Vitamins Flashcards
What are the physical exam findings of Vitamin A deficiency?
Papular Keratitis “goose bump rash”
What are the physical exam findings of Vitamin C deficiency?
Perifollicular hemorrhages
Hypertrophied bleeding gums
What are the physical exam findings of Vitamin B12 deficiency?
Loss of distal vibratory and position sense
What are the physical exam findings of Vitamin K deficiency?
Ecchymosis
What are the physical exam findings of Riboflavin or Niacin deficiency?
Angular stomatitis or Cheilosis
What are the physical exam findings of Thiamine deficiency?
Nystagmus
What are the physical exam findings of Iron deficiency?
Spooning of nails
What are the physical exam findings of Zinc deficiency?
LE rash “Flaky paint”
What are the physical findings of protein deficiency?
- Hollowing of the temporal muscles
- Wasting of upper arms and thigh muscles
- Easily plucked hair
- Peripheral edema
What are fat soluble vitamins?
A, D, E, K
These vitamins are stored in fat so can be toxic
What are water soluble vitamins?
B vitamins: B1 (thiamin), B2 (riboflavin), B3 (niacin), B5 (Pantothenic acid), B6 (pyridoxine), B12 (Cobalamin)
Vitamin C (ascorbic acid)
Folate
Biotin
**these are all vitamins you can pee out excess of (so cant overdose)
What is vitamin A needed for
◦Retinol, retinal, retinoic acid/carotenes
◦Bile needed for absorption
◦Stored in the liver
◦Bone and tooth structure
◦Healthy skin and mucous membranes
◦Vision in dim light
What does Vitamin A deficiency cause?
◦Night blindness
◦Xeropthalmia
◦Keratomalacia
◦Follicular hyperkeratosis (goose bump rash)
What does excess vitamin A cause?
◦Chronic toxicity can lead to liver damage and increased pressure on the brain
◦Vision changes
◦Bone pain
◦Rough skin and dry cracked lips
Vitamin D
- Assists with calcium homeostasis & bone metabolism
- Helps intestinal absorption of calcium and phosphorous
What can chronic high doses of glucocoticoids cause?
inhibit intestinal Vitamin D-dependent calcium absorption
So if you give high dose steroids for a long time, you should also give a Vitamin D supplement
In what patients should you consider giving a higher dose supplement of Vitamin D to?
Elderly, malabsorptive d/o, lack of sunlight, CKD, liver failure (hydroxylation of Vit d impaired)
Vitamin D deficiency
Rickets – soft bones, enlarged joints, enlarged skull, deformed chest, spinal curvature, bowed legs
Osteomalacia
Vitamin D excess
Anorexia, n/v, polydipsia, polyuria
What is the best laboratory indicator of vitamin D?
◦serum 25-hydroxyvitamin D
◦No consensus for optimal Vitamin D levels
◦IOM concluded 20 ng/ml (50 nmol/L) is sufficient for most individuals
◦American Geriatric Society suggests a minimal level of 30 ng/ml (75 nmol/L)
}RDA
◦Adult-70 yo 600 IU/day
◦>70 yo 800 IU/day
Vitamin E
◦AKA: Tocopherols
◦Important in vision & reproduction
◦Protects health of blood, brain, and skin
◦Protects cell membranes against oxidation and free radicals
◦Most people get sufficient Vitamin E in diet
◦May play a role in slowing progression of Alzheimers, but not conclusive
◦Supplementation may increase risk of prostate cancer
What might supplementation of VItamin D cause?
