Vitamin and Mineral Deficiency Syndromes

Question 1

Which vitamins can be measured directly and which cannot?

Answer 1

direct: folate, vitamins A, B12 and D (commonly), vitamin C, niacin, thiamine (not as often)

NOT: calcium and sodium (levels do not reflect body stores)

B6 (derivative), vitamin K (INR), B12 (metabolites), calcium (dietary intake)

Question 2

Describe the clinical signs and symptoms of vitamin A deficiency. What is the typical cause?

Answer 2

night blindness
xerophthalmia (drying of conjunctiva and cornea)
Bitot’s spots (caused by xerosis)
corneal xerosis and keratomalacia (degeneration of the cornea)
dry skin
flaky dermatitis
follicular hyperplasia

typically occurs with fat malabsorption

Question 3

Describe the clinical signs and symptoms of vitamin B1 (thiamine) deficiency. What is the typical cause?

Answer 3

1. Beriberi!
   Dry: peripheral neuropathy (sensory and motor), wrist/foot drop, ataxia, paresthesia, angular stomatitis

wet: neuropathy + cardiomyopathy and congestive heart failure
2. Wernicke-Korsakoff: confusion and delirium, disturbances of eye movement (nystagmus), ataxia, tremors
3. Korsakoff psychosis: chronic dementia, severe short-term memory impairment, confabulation

typically occurs in alcoholics (sources yeast, legumes, pork, rice, cereals)

Question 4

Describe the clinical signs and symptoms of vitamin B3 (niacin) deficiency. What is the typical cause?

Answer 4

Pellagra (4D’s)
dermatitis (on sun-exposed areas), Casals necklace
diarrhea, inflammation of the mouth/tongue
dementia
death

occurs in diets deficient in niacin and tryptophan eg. corn based diets

Question 5

Describe the clinical signs and symptoms of folate deficiency. What is the typical cause?

Answer 5

macrocytic anemia, cheliosis, sore tongue, diarrhea, depression, neural defects in fetus

diets poor in green leafy vegetables, impaired absorption

Question 6

Describe the clinical signs and symptoms of vitamin B12 deficiency. What is the typical cause?

Answer 6

macrocytic anemia, neurologic effects, chalices, anorexia, diarrhea, depression
pernicious anemia skin is often velvety, smooth yet inelastic

crohn’s disease, short bowel, celiacs, low acid levels or pernicious anemia

Question 7

Describe the clinical signs and symptoms of vitamin C deficiency. What is the typical cause?

Answer 7

scurvy (impaired collagen synthesis)
swollen and bleeding gums
perifollicular petechiae
brushing
hyperkeratosis, coiled hair

commonly occurs in a diet lacking fruits and vegetables

Question 8

Describe the clinical signs and symptoms of vitamin D deficiency. What is the typical cause?

Answer 8

1. Rickets (in children): defective mineralization especially at the growth plate–
   short stature
   bone deformities (enlarged joints and skulls) deformed rib cage, spinal curvature, bowed legs
2. osteomalacia (in adults): impaired mineralization of the bone matrix–
   decreased bone density, increased fractures
   bone pain, muscle weakness

occurs in fat malabsorption and norther climates

Question 9

Describe the clinical signs and symptoms of vitamin K deficiency. What is the typical cause?

Answer 9

bleeding
peri-orbital ecchymosis, or bruising in other unusual places

lack of dietary intake, blood thinning drugs,

Question 10

Describe the clinical signs and symptoms of iron deficiency. What is the typical cause?

Answer 10

microcytic anemia
pica (craving for non-nutritive substances)
pagophagia (ice craving)
pallor
spooning of the nail (koilonychia)

inadequate intake, slow GI bleed, heavy menses

Question 11

Describe the clinical signs and symptoms of calcium deficiency. What is the typical cause?

Answer 11

acute: muscle cramps, tetany
long term: osteopenia, osteoporosis

lactose intolerance, parathyroid imbalance, low stomach acidity

Question 12

Describe the clinical signs and symptoms of zinc deficiency.

Answer 12

poor wound healing

decreased/altered taste

Question 13

What is cheilosis?

Answer 13

fissuring of the lips

Question 14

Magenta tongue is characteristic of what?

Answer 14

B2, riboflavin deficiency

Question 15

Which vitamins have the shortest reserves in the human body?

Answer 15

thiamine 4-10 days (esp. alcoholics)
EDK, C 2-6 weeks
folate 3-4 months

Question 16

Those on a strict vegetarian or vegan diet are at risk for what dietary deficiencies?

Answer 16

B 12, Zinc, Calcium and vitamin D

Question 17

What supplements would you suggest for an alcoholic?

Answer 17

B1 thiamine, B6, folate, B12 and C

Question 18

What might put someone at risk for magnesium deficiency?

Answer 18

urinary loss in alcoholics, diarrhea, diuretics, uncontrolled diabetes

Question 19

What deficiencies should you remember when treating a person with celiacs?

Answer 19

folate, B12, AEDK, calcium, iron

Question 20

Blind look syndrome is caused by bacterial overgrowth, when would you consider this diagnosis?

Answer 20

decreased parastalsis: scleroderma, DM, Bilroth gastrectomy

Question 21

What vitamins do the following groups metabolize abnormally: smokers, cancer, liver disease.

Answer 21

smokers: C, folate, vitamin E
cancer: C, A, thiamine, iron, folate, Zn
liver disease: Zn, Mg, Cu, Se, K, vitamin K

Question 22

What vitamin deficiencies would you expect with the following meds:
corticosteroids
phenytoin
sulfasalazine
TMP/sulfa (chronically in HIV)
methotrexate
INH
PPI

Answer 22

corticosteroids: D, calcium
phenytoin: D, calcium, folate
sulfasalazine: folate
TMP/sulfa (chronically in HIV): folate
methotrexate: folate and B12
INH B6
PPI: B12, Mg, Ca, Fe

Question 23

What groups of health people require supplements?

Answer 23

pregnant and lactating women, women who may become pregnant and some infants
women with heavy menses
poor diary intake
strict vegetarians
patients on weight reduction diets
elderly
patients in northern climates