Vitamin deficiencies

Question 1

Vitamin A deficiency

Answer 1

Symptoms:
- Eyes: night blindness, foamy corneal deposits (Bitot spots d/t corneal squamous metaplasia) & degeneration, pancreatic duct obstruction (again squamous metaplasia)
- Skin: dry, scaly (hyperkeratosis/xerosis cutis)
Causes:
- Diet (found in “liver & leafy vegetables”)
- Fat malabsorption (pancreatic insufficiency, cholestasis, intestinal)

Question 2

Vitamin C deficiency

Answer 2

Symptoms: corkscrew hairs (“hyperkeratotic follicles”), poor wound healing, swollen gums, bleeding

Question 3

Vitamin E deficiency

Answer 3

Symptoms: hemolytic anemia, acanthocytosis, SCD (or at least dorsal columns + spinocerebellar tract damage)

• Vitamin E primarily serves to protect membranes from oxidative damage; long nerves are most susceptible
• Note how similar to vitamin B12 but w/o megaloblastic anemia

Question 4

Vitamin B7 deficiency

Answer 4

• Eating too many eggs (avidin binds biotin)
• Dermatitis, enteritis, alopecia
• Cofactor for 3 carboxylation reactions (pyruvate, Acetyl-CoA, propionyl-CoA)

Question 5

Vitamin B3 deficiency

Answer 5

• Diarrhea, Dermatitis, Dementia (“the 3 D’s of B3”)
  Causes:
• Vitamin B2 and B6 required for synthesis from tryptophan in vivo, so carcinoid syndrome (decr. tryptophan) and isoniazid (decr. B6) can cause
• Also Hartnup disease = renal tubular issue = less tryptophan

Question 6

Beriberi

Answer 6

Vitamin B1 deficiencies:

• Dry beriberi: polyneuropathy, symmetric muscle wasting
• Wet beriberi: DCOM, edema

Question 7

Vitamin B2 deficiency

Answer 7

• Recall riboflavin is used to make FADH, FADH2
• Symptoms (the 2 C’s of B2): Cheilosis (inflammation of lips, scaling + cracking at corners of mouth), Corneal vascularization

Question 8

Vitamin B5 deficiency

Answer 8

• Pantothenic acid (“pento” -thenic acid) is a component of CoA
• Symptoms: Dermatitis, enteritis, alopecia + adrenal insufficiency

Question 9

Vitamin B6 deficiency

Answer 9

Convulsions, hyperirritability, peripheral neuropathy, sideroblastic anemia

Question 10

Vitamin B9 deficiency

Answer 10

Obviously pregnancy (NTDs) but also seen in acloholics:

• Symptoms: megaloblastic anemia, glossitis (B12 deficiency minus neurologic sx)
• Labs: incr. homocysteine, normal MMA

Question 11

Zinc deficiency

Answer 11

“Hella enzymes”

• Symptoms: poor wound healing, immunosuppression, male hypogonadism, decr. body hair, dysgeusia, anosmia
• May be caused by acrodermatitis enteropathica (defect in intestinal zinc absorption)
• May predispose alcoholic cirrhosis

Question 12

Kwashiokor

Answer 12

Malnutrition/Muscle wasting
Edema
Anemia
Liver (fatty)
Skin lesions

Question 13

Marasmus

Answer 13

Kwashiokor minus edema and liver things (caloric deficiency only)
- I.e., muscle wasting only