Vitamin deficiencies

Question 1

Define vitamin A deficiency:

Answer 1

Lack of vitamin A which may cause xeropthalamia (dryness of the conjunctiva and cornea)

Question 2

What is the aetiology/risk factors of vitamin A deficiency:

Answer 2

Vitamin A is needed in rhodopsin (a photorecptor in the retina).

The deficiency is due to inadequate intake, fat malabsorption and liver disorders (liver stores vitamin A)

Xerophthalmia (the dryness occurs due to keratinisation. Will also get bitot spots in the conjunctiva (triangular or oval spots) and the cornea becomes soft

Question 3

Epidemiology of vitamin A deficiency:

Answer 3

Occurs mainly in the southern and eastern Asia as their diet is mainly rice (low in beta carotene which is a precursor for vitamin A)

Rare in the UK

Question 4

Symptoms of vitamin A deficiency:

Answer 4

Starts of as night blindness

Cornea becomes hazy and this leads to erosions which leads to complete blindness

drying + thickening of the skin due to keratinisation

Resp infections due to keratinisation of the mucous membranes

Question 5

Signs of vitamin A deficiency:

Answer 5

Night blindness

Dry skin and hair

Conjunctival and corneal xerosis (dry, dull and thick)

Bitots spots

corneal ulcerations

Keratomalacia

more prone to infections

Question 6

Investigations for vitamin A deficiency:

Answer 6

check eye sight in the darkness

serum retinal binding protein

zinc levels (involved in production of the retinal binding protein)

iron levels - affect the metabolism of vitamin A

FBC - to check for anaemia

Question 7

Management of vitamin A deficiency:

Answer 7

Vitamin A supplements

Re-educate and monitor diet

High in Vit A = eggs, leafy green vegetables and chicken

Question 8

Complications of vitamin A deficiency:

Answer 8

blindness

resp infections

Question 9

prognosis of vitamin A deficiency:

Answer 9

good if treated early otherwise blindness

Question 10

Define vitamin B1 deficiency:

Answer 10

This is thiamine deficiency also known as BeriBeri.

It can lead to Wernicke’s encephalopathy

Question 11

Describe the aetiology of vitamin B1 deficiency:

Answer 11

Thiamine is needed for glucose metabolism and so there is impaired glucose metabolism which leads to a decrease in cellular energy.

It is caused by - alcoholism, inadequate intake and malabsorption

Dry Beri Beri - CNS involvement usually due to a low caloric intake can lead to W-K syndrome

Wet Beri Beri - CVS involvement. there is vasodilation of the peripheral arteries leading to the retention of CO. This activates RAS leading to oedema and eventually heart failure.

Question 12

What are risk factors for vitamin B1 deficiency:

Answer 12

Alcoholism

High tea, coffee or betel nuts

Cancer and chemotherapy

Gastric bypass

paraentral feeding

diet high in milled rice and raw freshwater fish

prolonged vomiting

AIDS

Question 13

Epidemiology of vitamin b1 deficiency:

Answer 13

common in alcoholics and in the developing world due to malnutrition.

Question 14

Symptoms of B1 deficiency:

Answer 14

Wet - palpitations, SOB and leg swelling

Dry - numbness in peripheries, difficulty moving legs, pain and confusion

Question 15

signs of B1 deficiency:

Answer 15

W-K syndrome - confusion orpathlamoplegia and ataxia

Wet - tachycardia, peripheral cynosis and oedema, dypnnoea and orthopnea.

Dry - muscle wasting and weakness, reduced sensation and reflexes

Question 16

Investigations of B1 deficiency:

Answer 16

Often clinical diagnosis

ABG

Lactate

TFT’s

erythrocyte thiamine pyrophosphate

Question 17

Management of b1 deficiency:

Answer 17

Thiamine iv followed by oral supplements - Pabrinex

May be accompanied by magnesium, potassium and phosphate supplements

if hypoglycemic give thiamine before the glucose

Question 18

Complications of b1 deficiency;

Answer 18

Korsakoff’s syndrome which is irreversible

Question 19

prognosis of b1 deficiency:

Answer 19

good if treated early otherwise korsakoff’s.

Question 20

Definition of vitamin c deficiency:

Answer 20

lack of vitamin c which may lead to scurvy

Question 21

aetiology of vitamin C deficiency:

Answer 21

Used in the immune system, wound healing and iron absorption

Question 22

risk factors of vitamin c deficiency:

Answer 22

Famine

Refugees

Pregnancy

surgery

sepsis

ARDS

pancreatitis

critically ill

infants drinking only cow’s milk

HIV

Question 23

epidemiology of vitamin c deficiency:

Answer 23

Common in pregnancy and inadequate diet

Question 24

symptoms of vitamin c deficiency:

Answer 24

Rash

fatigue

depression

internal bleeding and bruising

Gingivitis - loose teeth and foul breath

bleeding from gums, nose, hair follicles and into joints

muscle pain, weakness and wasting

impaired bone growth in children

Question 25

signs of vitamin c deficiency:

Answer 25

Rash

petichae

oedema

cachexia

anorexia

Question 26

investigations of vitamin c deficiency:

