH2, NADH

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12
Q

Wenicke-Korsakoff Syndrome

A

B1 def

  • Confusion, ophthalmoplegia, ataxia
  • Confabulation, personality change, permanent memory loss
  • Damage to medial dorsal nucleus of thalamus, mammillary bodies
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13
Q

Dry Beriberi

A

B1 def

Polyneuritis, symmetrical muscle wasting

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14
Q

Wet Beriberi

A

B1 def

High-output cardiac failure (dilated cardiomyopathy), edema

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15
Q

Vitamin B2

A

Riboflavin

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16
Q

Vit B2 Function

A

Component of FAD and FMN

- Cofactors in redox rxns (ex. succinate dehydrogenase rxn in TCA cycle)

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17
Q

Vit B2 Deficiency

A
  • Cheilosis (inflammation of lips, scaling and fissures at the corner of the moth)
  • Corneal vascularization
  • Magenta tongue
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18
Q

When can B2 supplementation be helpful?

A

Infants undergoing UV light therapy for neonatal jaundice

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19
Q

Vitamin B3

A

Niacin

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20
Q

Vit B3 Function

A
  • Constituent of NAD+, NADP+ (redox rxns)
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21
Q

What is niacin derived from?

A

Tryptophan

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22
Q

What does niacin synthesis require?

A

B2 (riboflavin) and B6 (pyridoxine)

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23
Q

What is niacin used to treat?

A

Dyslipidemia - lower levels of VLDL and raises levels of HDL

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24
Q

Vit B3 Deficiency

A
  • Glossitis

- Pellagra

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25
Q

Symptoms of pellagra?

A
  • Diarrhea, dementia, dermatitis (C3/C4 dermatome circumfrential “broad collar” rash, hyperpigmentation of sun exposed skin)
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26
Q

Causes of pellagra?

A
  • Hartnup disease
  • Malignant carcinoid syndrome (increased tryptophan metabolism)
  • Isoniazid (decreased Vit B6)
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27
Q

Hartnup Disease

A
  • AR
  • Deficiency of neutral AA (ex. tryptophan) transporters in proximal renal tubule and on enterocytes –> neutral aminoaciduria and decreased absorption from gut –> decreased tryptophan conversion to niacin –> pellagra-like sx
  • Rx: high-protein diet and nicotinic acid
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28
Q

Vit B3 Excess

A
  • Facial flushing (induced by PG, not HA) - can avoid by taking aspirin with niacin
  • Hyperglycemia, hyperuricemia (gout)
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29
Q

Vit B5

A

Pantothenic acid

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30
Q

Vit B5 Function

A
  • CoA (cofactor for acyl transfer)

- Fatty acid synthase

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31
Q

Vit B5 Deficiency

A

Dermatitis, enteritis, alopecia, adrenal insufficiency

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32
Q

Vit B6

A

Pyridoxine

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33
Q

What is B6 converted into?

A

Pyridoxal phosphate

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34
Q

Vit B6 Function

A
  • Cofactor: transamination (ALT, AST), decarboxylation rxns, glycogen phosphorylase
  • Synthesis: cystathionine, heme, niacin, HA, and NT (5HT, Epi, NE, DA, GABA)
35
Q

Vit B6 Deficiency

A

Convulsions, hyperirritability, peripheral neuropathy

36
Q

What kind of anemia can B6 deficiency cause?

A

Sideroblastic anemia due to impaired Hb synthesis and iron excess
- Nucleated erythrocytes

37
Q

MCC of B6 deficiency?

A
  • isoniazid therapy for TB
38
Q

Vitamin B7

A

Biotin

39
Q

Function of B7?

A

Cofactor for carboxylation E

  • Pyruvate carboxylase: pyruvate (3C) –> oxaloacetate (4C) [gluconeogenesis]
  • Acetyl-CoA Carboxylase: acetyl-CoA (2C) –> malonyl-CoA (3C) [FA synthesis]
  • Propionyl-CoA carboxylase: propionyl-CoA (3C) –> methylmalonyl-CoA (4C) [metabolism of odd chain FA]
40
Q

Carboxylase enzymes require what 3 things?

A
  • ATP, biotin, CO2
41
Q

B7 Deficiency?

A

Dermatitis, alopecia, enteritis

42
Q

Causes of B7 deficiency?

A
  • ABx

- Excessive ingestion of raw egg whites (avidin)

43
Q

Biotinidase Def.

A
  • E involved in recycling biotin
  • Presents the same as biotin deficiency
  • Newborns screened
44
Q

Vitamin B9

A

Folate

45
Q

B9 Function

- Leafy green vegetables

A
  • Converted to tetrahydrofolic acid –> 1-carbon transfer/methylation
  • Synthesis of nitrogenous bases in DNA & RNA
46
Q

Where is B9 absorbed?

A

Jejunum

47
Q

B9 reserves?

A

Small reserve in liver

48
Q

Blood findings on B9 deficiency?

