Vitamin Deficiency Flashcards
summarise each vitamin, its site of absorption and the deficiency syndrome?
what is the active form of vitamin A?
Retionic acid
where is vitamin A found ?
liver, kidneys, butter, egg yolks, leafy vegetables
what is the deficiency syndrome for vitamin A?
XEROPHTHALMIA (ocular manifestations)
Abnormal dryness of conjunctiva and cornea of the eye with inflammation
outine the pathophysiology of vitamin A deficiency?
Vitamin A is required for formation of rhodopsin, photoreceptor pigment in the retina so important for vision. It is also important for antioxidation, gene transcription, differentiation of epi cells into specialised tissue and prevent squamous metaplasia (hence prevent formation of Bitot spots)
Deficiency can be due to inadequate intake, fat malabsorption or liver disorders (liver stores vit A)
In xerophthalmia, there is dryness of the conjunctiva and cornea due to keratinisation of the eyes. Conjunctivae develop oval/triangular spots (Bitots spots), and cornea becomes cloudy and soft.
what are the risk factors/causes of vitamin A deificency?
inadequate intake
fat malabsorption
liver disorders ( liver stores vitamin A)
summarise the epidemiology of vitamin A deficiency?
common in southern and eastern asia where rice is staple food- rice is completely lacking beta carotene ( precursor to vitamin A )
Rare in the uK
What are the presenting symptoms of vitamin A deficiency?
Starts off with night blindness
As diseases progresses, cornea becomes hazy and can develop erosions which can lead to its destruction 🡪 complete blindness.
Can also get drying, scaling and follicular thickening of the skin due to keratinisation of skin
Respiratory infections due to keratinisation of mucous membranes in respiratory tract.
what are the clinical features of xerophthalmia?
dryness of the conjuctiva and cornea due to keratinisation of eyes
conjuctiva develop oval/ triangular spots ( Bitot spots)
cornea becomes cloudy and soft
what are the signs of vitamin A deficiency?
Night blindness, which may cause injuries
Bitots spots on conjunctiva
Corneal xerosis – cornea appears dry and dull
Corneal ulcerations
Keratomalacia – last stage of xerophthalmia - softening of cornea, followed by perforation of eyeball and blindness
Dry skin
Dry hair
More prone to infection
what are the appropriate investigations for vitamin A deficiency and interpret the results?
Check sight in darkness
serum renitol binding protein
zinc levels- zinc deficiency can interfere with production of retinol binding protein
iron studies - can affect metabolism of vitamin A
FBC- for anaemia or infection
Generate a management plan for vitamin A deficiency
Treat with vitamin A supplements
Re-educate and monitor diet
High vit A: chicken, eggs, leafy green veg
Identify the possible complications of vitamin A deficiency
Blindness
Respiratory infections
Summarise the prognosis for patients with vitamin A deficiency
Good if treated early, before blindness progresses
What is the deficiency syndrome for B1 ( thiamine)?
Beri Beri-> can lead to Wernicke’s encephalopathy
what systems can be affected by a B1 ( thiamine) deficiency?
Cardio, MSK, GI and nervous system can be affected
What are the risk factors for B1 ( thiamine) deficiency?
Diets consisting of high levels of milled rice and raw freshwater fish
High consumption of tea, coffee and betel nuts
Alcoholic state
Starvation state
Prolonged vomiting
Gastric bypass surgery – due to limited caloric intake post surgery
Parental nutrition without adequate thiamine supplementation
What are the 2 main types of beriberi?
Dry beriberi
Wet beriberi
what are the features of dry beriberi?
Thiamine deficiency with nervous system involvement
Usually occurs with poor caloric intake and physical inactivity
Involves peripheral neuropathy
Wernicke encephalopathy and Korsakoff syndrome are forms of dry beriberi
What are the features of wet beriberi?
Thiamine deficiency with cardiovascular involvement
First, peripheral vasodilation occurs causing high CO. This leads to salt and water retention via RAAS. As vasodilation progresses, kidneys detect relative loss of volume and therefore conserve salt. Salt retention causes fluid absorption into vessels, hence oedema.
The high cardiac workload results in heart failure with general oedema.
summarise the epidemiology of B1/ thiamine deficiency?
Common in alcoholics
More common in developing countries due to malnutrition
what are the symptoms of B1 ( thiamine ) deificency?
EARLY FEATURES: fatigue, apathy, irritability, drowsiness, depression, poor concentration, anorexia, N+V, abdo pain
LATER FEATURES Wet: palpitations, SOB, leg swelling, dyspnoea, orthopnea
LATER FEATURES Dry: numbness of peripheries, confusion, trouble moving legs, pain (cramps)