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DEMS > Vitamin Deficiencies > Flashcards

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
Q

Folate source

A

foliage, OJ, whole grains

destroyed with prolonged cooking

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26
Q

Vitamin D Function

A

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

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27
Q

Cheiolosis

A

Vitamin B2 deficiency

cracked lips

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28
Q

Uses of Vitamin E?

A

Mega doses prevent CV disease or cancer

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29
Q

Fe toxicity

A

Potent prooxidant to cuase decreased growth, increase oxidative stress and inflammation
Hereditary hemochromatosis - iron accumulation in liver
Gastroenteritis, hemorrhagic shock, liver failure

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30
Q

what are the Energy Releasing B complex vitamins

A

Thiamin (b1), Riboflavin B2, niacin B3

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31
Q

risks of vitamin E deficiency

A

prematurity
fat malabsorption
short gut
CF

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32
Q

Beri Beri

A

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)

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33
Q

Pathway of Vitamin b12

A

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

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34
Q

Risk factors for Vitamin K deficiency

A

Newborns due to poor placental transport, sterile gut, decreased clotting factors
breast fed infants
fat malabsorption

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35
Q

Vitamin A

A

Retinol

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36
Q

Vitamin E

A

Tocopherol

Tocotrienol

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37
Q

Retinol with inflammation

A

Retinol decreases with acute phase reactant

38
Q

Vitamin D Toxicity

A

> 10,000 ID/day for weeks

cause hypercalcemia, vomiting, seizures, hydrocephalus, soft tissue calcification, sarcoidosis

39
Q

Function of iron

A

Tissue oxidation - O2 transport, Electron transport chain (cytochormes), enxyme of O2 activations
CNS myelination - DA syntehsis

40
Q

Activation of vitamin D

A

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
Q

Risk of Zinc Deficiency

A 
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
Q

what are the hematopoetic B complex vitamins

A

Folate B9, B12 (cobalamin)

43
Q

Source of Nacin

A

Vitamin B3 - derivative of tryptophan

Meat and poultry, corn that is treated with alkaline (lime)

44
Q

Zinc homeostasis

A

Absorption is under crude control of GI tract

Endogenous losses into GI - fecal loss contribute to deficiency

45
Q

how do you tell a vitamin A deficiency?

A

Signs and symptoms

you cant detect abnormal Serum Retinol level until liver stores are completely depleted

46
Q

Vitamin K function

A

Cofactor of gamma carboxylation of coagulation facotors (II, VII, IX, X)

47
Q

Zinc absorption

A

dependent on

1) amount ingested
2) phytate content in diety

48
Q

Source of Vitamin C

A

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
Q

Fe deficiency signs

A

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
Q

Total body iron amount

A

5 g

51
Q

Deficiency in Vitamin A

A

1) Xerophthalmia - dry cornea
2) Bitot’s spots
3) Nyctalopia - night blindness
4) xerosis Cutis: dry, keratinized skin
4) dysregulated immune system

52
Q

Vitamin D

A

2 forms
D2: ergocalciferol
D3: Cholecalciferol

53
Q

Wernicke Korsakoff Syndrome

A

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
Q

Neural tube defects are due to

A

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
Q

When is vitamin K given

A

IM 0.5-1 mg to all newborns

56
Q

sources of Vitamin A

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
Q

Vitamin A and child mortality

A

vitamin A supplements decrease mortality by 23-34%

58
Q

Phyate

A

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
Q

Vitamin D Deficiency signs

A

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
Q

Iron absorption mechanism

A

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
Q

Risk factors for Vitamin A Deficiency

A

low intake, low fat intake <5%, fat malabsorption, protein energy malnutrition

62
Q

how do you tell Vitamin D Deficiency?

A

Normal: >30 ng/ml
Insufficiency 21-28 ng/ml
Deficiency: <20 ng/ml

63
Q

Moderate to severe zinc deficiency

A 
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
Q

Cobalamin fxn

A

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
Q

What is vitamin A used to treat?

A

Measles and AML

66
Q

Vitamin B9 deficiency

A

Folate deficiency
Macrocytic anemia, hypersegmented PMNs, glossitis, homocystinemia that is reversible
Neural tube defects (occurance and reoccurance)

67
Q

Vitamin C function

A

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
Q

Sources of Thiamin

A

Vit B1

Legumes, rice bran, grain (not polished rice)

69
Q

Angular Stomatitis

A

Vitamin B2 deficiency

inflammation and cracks in corners of mouth

70
Q

Risks for Niacin Deficiency

A

Diet due to cornmeal without germ or alakaline treatment
malabsorption
alcoholism
metabolic shunting - (carcinoid tumor that increases serotonin and decreases tryptophan breakdown)

71
Q

Risks for vitamin B2 deficiency

A

due to decreased ingestion of dairy and animal products

common in low resource settings

72
Q

Prevalence of Iron deficiency

A

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
Q

Function of energy releasing V complex mitamins

A

B1, B2, B3
used for glycolysis and TCA cycle cofactors.
TPP, FAD, NAD, decarboxylation, redox
B3 is a derivative of tryptophan

74
Q

what do you give for vitamin d supplementation in Liver or Kidney failure

A

Calcitriol

75
Q

Hepcidin

A

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
Q

Iron in body is stored where

A

50% in Hb
10% in myoglobin
5% in enzymes

77
Q

Iron Absorption

A

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
Q

Pellagra

A

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
Q

Sources of iron

A

Heme - meat and liver
Non heme: plants - legumes, whole grains, nuts
Fe fortified foods - formula, cereals/grains

80
Q

Risk of Thiamin deficiency

A 
Alcoholics
Frequent vomiting (post bariatric surgery)
TPN
anorexia
re-feeding syndrome
south Asia- polished rice diet
81
Q

Vitamin K deficiency

A

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
Q

Vitamin D sources

A

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
Q

Vitamin A Toxicity

A

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
Q

D3 vs D2

A

D3 is absorbed 2-3x better than D2

85
Q

Source of Riboflavin

A

Vitamin B2 - dairy, egg, meat

86
Q

who is at risk of iron deficiency

A

1) poor bioavalibility in diet
2) high demand - hemolysis, pregnancy, infancy
3) chronic inflammatory

87
Q

Function - Vitamin A

A

1) photochemical for vision
2) maintenance of conjunctiva and cornea
3) epithelial differentiation/proliferation
4) antioxidant
5) prevents squamous metaplasia

88
Q

which is better human breastmilk or formula for iron absorption?

A

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
Q

Folate function

A

Vitamin B9
Single carbon transfers in nucleic acid synthesis and amino acid metabolism
DNA methylation - regulation of gene expression/epigenetics

90
Q

Vitamin E Deficiency signs

A

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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