Answer 26

Clinical diagnosis often

Absorbic acid levels - whole blood, leukocytes and serum

FBC and blood smear

X-ray of the wrist and ankle

Question 27

management of vitamin c deficiency:

Answer 27

Vitamin C supplements

Dietary education

Absorbic acid >250mg/24 hr PO

Question 28

complications of vitamin c deficiency:

Answer 28

Intracerebral haemorrhage

Endocardial haemorrhage

Neck pain

Back pain

Question 29

Prognosis of vitamin c deficiency:

Answer 29

Good prognosis and will resolve if early treatment with supplements

Question 30

define vitamin d deficiency:

Answer 30

In adults this usually leads to osteomalacia - this is a disorder of reduced mineralisation of the bone matrix

In children usually leads to rickets - defective mineralisation of the cartilage of the epiphyseal growth plates

Question 31

Aetiology/risk factors of vitamin D deficiency:

Answer 31

Risk factors:

• Lack of exposure to sunlight
• Dietary deficiency
• Liver disease + anticonvulsants (lack of 25-hydroxylation)
• Chronic renal disorders (lack of 1a-hydroxylation)
• Tumours
• hypoparathyroidism
• Faconis syndrome - Phosphaturia, Glycosuria, Amino aciduria
• Hereditary
• renal phosphate wasting

Question 32

Epidemiology of vitamin D deficiency:

Answer 32

common in industrialised countries

more common in females

Question 33

symptoms of vitamin D deficiency:

Answer 33

Osteomalacia:

• Bone weakness
• Bone pain
• Malaise

Rickets:

• Hypotonia
• growth retardation
• skeletal deformities

Question 34

Signs of vitamin D deficiency:

Answer 34

osteomalacia:

• bone tenderness
• proximal weakness
• waddling gait
• hypocalacemia (troussau’s and Chvostek’s sign)

Rickets:

• short stature
• knock knees
• rickety rosary (chostrachondral inflammation)
• Bow legs
• bossing of pariatel and frontal bone

Question 35

investigations of vitamin d deficiency:

Answer 35

Bloods:

• low or normal calcium
• low phosphate
• high PTH
• high ALP
• low 25-hydroxy vitamin D

U+ E’s

ABG

Radiographs: may be normal, may show looser’s zones (pseudofractures), may show oesteopenia.

Bone biopsy after tetracycline

Question 36

management of vitamin d deficiency:

Answer 36

replace vitamin d and calcium

monitor 24hr urinary - calcium, vitamin d, phosphate, ALP and PTH

Treat the underlying cause

Question 37

complications of vitamin d deficiency:

Answer 37

hypocalcemia- CATS go NUMB

• convulsions
• arrythmias
• tetany
• seizures
• Numbness/parasthesia

Bone deformaties

Question 38

Prognosis of vitamin D deficiency:

Answer 38

improvement on imaging with vitamin d

bone deformities in children tend to be permanent.

Question 39

define vitamin e deficiency:

Answer 39

lack of vitamin e

Question 40

what is the aetiology/risk factors of vitamin e deficiency:

Answer 40

found in nuts, seeds and whole grains

Risk factors: chronic pancreatitis, cystic fibrosis, PBC, short bowel syndrome, chron’s, cholestatis, abetalipoproteinemia

Causes neurological deficit and haemolysis

Question 41

epidemiology of vitamin e deficiency:

Answer 41

very rare

Question 42

symptoms of vitamin e deficiency:

Answer 42

weakness

loss of vibration sense

decline in visual field

Question 43

signs of vitamin e deficiency:

Answer 43

hyporeflexia

decreased proprioception

distal muscle weakness

loss of vibration sense

ataxia

dysarthria

retinopathy

compromised immune system

Question 44

investigations of vitamin e deficiency:

Answer 44

levels of vitamin e in the blood

Question 45

management of vitamin e deficiency:

Answer 45

supplements and dietary

Question 46

complications of vitamin e deficiency:

Answer 46

neurological

Question 47

prognosis if vitamin e deficiency:

Answer 47

good if treated early.

Question 48

define vitamin k deficiency:

Answer 48

low vitamin K

Question 49

aetiology/risk factors of vitamin K deficiency:

Answer 49

vitamin k is important in coagulopathy therefore the main symptom is excessive bleeding

RFs:

• anticoagulants
• lack of dietary vitamin k
• antibiotics which interfere with vitamin k absorption
• malabsorption - coeliac and CF
• breast milk low in vitamin k

Question 50

epidemiology of vitamin k deficiency:

Answer 50

rare in adults, more common in infants

Question 51

symptoms of vitamin k deficiency:

Answer 51

easy bruising
excessive bleeding from wounds
dark black, tarry stools
blood in urine
nose bleeds
heavy periods

Question 52

signs of vitamin K deficiency:

Answer 52

bruising

haematuria

malena

Question 53

investigations of vitamin k deficiency:

Answer 53

PT time mainly + history

Can do other coagulation tests such as platelet count etc.

Question 54

management of vitamin k deficiency:

Answer 54

supplements orally or iv

Question 55

complications of vitamin k deficiency:

Answer 55

intracranial haemorrhage

anaemia

excess bleeding

Question 56

prognosis of vitamin k deficiency:

Answer 56

good if treated early