Vitamins and Minerals

Question 0

Vitamin A Deficiency

Answer 0

Night blindness, Dry eyes
*most common worldwide cause pediatric blindness
Bitot’s spots (keratin debris build-up on conjunctiva)
Hyperkeratosis, pruritus
Decreased antibody production
Poor bone growth

Question 1

Vitamin A Function

Answer 1

(retinol)

Vision, Skin, Bone

Question 2

Vitamin A Toxicity

Answer 2

Acute > pseudotumor cerebri

Chronic > alopecia, scaly skin, hepatic fibrosis, hyperostosis

Question 3

Vitamin D Function

Answer 3

(calciferol)
Bone resorption
*metabolism interrupted by AED’s

Question 4

Vitamin D Deficiency

Answer 4

Osteomalacia

Rickets

Question 5

Vitamin D Toxicity

Answer 5

• Hypercalciuria, hyperphosphatemia (taken from bone)
• Azotemia, nephrocalcinosis
• polyuria, ploydipsia

Treatment: replace Na/K, IVF, lasix

Question 6

Vitamin E Function

Answer 6

(alpha-tocopherol)
Membrane stability
Antioxidant

Question 7

Vitamin E Deficiency

Answer 7

Hemolytic anemia (preemies)
Thrombocytosis
Peripheral neuropathy&raquo_space; ataxia, weakness
Obstructive jaundice

3 E’s “elevated platelets, erythrocyte destruction, edema”

Question 8

Vitamin K Function

Answer 8

(phylloquinone)

Clotting factors II, VII, IX, X

Question 9

Vitamin K Deficiency

Answer 9

bleeding
Occurs in newborns, malabsorption, chronic abx use
*NBN’s b/c doesn’t cross placenta well, can’t make it well yet
*higher risk if BF (lower levels in breast milk)

Question 10

Vitamin K Toxicity

Answer 10

hyperbilirubinemia

Question 11

Vitamin B1

Answer 11

Thiamine (carbo metabolism)
Deficiency >> weakness, confusion, tachycardia, cardiomegaly
     wet beriberi (heart failure)
     dry beriberi (polyneuritis)
^Thigh-man gets weak and confused

Question 12

Vitamin B2

Answer 12

Riboflavin (cofactor)
Deficiency&raquo_space; photophobia, glossitis, cheilosis, seborrheic dermatitis, anemia
*can be caused by phototherapy in newborns
^It is SAD (stomatitis, anemia, dermatitis) when you run out of rib-flavor

Question 13

Vitamin B3

Answer 13

Niacin (cofactor)
Deficiency&raquo_space; pellagra: diarrhea, dermatitis, dementia
Excess: flushing, pruritus, vasodilation
^3 d’s of 3D(eficiency)- dementia, diarrhea, dermatitis (and glossitis)

Question 14

Vitamin B5

Answer 14

Pantothenic acid (cofactor)
Deficiency >> depression, hypotension, weakness

Question 15

Vitamin B6

Answer 15

Pyridoxine (cofactor)
Deficiency&raquo_space; microcytic anemia, glossitis, cheilosis, peripheral neuritis
irritability/seizures in infants
Excess: neuropathy

*take w/isoniazid to avoid deficiency

Question 16

Vitamin B12

Answer 16

Cyanocobalamin (cofactor, RBC maturation, CNS metabolism)
Deficiency&raquo_space; pernicious anemia neuropathy, demyelination
*absorption requires intrinsic factor and terminal ileum
*mostly from meat- deficiency if vegan, anemia masked by extra folic acid

Question 17

Biotin

Answer 17

(cofactor)

Deficiency: seborrheic dermatitis, alopecia, muscle pain, anorexia

Question 18

Vitamin B9

Answer 18

Folate
(neucleoprotein synthesis)
Deficiency&raquo_space; megaloblastic anemia, impaired cellular immunity, neural tube defects
Excess: irritability, masks B12 deficiency

Question 19

Vitamin C Function

Answer 19

Ascorbic acid (collagen synthesis, folic acid metabolism, iron absorption/transport)

Question 20

Vitamin deficiencies that cause microcytic anemia

Answer 20

Vitamin C, Iron, Copper, Vitamin B6

Question 21

Vitamin C Deficiency

Answer 21

Deficiency&raquo_space; scurvy (hemorrhage, hysteria, depression, poor wound healing)
* can trigger hemolytic crisis if G6PD deficiency

Question 22

Vitamin C Toxicity

Answer 22

oxalate/cysteine kidney stones

*can trigger hemolytic crisis if G6PD deficiency

Question 23

Zinc Deficiency

Answer 23

*acrodermatits enteropathica
autosomal-recessive (intestinal zinc transporter deficiency)
OR
premie/malnourished infants
*often presents after stopping breast-feeding (protein in milk helps zinc absorption)
*rash (perioral), dry skin, thin hair, poor wound healing, diarrhea
moist, erythematous, eczematous/vesiculopapular plaques around orifices ( mouth/nose/ears/perineum), acral area (hands/feet)
foul-smelling frothy diarrhea
alopecia
irritability, FTT
*low zinc and alk phos (zinc-dependent enzyme)

Question 24

Vitamin Names

Answer 24

``` A- Retinol B1- Thiamine B2- Riboflavin B3- Niacin B5- Pantothenic Acid B6- Pyridoxine B9- Folate B12- Cyanacobalamin *biotin is a B vitamin w/o a number C- Ascorbic Acid ```

Question 25

Vitamin D Names

Answer 25

25-OH > Calcidiol processed in liver (1 liver, 1 OH) 1,25-OH > Calcitriol processed in kidney (2 kidneys, 2 OH's) D2 > ergocalciferol (2 c's) D3 > cholecalciferol (3 c's)

Question 26

Copper Deficiency

Answer 26

Menkes Kinky Hair Syndrome

Question 27

Rickets Causes

Answer 27

``` Vitamin D Deficiency - poor diet/sun exposure - poor absorption (liver dz > lack of bile salts) - altered metabolism (liver/kidney dz) - genetic (1a-hydroxylase deficiency) - vitamin D resistance Familial Hypophosphatemic Rickets - renal phosphate loss - abnl FHF23 Hypocalcemia - dietary deficiency - poor absorption in preemie Hypophosphatemia - poor absorption in preemie ```

Question 28

Rickets Labs

Answer 28

High PTH, Alk Phos Ca, Phos can be normal Low Vit D

Question 29

Rickets Presentation

Answer 29

- craniotabes (soft skull bones), delayed fontanelle/suture closure, skull thickening, frontal bossing - bad tooth enamel - widened physes in ankle/wrist - metaphyseal flaring (bowing) of legs - rachitic rosary (enlarged costochondral joints), pectus carinatum ("pigeon chest")

Question 30

Nutritional Differences in Preemies

Answer 30

- - Need more vitamin D - - Need extra vitamin E to prevent hemolytic anemia if formula high in polyunsaturated FA - - Less bile acids so trouble absorbing long-chain TG's, fat-soluble vitamins * lose 20% ingested fat through stool * formulas use > medium-chain TG * long-chain in breast milk better absorbed so sufficient * breast milk also has linoleic and linolenic acids (essential FA's) >> need to be in formula along w/med-chain TG (they're long-chain TG) - - prolonged (>1mo) TPN can >> phosphorous deficiency in VLBW * elevated alk phos * bone demineralization - - excess phosphorous in VLBW can >> hypocalcemia, tetany, seizures - - hypocalcemia can >> bone demineralization