MAY cause prostate cancer
RDA: 15 mg/day
Vit E deficiency
Neuropathy
Red cell hemolysis in malnourished infants
vitamin E excess
Low toxicity
Augments effects of anticoagulants
Vitamin K
◦Forms prothrombin for normal blood clotting
◦Synthesized in the intestines
◦Antibiotics can kill Vitamin K producing bacteria in the intestine altering Vitamin K availability
◦Oral bile acid sequestrants, such as, cholestyramine for lowering cholesterol can reduce absorption of Vitamin K and other fat soluble vitamins
Vitamin K deficiency
Prolonged clotting time
Hemorrhage, especially in newborn infants and biliary tract disease
Vitamin K excess
Large amounts toxic
Vitamin C
◦Forms collagen
◦Teeth firm in gums
◦Hormone synthesis
◦Resistance to infection
◦Improve iron absorption (so give with iron supplements)
Vitamin C deficiency
Poor wound healing
Poor bone, tooth development
Dry skin
Petechiae
Fatigue
Scurvy (Rare)–> Bruising and hemorrhage, bleeding gums, loose teeth
Excess Vitamin C
Can lead to oxalate urinary calculi = kidney stones
Can cause false negative urinary glucose in diabetic patients
Vitamin B1- Thiamine
◦Coenzyme for breakdown of glucose for energy
◦Healthy nerves
◦Good digestion
◦Normal appetite
◦Good mental outlook
Vitamin B1 (Thiamine ) Deficiency
-Aphonia
-Peripheral neuropathy
-Wernicke encephalopathy (nystagmus, ophthalmoplegia, ataxia)
-Confusion/Coma
-Beriberi disease (dry and wet)
-Inflammation of the nerves and heart failure
**often seen in alcoholics
What do you give to all patients that present with encephalopathy and/or alcoholism?
treat ALL with supplemental thiamine
Vitamin B2
AKA Riboflavin
◦Coenzymes for protein and glucose metabolism
◦Fatty acid synthesis
◦Catalyst in many mitochondrial oxidation-reduction reactions and function as electron transporters
◦Healthy skin
Vitamin B2 (Riboflavin) deficiency
Cheilitis (cracked/dry corners of mouth)
Burning, itching, sensitive eyes
Glossitis/Scarlet colored tongue (“Beefy Red tongue”
Vitamin B3
AKA Niacin
◦Required by all cells and is a coenzyme for energy metabolism (turns food into energy)
◦Role in synthesis of macronutrients, needed for formation of RNA and DNA
◦Normal digestion
◦Healthy skin
◦Healthy nervous system
◦Tryptophan is a precursor, 60mg = 1mg niacin
Vitamin B3 (Niacin) deficiency
Pellagra (when Niacin and Tryptophan are limited):
-Dermatitis, angular stomatitis, and the 4 Ds (diarrhea, depression, delirium, death)
-Hyperpigmentation of sun exposed areas
-Glossitis
Has been linked to birth defects
Vitamin B3 (Niacin) Excess
Flushing, itching, burning, tingling
Liver failure (high doses)
Diabetes (high doses)
Gout (high doses)
Hypotension
Activate Peptic Ulcer Disease
Benefits of Niacin Supplementation
◦Releases fatty acids from adipose tissue
◦Reduces the amount of cholesterol in the blood”
1. Positively effects HDL (Helps lower LDL)
2. Lowers cardiovascular dz risk, but isn’t linked to lower rates of death, MI or stroke
Therapeutic doses are high (1000-3000 mg)
Vitamin B5- Pantothenic acid
◦Bioactive form=coenzyme A
◦Synthesis of sterols, fatty acids, heme
Vitamin B6
AKA Pyridoxine
◦Coenzymes for protein metabolism
◦Conversion of tryptophan to niacin
◦Formation of heme
Vitamin B6 (Pyridoxine) Deficiency
Cheilosis
Anemia
Stomatitis
Weak gait
Irritability/Insomnia
Nasolabial seborrheic dermatitis
Vitamin B6 (Pyridoxine) excess
Peripheral neuropathy
Photosensitivity
Nausea
Vitamin B12
◦Formation of mature red blood cells
◦Synthesis of DNA, RNA
◦Requires intrinsic factor from stomach for absorption (lack of IF results in no absorption of B12)
Vitamin B12 deficiency
- Pernicious anemia: lack of intrinsic factor or after gastrectomy
2. Macrocytic anemia
- Neurologic degeneration:
-Impaired proprioception
-Peripheral Neuropathy
-Slowed mentation
- Pallor
Vitamin- Folic Acid
- Maturation or RBCs
- Synthesis of DNA, RNA
AKA folate
Folic Acid deficiency
Macrocytic anemia
–>Needs supplementation in pregnancy to prevent neural tube defects
Biotin
◦Components of coenzymes in metabolism
◦Synthesis in intestine
Biotin deficiency
AMS
Myalgia
Anorexia/Nausea
Dermatitis around the eyes
Alopecia