A
  • Macrocytic megaloblastic anemia

- Hypersegmented PMNs

49
Q

B9 deficiency sx?

A
  • Glossitis

- NO NEURO SX

50
Q

B9 deficiency labs?

A

Increased homocysteine

Normal methylmalonic acid

51
Q

Who gets B9 deficient?

- most common vit deficiency in U.S.

A
  • Alcoholism
  • Pregnancy
  • Drugs (phenytoin, sulfonamides, MTX)
52
Q

Vitamin B12

A

Cobalamin

53
Q

Vit B12 Function

- Animal products

A
  • Methionine synthase (transfers CH3 groups as methylcobalamin)
  • Methylmalonyl-CoA mutae (odd #C FA metaboilsm)
54
Q

Who needs B12 supplement?

A

Vegans

55
Q

Who needs B9 supplement?

A

Pregnant women

56
Q

B12 reserve?

A

very large pool in liver (several years)

57
Q

B12 deficiency caused by?

A
  • Malabsorption (sprue, enteritis, Diphyllobothrium latum)
  • Lack of IF (pernicious anemia [anti-IF Ab], gastric bypass surgery)
  • Absence of terminal ileum (surgical resection - Crohn DZ)
  • Insufficient intake (veganism)
  • Long term omeprazole use
58
Q

B12 deficiency sx?

A
  • Macrocytic, megaloblastic anemia
  • Hypersegmented PMNs
  • Paresthesias
  • Subacute combined degeneration
  • Prolonged deficiency –> irreversible nerve damage
59
Q

Subacute combined degeneration?

A

Abnormal myelin

  • Dorsal columns
  • Lateral corticospinal trats
  • Spinocerebellar tracts
60
Q

Labs in B12 deficiency?

A

Increased serum homocysteine and methylmalonic acid

61
Q

Vitamin C Function

A
  • Antioxidant
  • Facilitates iron absorption (reduces to Fe2+)
  • Hydroxylation of proline and lysine in collagen synthesis
  • Necessary for DA beta-hydroxylase (converts DA to NE)
62
Q

What can Vit C treat?

A
  • Ancillary treatment for methemoglobinemia
63
Q

Vit C deficiency?

A

Scurvy - swollen gums, bruising, petechiae, hemarthrosis, anemia, poor wound healing, perifollicular and subperiosteal hemorrhages, “corkscrew hair

  • Weakened immune resopnse
  • Fe-deficient anemia
64
Q

Vit C excess?

A

N/v, diarrhea, fatigue

  • Calcium oxalate nephrolithiasis
  • Increased risk of iron toxicity in predisposed (transfusions, hereditary hemochromatosis)
65
Q

Vit D2

A

Ergocalciferol

- Plants

66
Q

Vit D3

A

Cholecalciferol

- Milk, sun (stratum basale)

67
Q

25-OH D3

A 
Storage form (measured in serum)
- Liver
68
Q

1,25-(OH)2D3

A

Calcitriol - Active form

  • PTH regulation
  • Kidney
69
Q

Vit D Function

A
  • Increased intestinal absorption of calcium and phosphate
  • Increased bone mineralization at low levels
  • Increased bone resorption at higher levels
70
Q

Vit D Deficiency

A

Rickets (children), osteomalacia (adults)

- Hypocalcemic tetany

71
Q

Who needs Vit D supplement?

A

Exclusively breastfed infants

72
Q

What exacerbates Vit D deficiency?

A

Low sun exposure, pigmented skin, prematurity

73
Q

What causes Vit D deficiency?

A

Low sunlight, malabsorption, liver/renal DZ, elderly

74
Q

Vit D Excess

A
  • Hypercalcemia, hypercalcuria, loss of appetite, stupor
75
Q

When is Vit D excess seen?

A

Granulomatous disease

Increased activation of Vit D by epithelioid macrophages

76
Q

Vitamin E

A

Antioxidant (protects RBCs and membranes from free radical damage)

77
Q

Vit E Deficiency

A

Hemolytic anemia, acanthocytosis, muscle weakness

78
Q

What part of the spinal cord is affected in Vit E deficiency?

A
  • Posterior column and spinocerebellar tract demyelination
  • Neuro presentation similar to B12 deficiency but no megaloblastic anemia, hypersegmented PMNs, or increased serum methylmalonic acid
79
Q

Vit K

A

Cofactor for gamma-carboxylation of glutamic acid residues on various proteins required for blood clotting

80
Q

Where is Vit K synthesized?

A

Intestinal flora

81
Q

Who gets vit K deficient?

A
  • Neonates (sterile intestines) - increased PT and PTT, normal BT - given Vit K injection at birth
  • Prolonged broad-spectrum ABx (kill gut bacteria)
82
Q

Vit K antagonist?

A

Warfarin

83
Q

Vit K Deficiency

A

Easy bruisability, blood in stool, bleeding into joints

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