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Vitamin Deficiencies Flashcards

1
Q

Toxicity in vitamin E

A

low

coagulopathy due to vitamin K inhibition

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2
Q

Infantile Beri Beri

A

Infection, vomiting, lethargy, ophthalmoplegia, acidosis

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3
Q

Vitamin D Deficiency Risk Factors

A

1) lack of sun exposure
2) dark pigmentation
3) Fat malabsorption
4) obesity (sequestered in fat)
5) liver or renal disease (where it can’t be activated)

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4
Q

Folate deficiency risks

A

1) inadequate intake/decreased by food preparation
2) alcoholic
3) pregnancy- WHO recommends supplements
4) hematopoetic conditions
5) drug/nutrient interactions

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5
Q

signs of Riboflavin Deficiency

A

Cheilosis

Agular stomatitis

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6
Q

Zinc function

A

1) gene expression regulation
2) stabalize molecular structures
3) cofactor for enzymes
4) modulation of hormones and NTs
5) Growth and tissue proliferation - somatic/linear growth, immune system, wound healing, GI tract integrity, skin
6) anti oxidant
7) sexual maturation

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7
Q

B12 deficiency

A

Macrocytic anemia, hypersegmented PMNs

2) neurologic distrubances - depresion, parasthesia, gait problems, bruning tongue, dizzy - that is irreverisble

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8
Q

Zinc supplementation

A

decreases incidence of diarrhea and pneumonia, 4th most effective supplement to prevent childhood death.

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9
Q

Niacin deficiency signs

A

Pellagra

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10
Q

Source of Vitamin B12

A

Soil bacteria

animal products only!

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11
Q

zinc toxicity

A

low compared to iron

high doses >50mg/day decrease copper abosorption, and decrease HDL

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12
Q

Risk of deficiency for B12

A

pernicious anemia (inadequate IF)
Gastric atrophy or gastrectomy
Illeal resection
breastfed with Vitamin B12 deficient mom

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13
Q

Isotretinoin

A

Acutane - associated with vitamin A teratrogenic effects

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14
Q

megadoses of VitaminC?

A

prevent cold by prevention of PMN chemotaxis, prevent CVD, but is used in wound healing to decrease inflammation and proliferation and maturation.

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15
Q

Vitamin K source

A

Leafy veggies, fruit, seeds, beef liver, intestinal bacteria

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16
Q

Sources of Vitamin E

A

Polyunsaturated oils, nuts, wheat germ

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17
Q

When should vitamin D be supplemented?

A

400 IU to all breastfed or non-breastfed infants not recieving appropriate supplementation
600 IU/day for <70 yrs
4000 IU/day upper limit for >70 yo

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18
Q

Zinc Source

A

Animal Beef>poultry>fish
plants: whole grain, legumes
breast milk is independent of mother’s zinc levels

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19
Q

Vitamin C deficiency

A

Scurvy - bleeding gums, ecchymoses, petichiae, hyperkeratosis, perifollicular hemorrhage, hypochondriasis, Anemia that looks like Fe or folate deficiency, progression to weak, achy, hemorrhage

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20
Q

Risks in Vitamin B1 deficiency

A

Thiamin Def

1) Beri Beri (dry and wet)
2) Wernicke-Korsakoff

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21
Q

Regulation of iron

A

in absorption!
in deficiency we increase absorption
but in inflammation, we decrease absorption via hepcidin

