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Vitamins and Minerals Flashcards

1
Q

In what organs is excess iron stored

A

Liver, spleen, bone marrow

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2
Q

Pathophysiology of iron poisoning

A

Causes peroxidation of membrane lipids and free radical generation

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3
Q

symptoms of acute iron poisoning

A

GI: nausea/vomiting, gastric bleeding (iron settles in the stomach), hematemesis, abdominal pain. If bleeding severe - hypovolemic shock

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4
Q

Symptoms of iron poisoning 6-72 hours after ingestion

A

Metabolic acidosis

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5
Q

Symptoms of iron poisoning 2-8 weeks after ingestion

A

Scarring of GI tract, obstruction

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6
Q

Ferritin

A

Iron-protein complex of ferric acid and apoferritin, is cellular storage protein for iron
An acute phase reactant - take it away from circulation from bacteria who like iron

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7
Q

Transferrin

A

Protein that binds ferric molecules and transports them through plasma
Made in liver

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8
Q

What are the levels of transferrin in iron deficiency

A

Increased - cells hungry for iron so looking for transport molecule to bring them more

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9
Q

Half life of transferrin

A

8 days

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10
Q

Function of Zinc

A 
Essential for 100+ enzymes
Important in formation of zinc fingers (transcription factor motif)
Healing, immune system
Essential for carbonic anhydrase
Essential for lactate dehydrogenase
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11
Q

Zinc deficiency

A 
Delayed wound healing
Decreased body and facial hair
Hypogonadism
Anosmia
Dysgeusia
Decr immune response
Rash around eyes, mouth, nose, anus (acrodermatitis)
Anorexia and diarrhea
Growth retardation
Depressed mental function
Infertility
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12
Q

What is acrodermatitis

A

Rash seen in zinc deficiency - around eyes, mouth, nose, and anus

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13
Q

Signs of lead poisoning

A

Decreased IQ, hearing problems, growth impairment, impaired peripheral nerve function (wrist, foot drop), lead lines in growing bones and teeth (burton’s lines)
With severe: Anemia, colic/abd pain, nephropathy, encephalopathy

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14
Q

What enzymes does lead inhibit

A

Ferrochelatase and ALA dehydratase –> decreased heme synthesis and increased RBC protoporphyrin

