Vitamin and trace element deficiencies

Question 1

Fat-soluble vitamins

Answer 1

Vitamin A (retinol)
Vitamin D (cholecalciferol)
Vitamin E (alpha-tocopherol)
Vitamin K (K1 = phylloquinone, K2 = menaquinone)

Question 2

Vitamin A (retinol) deficiency

Answer 2

Found in dairy produce, eggs, fish oils, and liver.

Deficiency causes night blindness, xerophthalmia, keratomalacia (corneal thickening), and follicular hyperkeratosis.

Question 3

Vitamin D (cholecalciferol) deficiency

Answer 3

Found in fish liver oils, dairy produce, and undergoes metabolism at the kidneys and the skin using UV light.
Deficiency causes rickets (in children) and osteomalacia (in adults). Proximal muscle weakness may be evident.

Question 4

Vitamin E (alpha-tocopherol) deficiency

Answer 4

Widely distributed, green vegetables, and vegetable oils.

Deficiency causes haemolytic anaemia (premature infants) and gross ataxia.

Question 5

Vitamin K (phylloquinone or menaquinone) deficiency

Answer 5

Widely distributed by particularly in green vegetables.
Synthesised by intestinal bacteria.
Deficiency causes coagulation defects seen as easy bruising and haemorrhage.

Question 6

Water-soluble vitamins

Answer 6

Vitamin B1 (thiamine)
Vitamin B2 (riboflavin)
Vitamin B3 (niacin)
Vitamin B6 (pyridoxine)
Vitamin B9 (folic acid)
Vitamin B12 (cyanocobalamin)
Vitamin C (ascorbic acid)

Question 7

Vitamin B (thiamine) deficiency

Answer 7

Found in cereals, peas, beans, yeast, and wholemeal flour.
An essential factor in carbohydrate metabolism and transketolation reactions.
Deficiency causes dry beri-beri (sensory and motor peripheral neuropathy), wet beri-beri (high output cardiac failure and oedema), and Wernicke-Korsakoff syndrome.

Question 8

Vitamin B2 (riboflavin) deficiency

Answer 8

Found in wholemeal flour, meat, fish, and dairy produce.
A coenzyme in reversible electron carriage in oxidation-reduction reactions.
Deficiency gives angular stomatitis (fissuring and inflammation at the corners of the mouth), inflamed oral mucous membranes, seborrhoeic dermatitis, and peripheral neuropathy.

Question 9

Vitamin B3 (niacin) deficiency

Answer 9

Found in fish, liver, nuts, and wholemeal flour.

Deficiency causes pellagra: dermatitis, diarrhoea, and dementia.

Question 10

Vitamin B6 (pyridoxine) deficiency

Answer 10

Widespread distribution, also synthesised from tryptophan.
Deficiency causes peripheral neuropathy, convulsions, and sideroblastic anaemia.
Deficiency may be provoked by a number of commonly used drugs (e.g. isoniazid, hydralazine, penicillamine) and is also seen in alcoholism and pregnancy.

Question 11

Vitamin B9 (folic acid) deficiency

Answer 11

Deficiency can be caused by poor diet, malabsorption states, coeliac disease, Crohn’s disease, gastrectomy, drugs (e.g. methotrexate, phenytoin), excessive utilisation (e.g. leukaemia, malignancy, inflammatory disease).
Consequences of deficiency include megaloblastic anaemia and glossitis.

Question 12

Vitamin B12 (cyanocobalamin) deficiency

Answer 12

Causes of a deficiency are numerous and include partial or total gastrectomy, Crohn’s disease, ideal resection, jejunal diverticular, blind loop syndrome, and tapeworm.
Deficiency causes megaloblastic anaemia, peripheral neuropathy, subacute combined degeneration of the spinal cord, depression, psychosis, and optic atrophy.

Question 13

Vitamin C (ascorbic acid) deficiency

Answer 13

Deficiency causes scurvy (perifollicular haemorrhage, bleeding swollen gums, spontaneous bruising, corkscrew hair, failure of wound healing), anaemia, and osteoporosis.

Question 14

Trace elements

Answer 14

Copper
Zinc
Magnesium
Iodine

Question 15

Copper deficiency

Answer 15

Deficiency results in hypochromic and microcytic anaemia, neutropenia, impaired bone mineralisation, Menke’s kinky hair syndrome (growth failure, mental deficiency, bone lesions, brittle hair, anaemia), sensory ataxia, muscle weakness, visual loss (optic neuropathy), peripheral neuropathy.
Usually caused by copper malabsorption.

Question 16

Zinc deficiency

Answer 16

Deficiency causes achondromatosis enterpathica (infants develop growth retardation, hair loss, severe diarrhoea, candida and bacterial infections), impaired wound healing, skin ulcers, alopecia, night blindness, confusion, apathy, and depression.

Question 17

Magnesium deficiency

Answer 17

Severe deficiency can cause cardiac arrhythmias, paraesthesia, and tetany.

Question 18

Iodine deficiency

Answer 18

Severe deficiency can cause cretinism (children), hypothyroidism, and goitre.