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22
Q

Vitamin E function

A

Antioxidant - free radical scavenger

Cell membrane stabalization

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23
Q

Mild zinc deficinecy

A

growth delay, anorexia, impaired immune rxn, stunting

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24
Q

total body zinc agmount

A

2 g

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25
Folate source
foliage, OJ, whole grains | destroyed with prolonged cooking
26
Vitamin D Function
1) hormone 2) increased intestinal absorption of Ca and P 3) bone mineralization of Ca and P 4) innate immune fxn - antimicrobial peptides like cathelicidin, defensins, modultion of cytokines, generation of toxic radicals 4) flu reductions
27
Cheiolosis
Vitamin B2 deficiency | cracked lips
28
Uses of Vitamin E?
Mega doses prevent CV disease or cancer
29
Fe toxicity
Potent prooxidant to cuase decreased growth, increase oxidative stress and inflammation Hereditary hemochromatosis - iron accumulation in liver Gastroenteritis, hemorrhagic shock, liver failure
30
what are the Energy Releasing B complex vitamins
Thiamin (b1), Riboflavin B2, niacin B3
31
risks of vitamin E deficiency
prematurity fat malabsorption short gut CF
32
Beri Beri
Vitamin B1 deficiency that affects CV and Nervous System 1) dry - peripheral neuropathy (muscle tenderness, feeling of bugs on skin, weakness, atrophy (foot drop); also called paralytic beri beri 2) wet (cardiac) - dry beriberi + CHF with edema, circulatory collapse, high output CHF (dilated)
33
Pathway of Vitamin b12
cleavage from protein in stomach --> binds to IF in stomach --> absorbed in distal ileum and transported in ciruculation by transcobalamin II Stored in liver, excreted in bile
34
Risk factors for Vitamin K deficiency
Newborns due to poor placental transport, sterile gut, decreased clotting factors breast fed infants fat malabsorption
35
Vitamin A
Retinol
36
Vitamin E
Tocopherol | Tocotrienol
37
Retinol with inflammation
Retinol decreases with acute phase reactant
38
Vitamin D Toxicity
>10,000 ID/day for weeks | cause hypercalcemia, vomiting, seizures, hydrocephalus, soft tissue calcification, sarcoidosis
39
Function of iron
Tissue oxidation - O2 transport, Electron transport chain (cytochormes), enxyme of O2 activations CNS myelination - DA syntehsis
40
Activation of vitamin D
in liver D3 and D2 is hydroxylated to 25-Hydroxy-cholecalaferol 25-OH-D. This represents the stores inthe body. In Kidney, converted to Calcitriol - the most active type of Vitamin D.
41
Risk of Zinc Deficiency
``` BF infants >6 months Children with high growth and low intake pregnancy or lactation elderly monotonous diet with phytate GI illness/injury wound or burns ```
42
what are the hematopoetic B complex vitamins
Folate B9, B12 (cobalamin)
43
Source of Nacin
Vitamin B3 - derivative of tryptophan | Meat and poultry, corn that is treated with alkaline (lime)
44
Zinc homeostasis
Absorption is under crude control of GI tract | Endogenous losses into GI - fecal loss contribute to deficiency
45
how do you tell a vitamin A deficiency?
Signs and symptoms | you cant detect abnormal Serum Retinol level until liver stores are completely depleted
46
Vitamin K function
Cofactor of gamma carboxylation of coagulation facotors (II, VII, IX, X)
47
Zinc absorption
dependent on 1) amount ingested 2) phytate content in diety
48
Source of Vitamin C
Fruit, potato, veggies saturable - with low intake 100% absorption, but with mega doses only 15% absorption excreted renally, so increase dose causes no change in plasma if dose is large enough
49
Fe deficiency signs
first signs in liver, then skeletal muscle and intestine, then hear, then brain, then RBCs Fatigue, attention deficit, sleep deprivation impaired growth late stage microcytic anemia, hypochromic impaired cognitive fxn that is irreversible
50
Total body iron amount
5 g
51
Deficiency in Vitamin A
1) Xerophthalmia - dry cornea 2) Bitot's spots 3) Nyctalopia - night blindness 4) xerosis Cutis: dry, keratinized skin 4) dysregulated immune system
52
Vitamin D
2 forms D2: ergocalciferol D3: Cholecalciferol
53
Wernicke Korsakoff Syndrome
Thiamin deficiency Confusion + ophthalmoplegia + Ataxia Memory loss (25% can have complete correction, 50% is partial), personality change, peripheral neuropathy due to damage to mammillary bodies
54
Neural tube defects are due to
folate (Vitamin B9) deficiency in first 4-6 weeks of pregnancy. give 400-800 ug/day to prevent. only 30-50% of women in US consume enough folate
55
When is vitamin K given
IM 0.5-1 mg to all newborns
56
sources of Vitamin A
1) Preformed (retinol/al): liver, dairy, egg yolk, fish oil | 2) Precursor (beta-carotene): orange or green veggies that are activated in the body
57
Vitamin A and child mortality
vitamin A supplements decrease mortality by 23-34%
58
Phyate
binds to zinc, iron and calcium in gut common feed enzyme in poultry and pigs high in maize>wheat>legume> rice decreases Non Heme iron and zinc absorption
59
Vitamin D Deficiency signs
1) Rickets when <11 ng/ml - failure of cartilage and calcification maturation to cause Richitic rosary on ribs, bowed legs, wide metaphyses on wrists, bone pain, osteomalacia (in adults) 2) decrease Ca, P, and alk Phos, 3) increase PTH 4) under investigation about autoimmune, neuromuscular, CA, mortality
60
Iron absorption mechanism
