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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
Symptoms of pellagra?
- Diarrhea, dementia, dermatitis (C3/C4 dermatome circumfrential "broad collar" rash, hyperpigmentation of sun exposed skin)
26
Causes of pellagra?
- Hartnup disease - Malignant carcinoid syndrome (increased tryptophan metabolism) - Isoniazid (decreased Vit B6)
27
Hartnup Disease
- 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
28
Vit B3 Excess
- Facial flushing (induced by PG, not HA) - can avoid by taking aspirin with niacin - Hyperglycemia, hyperuricemia (gout)
29
Vit B5
Pantothenic acid
30
Vit B5 Function
- CoA (cofactor for acyl transfer) | - Fatty acid synthase
31
Vit B5 Deficiency
Dermatitis, enteritis, alopecia, adrenal insufficiency
32
Vit B6
Pyridoxine
33
What is B6 converted into?
Pyridoxal phosphate
34
Vit B6 Function
- Cofactor: transamination (ALT, AST), decarboxylation rxns, glycogen phosphorylase - Synthesis: cystathionine, heme, niacin, HA, and NT (5HT, Epi, NE, DA, GABA)
35
Vit B6 Deficiency
Convulsions, hyperirritability, peripheral neuropathy
36
What kind of anemia can B6 deficiency cause?
Sideroblastic anemia due to impaired Hb synthesis and iron excess - Nucleated erythrocytes
37
MCC of B6 deficiency?
- isoniazid therapy for TB
38
Vitamin B7
Biotin
39
Function of B7?
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
Carboxylase enzymes require what 3 things?
- ATP, biotin, CO2
41
B7 Deficiency?
Dermatitis, alopecia, enteritis
42
Causes of B7 deficiency?
- ABx | - Excessive ingestion of raw egg whites (avidin)
43
Biotinidase Def.
- E involved in recycling biotin - Presents the same as biotin deficiency - Newborns screened
44
Vitamin B9
Folate
45
B9 Function | - Leafy green vegetables
- Converted to tetrahydrofolic acid --> 1-carbon transfer/methylation - Synthesis of nitrogenous bases in DNA & RNA
46
Where is B9 absorbed?
Jejunum
47
B9 reserves?
Small reserve in liver
48
Blood findings on B9 deficiency?
- Macrocytic megaloblastic anemia | - Hypersegmented PMNs
49
B9 deficiency sx?
- Glossitis | - NO NEURO SX
50
B9 deficiency labs?
Increased homocysteine | Normal methylmalonic acid
51
Who gets B9 deficient? | - most common vit deficiency in U.S.
- Alcoholism - Pregnancy - Drugs (phenytoin, sulfonamides, MTX)
52
Vitamin B12
Cobalamin
53
Vit B12 Function | - Animal products
- Methionine synthase (transfers CH3 groups as methylcobalamin) - Methylmalonyl-CoA mutae (odd #C FA metaboilsm)
54
Who needs B12 supplement?
Vegans
55
Who needs B9 supplement?
Pregnant women
56
B12 reserve?
very large pool in liver (several years)
57
B12 deficiency caused by?
- 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
B12 deficiency sx?
- Macrocytic, megaloblastic anemia - Hypersegmented PMNs - Paresthesias - Subacute combined degeneration - Prolonged deficiency --> irreversible nerve damage
59
Subacute combined degeneration?
Abnormal myelin - Dorsal columns - Lateral corticospinal trats - Spinocerebellar tracts
60
Labs in B12 deficiency?
Increased serum homocysteine and methylmalonic acid
61
Vitamin C Function
- 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
What can Vit C treat?
- Ancillary treatment for methemoglobinemia
63
Vit C deficiency?
Scurvy - swollen gums, bruising, petechiae, hemarthrosis, anemia, poor wound healing, perifollicular and subperiosteal hemorrhages, "corkscrew hair - Weakened immune resopnse - Fe-deficient anemia
64
Vit C excess?
N/v, diarrhea, fatigue - Calcium oxalate nephrolithiasis - Increased risk of iron toxicity in predisposed (transfusions, hereditary hemochromatosis)
65
Vit D2
Ergocalciferol | - Plants
66
Vit D3
Cholecalciferol | - Milk, sun (stratum basale)
67
25-OH D3
``` Storage form (measured in serum) - Liver ```
68
1,25-(OH)2D3
Calcitriol - Active form - PTH regulation - Kidney
69
Vit D Function
- Increased intestinal absorption of calcium and phosphate - Increased bone mineralization at low levels - Increased bone resorption at higher levels
70
Vit D Deficiency
Rickets (children), osteomalacia (adults) | - Hypocalcemic tetany
71
Who needs Vit D supplement?
Exclusively breastfed infants
72
What exacerbates Vit D deficiency?
Low sun exposure, pigmented skin, prematurity
73
What causes Vit D deficiency?
Low sunlight, malabsorption, liver/renal DZ, elderly
74
Vit D Excess
- Hypercalcemia, hypercalcuria, loss of appetite, stupor
75
When is Vit D excess seen?
Granulomatous disease | Increased activation of Vit D by epithelioid macrophages
76
Vitamin E
Antioxidant (protects RBCs and membranes from free radical damage)
77
Vit E Deficiency
Hemolytic anemia, acanthocytosis, muscle weakness
78
What part of the spinal cord is affected in Vit E deficiency?
- Posterior column and spinocerebellar tract demyelination - Neuro presentation similar to B12 deficiency but no megaloblastic anemia, hypersegmented PMNs, or increased serum methylmalonic acid
79
Vit K
Cofactor for gamma-carboxylation of glutamic acid residues on various proteins required for blood clotting
80
Where is Vit K synthesized?
Intestinal flora
81
Who gets vit K deficient?
- Neonates (sterile intestines) - increased PT and PTT, normal BT - given Vit K injection at birth - Prolonged broad-spectrum ABx (kill gut bacteria)
82
Vit K antagonist?
Warfarin
83
Vit K Deficiency
Easy bruisability, blood in stool, bleeding into joints

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