Vitamins

Question 1

Thiamine B1

Answer 1

ETOH induced deficency

co factor in many processes including alpha ketoglutarate dehydrogenase

Wernike - korsakoff syndrome

W = wobbly and weird
K - Kant remember things

W comes first then it progresses to K.

GIve patients thiamine as soon as you see W so that they dont progress into K.

Beri-beri

Dry beri beri = peripheral neuropathy

wet beri beri = peripheral neruopathy + heart failure.

Question 2

When you have an alcoholic come into the emergency room what should you do first?

Answer 2

alcoholism induces hypoglycemia and deficiency of thiamine.

ALWAYS GIVE THIAMINE (B1) BEFORE GLUCOSE!!!

If you give glucose, first the patients body will start the glycolysis process. If you dont have B1.. then you cant activate alpha ketoglucarate dehydrogenase.. and thus pyruvate builds up… and this causes lactic acidosis!

never give glucose before thiamine.

Question 3

Riboflavin (B2)

Answer 3

Precursor to FAD and FMN

Angular chelitis - corners of mouth crack
corneal vascularization
colored tongue - red tounge

Question 4

Niacin (B3)

Answer 4

Precursor to NAD and NADP+

Tryptophan is a precursor to niacin.

Hartnup disease -> decreased absorption of tryptophan .. if you dont have tryptophan then you cant make niacin.

Carcinoid syndrome –> increased formation of serotonin. Tryptophan is a precursor to formation of serotonin. If we are using up all the tryptophan to form serotonin.. then we wont have enough left over to make Niacin –> niacin deficiency.

INH (isoniazid) –> INH decreased B6 (we know this).. but B6 is a co-factor for Niacin (B3).. thus if you dont have B6. you cant make B3.!

Niacin deficency = pellagra
Dermatitis
Dementia
DIarrhea

Question 5

Pantothenic acid (B5)

Answer 5

all we need to know si that its a co-factor to CoA

Question 6

Pyridoxine (B6)

Answer 6

INH – Decreased B6 –> peripheral neuro

No B6 --> cant make Heme:
Sideroblastic anemia
neuropathy
irritability
GI Upset

Question 7

Biotin (B7)

Answer 7

1 effect of decreased biotin = alopecia!!!!

Too many egg whites –> blocks biotin

body builder will start losing hair.

Question 8

Folate (B9) vs Cobalamin (B12)

Answer 8

Folate (B9):
converted to THF
Most common vitamin deficiency in the world
Absorbed in Jejunum

Cobalamin (B12)
Rarely deficient
absorbed in illeum

Both cause elevated homocysteine.

Only B12 will have Neuro symptoms

Only B12 will have Methyl Malonic Acid elevation!!

B12 is used to build the myelin sheeth –> no B12 means no myelin sheath –> neuro symptoms –> this is called subacute combined degeneration of the dorsal columns –> no postional / vibration sense.. and psych sypmptoms

Question 9

Vitamin C (ascorbic acid)

Answer 9

hydroxylation of hydroxyprolene and lysine
antioxidant regeneration of vitamin E
reduction of Iron

SCURVY:
bleeding gums
pour wound healing
anemia
folicular hemorrhage