1) iron is converted from Fe3+ (ferrous) to Fe2+ (ferric) in proximal duodenum enterocyte. 2) Ferric is shuttled inside and either 2A) stored as ferritin 2B) released by feroprotin into circulation 3) in ciruclation, iron is bound to Transferrin 4) uptake into tissue is regulated by Transferrin Receptor 1 or 2 Hepcidin regulates iron uptake Iron also comes from erythrocytes that are engulfed by macrophages and excreted into circulation by ferroprotin
61
Risk factors for Vitamin A Deficiency
low intake, low fat intake <5%, fat malabsorption, protein energy malnutrition
62
how do you tell Vitamin D Deficiency?
Normal: >30 ng/ml Insufficiency 21-28 ng/ml Deficiency: <20 ng/ml
63
Moderate to severe zinc deficiency
``` Periacral or periorifical dermatitis that responts to supplements Personaltiy changes immune system dysfunction delayed sexual maturation anorxia diarrhea Acrodermatitis enteropathica Transient neontal zn deficiency ```
64
Cobalamin fxn
Vitamin B12 1) reform tetrahydrofolate from methylfolate (synthesis of methionine) 2) catabolism of odd chain Fatty acids 3) isomerization of methylmaolonyl Coa to succinyl coA in lipid metabolism 4) intimately related to folate in methionine production, protein and NA synthesis
65
What is vitamin A used to treat?
Measles and AML
66
Vitamin B9 deficiency
Folate deficiency Macrocytic anemia, hypersegmented PMNs, glossitis, homocystinemia that is reversible Neural tube defects (occurance and reoccurance)
67
Vitamin C function
Ascorbic acid antioxidant, Vitamin E sparing Reducing equivalents of iron to increase absorption increases leukocyte fxn hydroxylation of proline and lysine in collagen synthesis conversion of tryptophan to serotonin and DA to NE
68
Sources of Thiamin
Vit B1 | Legumes, rice bran, grain (not polished rice)
69
Angular Stomatitis
Vitamin B2 deficiency | inflammation and cracks in corners of mouth
70
Risks for Niacin Deficiency
Diet due to cornmeal without germ or alakaline treatment malabsorption alcoholism metabolic shunting - (carcinoid tumor that increases serotonin and decreases tryptophan breakdown)
71
Risks for vitamin B2 deficiency
due to decreased ingestion of dairy and animal products | common in low resource settings
72
Prevalence of Iron deficiency
most common micronutrient deficiency in world highest in older infants/toddlers (75% of all cases) most vulnerable are infants (breastfed exclusively for longer than 6 months, premature), pregnancy, menstural years, blood loss, obese (inflammatory state), bariatric surgery pts
73
Function of energy releasing V complex mitamins
B1, B2, B3 used for glycolysis and TCA cycle cofactors. TPP, FAD, NAD, decarboxylation, redox B3 is a derivative of tryptophan
74
what do you give for vitamin d supplementation in Liver or Kidney failure
Calcitriol
75
Hepcidin
regulatory hormone that blocks Fe transport that is upregulated in inflammation. so low hepcidin promotes abundant feroportins and increased plasma Fe high hepcidin promotes degradation of feroportin and decreased plasma Fe
76
Iron in body is stored where
50% in Hb 10% in myoglobin 5% in enzymes
77
Iron Absorption
Heme: >30% absorption; decreases with Calcium only! Non Heme: <10% absorption increases with: vitamin C, fish and meat decreases with phyate, Calcium, polyphenol, fiber, soy protein
78
Pellagra
Vitamin B3 deficiency 1) Diarrhea 2) dermatitis - symmetric, saling, hypo and hyperpigmented, casal's necklace (increased rxn with sun due to decreased DNA repair) 3) dementia 4) death
79
Sources of iron
Heme - meat and liver Non heme: plants - legumes, whole grains, nuts Fe fortified foods - formula, cereals/grains
80
Risk of Thiamin deficiency
``` Alcoholics Frequent vomiting (post bariatric surgery) TPN anorexia re-feeding syndrome south Asia- polished rice diet ```
81
Vitamin K deficiency
1) Hemorrhagic disease of newborn with purpura, GI bleeding, CNS bleeds that can be fatal most due to decrease baceria in GI 2) increased PT and aPTT
82
Vitamin D sources
1) Precursor dehydrocholesterol in skin that is converted to D3 via UVB D3: from fish, liver oil, fatty fish, egg yolk, fortified milk/formula D2: plant algae
83
Vitamin A Toxicity
only with preformed! Vomit, vertigo, increased ICP, blurred vision, headache perosteal proliferation bone mineral loss liver damage teratrogenic - cleft palate, CV abnormalities, associated with Isotretinoin use (acutane)
84
D3 vs D2
D3 is absorbed 2-3x better than D2
85
Source of Riboflavin
Vitamin B2 - dairy, egg, meat
86
who is at risk of iron deficiency
1) poor bioavalibility in diet 2) high demand - hemolysis, pregnancy, infancy 3) chronic inflammatory
87
Function - Vitamin A
1) photochemical for vision 2) maintenance of conjunctiva and cornea 3) epithelial differentiation/proliferation 4) antioxidant 5) prevents squamous metaplasia
88
which is better human breastmilk or formula for iron absorption?
Breastmilk has lower heme content, but increase absoprtion % Formula has higher heme content, but decreased absorption overall - babies get more iron absorption with formula due to high concentration
89
Folate function
Vitamin B9 Single carbon transfers in nucleic acid synthesis and amino acid metabolism DNA methylation - regulation of gene expression/epigenetics
90
Vitamin E Deficiency signs
1) Neuro degeneration that is irreversible. loss of DTRs, spinocerebellar demyelination, ophthalmoplegia, incoordination, loss of vibration/position (looks like Vitamin B12 deficiency without the megaloblastic anemia) 2) hemolytic anemia

DEMS (5 decks)

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