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15
Q

What is basophilic stippling

A

RBCs retain aggregates of rRNA because lead inhibits rRNA degradation

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16
Q

Treatment of lead poisoning in kids vs adults

A

Remove exposure
1st line: Dimercaprol (SEVERE) and EDTA
Kids: Succimer

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17
Q

Where does mercury accumulate

A

Kidney and brain

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18
Q

Side effects of mercury poisoning

A

Neuropsych effects

Acrodynia - peeling of fingertips

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19
Q

Bluish colored lines on gingivae

A

Burton’s lines = lead poisoning

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20
Q

Ergocalciferol

A

D2 - ingested form - from plants

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21
Q

Cholecalciferol

A

D3 - synthesized in skin

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22
Q

25-OH D3

A

Made in the liver from D3

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23
Q

1,25 DHCC

A

Physiologic active form in vitamin D, made in kidneys

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24
Q

FUnction of 1,25 DHCC

A
  • Increases Calcium uptake in intestine by increasing expression of calcium binding protein
  • Works in intestine to increase absorption of Mg and P
  • Stimulates PTH-dependent reabsorption in distal tubules
  • Stimulates bone reabsorption when necessary (with PTH)
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25
Vit D deficiency mechanisms
1. Inadequate dietary 2. Impaired hydroxylation by liver 3. Impaired hydroxylation by kidneys 4. End organ insensitivity
26
Vit D deficiency clinical
Rickets/Osteomalacia Demineralization problems of bone Bone tenderness, skeletal deformities, bowing of legs, growth problems, pathologic fractures, dental problems
27
Pathophysiology of Vit D deficiency
Serum calcium drops so PTH increases which breaks down bone, decreasing serum phosphate and trying to increase serum calcium
28
Vitamin D toxicity
Too much Vitamin D supplementation Hypercalcemia From sarcoidosis - increase conversion to 1,25 from macrophages in granulomas
29
Vitamin K
Involved in post translational modification of clotting factors Made in intestinal flora
30
Clotting factors dependent on K
Protein C and S Prothrombin 2, 7, 9, X
31
Vitamin K deficiency
Medications: Coumadin (vitamin K antagonist), Anticonvulsants (phenytoin), antibiotics (wipe out gut flora)
32
Vitamin A
Retinol, Retinal Retinol: Eye, immune system, epithelial and mucus cell maintenance Beta carotene - cleaved in intestine to get two molecules of retinol
33
Vitamin A used clinically
``` Acne - tretinoin Isotretinoin Decrease size and secretion of sebaceous gland Measles AML (M3 subtype) ```
34
Vitamin A deficiency
Night blindness Xerophthalmia - corneal ulcerations Keratomalacia - wrinkling and clouding of cornea Bitot spots - in bulbar conjunctiva
35
Vitamin A toxicity
HA, N/v, stupor, increased ICP Dry and pruritic skin Too much beta carotene - orange, but not vitamin A tox Hepatomegaly, bone and joint pain, alopecia From eating polar bear - high levels Arthralgias
36
Vit A supplementation a bad idea in..?
Pregnancy - risk teratogenesis
37
Vitamin E
alpha-tocopherol | Primarily an antioxidant: Prevents non-enzymatic oxidation of cell components by oxygen-free radicals (RBC's important)
38
Vit E deficiency
Hemolytic anemia - less protection for RBCs Spinocerebellar degeneration -> ataxia Peripheral neuropathy and proximal muscle weakness
39
Vitamin C
Antioxidant Involved in hydroxylation of proline and lysine residues of collagen Required in conversion of dopamine to NE (dopamine beta hydroxylase) Facilitates iron absorption in gut (keeps it in reduced state)
40
Scurvy
``` Sore spongy gums Loose teeth Fragile blood vessels -> hemorrhages Swollen joints Hemarthrosis Impaired wound healing Anemia ```
41
Treatment of choice for rickets or osteomalacia
Vitamin D
42
Vitamin B1
Thiamine Pyruvate to acetyl CoA Alphaketoglutarate to succinyl CoA Ribose 5 P to G3P (transketolase)
43
Thiamine deficiency
Poor nutrition (EtOH), malabsorption, dialysis Can't breakdown glucose to make ATP Damage to medial thalamus and mamillary bodies of posterior HT Generalized cerebral atrophy
44
Wernicke-Korsakoff syndrome
Wernicke: Acute Korsakoff: Chronic
45
Triad of wernicke encephalopathy
Encephalopathy, oculomotor dysfunction, gait ataxia | Also stupor, coma, hypotension, hypothermia
46
Korsakoff syndrome
Memory loss (retro and anterograde) Confabulation Personality change Apathy
47
Beriberi
Another problem of thiamine deficiency - from dehusked rice Wet or Dry Wet: Nerves Dry: Heart
48
Dry beri beri
``` Nonspecific peripheral neuropathy w/myelin degeneration Toe, wrist, foot drop Muscle weakness Hyporeflexia Areflexia ```
49
Wet beri beri
Peripheral vasodilation High output HF Peripheral edema Cardiomegaly
50
B2
Riboflavin - two active forms 1. FMN 2. FAD Cofactors for redox reactions, eg succinate dehydrogenase
51
B2 deficiency
Dermatitis, glossitis, cheilosis (inflammation of lips, scaling at corners of mouth), corneal vascularization
52
B3
``` Niacin - two active forms 1. NAD 2. NADP Derived from tryptophan Used in pts w/dyslipidemia ```
53
Niacin deficiency
Pellagra 1. Dermatitis 2. Diarrhea 3. Dementia
54
What diseases can cause Pellagra
1. Hartnup disease 2. Malignant carcinoid syndrome (increased tryptophan metabolism) 3. INH - inhibits B6 and B3
55
B5
Pantothenate | Component of coenzyme A
56
B5 deficiency
Nonspecific: Dermatitis, enteritis, alopecia, adrenal insufficiency
57
Vitamin B6
Pyradoxine Active: Pyridoxal phosphate Coenzyme for many enzymes including AA metabolism (Trans and deaminations) Converting AA precursors into things like heme, GABA, etc
58
B6 deficiency
Angular chelosis Glossitis Unique: Convulsions (need gaba), hyperirritability, peripheral neuropathy
59
B7
Biotin | Apoenzyme for carboxylation reactions
60
B7 deficiency causes
Avidin found in egg whites prevents absorption of biotin | Abx
61
Vitamin B9
``` Folate Biol active form: THF Crucial for synthesis of DNA and repair of DNA Syntehsis of purines and pyrimidines Rapid cell division and growth ```
62
B9 deficiency causes
Medications malnutrition Pregnancy
63
Medications that can cause B9 deficiency
Phenytoin Sulfonamide TMP MTX
64
B9 deficiency
In utero: NTD Growth failure Megaloblastic anemia Nonsp: glossitis, diarrhea, depression, confusion
65
B12
Cobalamin | Cofactor with homocysteine methyltransferase to make methionine from homocysteine, in the process THF is used.
66
B12 deficiency sx
Megaloblastic anemia Elevated MMA or homocysteine Neuro sx: paresthesias, ataxia, memory loss, dementia, severe weakness
67
How is B12 absorbed
Bound IF in duodenum Complex absorbed in terminal ileum IF is produced by parietal cells in stomach Pernicious anemia, gastric bypass (decreased IF)
68
Causes of B12 deficiency
Pernicious anemia, gastric bypass | Crohn's, celiac sprue, enteritis
69
Convulsions and irritability - deficiency?
B6 - required for GABA
70
Where is B12 absorbed in gut
Terminal ileum
71
Peripheral neuropathy and glossitis
B12
72
Dermatitis, diarrhea, dementia
B3
73
Used in oxidative/reduction reactions
B2 and B3
74
Used in carboxylation reactions
Biotin
75
Used by pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase
Thiamine B1
76
Cobalt is found with this vitamin
B12
77
Dilated cardiomyopathy, edema, and polyneuropathy
Wet Beriberi (B1 deficiency)

Biochem (10 decks)

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