Vitamins and Minerals Flashcards
Neurological symptoms, acrodynia (peeling of fingertips), enlarged spleen, abdominal pain after eating lots of large fish
Mercury poisoning
Common sources of mercury poisoning
shark, tilefish, king mackerel, swordfish
Decreased IQ, growth impairment, hearing problems, abdominal pain, encephalopathy, peripheral neuropathy (wrist and foot drop), blue lines on gums, basophilic stippling on smear, ringed sideroblasts
Lead poisoning
Treatment for lead poisoning
succimer, EDTA
Nausea, vomiting, gastric bleeding (possibly), metabolic acidosis, eventual scarring leading to GI obstruction
iron poisoning
- commonly kid consuming too many of mom’s prenatal vitamins
Treatment for iron poisoning
chelation with deferoxamine
Delayed wound healing, hypogonadism (leading to infertility), decreased body and pubic hair growth, dysgeusia, anosmia, acrodermatitis enteropathica (rash around eyes, mouth, nose, anus)
Zinc deficiency
-zinc is needed for zinc fingers –> allows transcription factors to bind, therefore required during times of high cell turnover like healing
Signs of hypocalcemia
Trousseau - tighten BP cuff and hand cramps up
Chvostek - stroke cheek and facial muscles twitch
Signs of hypercalcemia
Stones - kidney stones
Bones - bone pain
Moans - abdominal pain
Groans - weakness, confusion, lethargy
Different forms of Vit D and their sources
D2 - plants
D3 - milk, sun-exposure
25-OH D3 = storage form (what is measured on labs, made by 25-hydroxylase in liver)
1,25-OH2 D3 = active form (made by kidney by 1alpha-hydroxylase)
Bone tenderness, bowing of legs, tooth problems, muscle weakness, tetany
Vit D deficiency (Rickets in kids, osteomalacia in adults)
Hypercalcemia, hypercalciuria, loss of appetite, stupor, can be seen with Sarcoidosis
Vit D excess - leads to high calcium
Sarcoid - macs increase activation of Vit D
Hemolytic anemia, muscle weakness, ataxia
Vit E deficiency
ataxia due to posterior column and spinocerebellar tract demyelination
Function of Vit E
antioxidant - protects RBCs from free radical damage
Epistaxis, hematoma, GI bleeding, easy bruising, can be associated with recent broad-spectrum Abx use
Vit K deficiency
-due to abx, fat malabsorption (CF pts), warfarin, phenytoin
Function Vit K
cofactor for gamma-carboxylation of glutamic acid residues on various proteins required for blood clotting, synthesize by intestinal flora (MICRO = AWESOME)
Factors 2, 7, 9, 10, Protein S and C
What are neonates given IM Vit K shot at birth?
neonates have sterile intestines and can’t produce Vit K - can result in neonate hemorrhage (increased PT and PTT)
Swollen gums, loose teeth, brusing, petechiae, hemarthrosis, anemia, poor wound healing, corkscrew hair
Vit C deficiency
Function of Vit C
antioxidant, facilitates iron absorption by keeping iron in Fe2+ state, hydroxylation of proline and lysine residues on collagen, needed by dopamine beta-hydroxylase which converts dopamine to NE
What collagen residues are hydroxylated with the help of Vit C?
proline, lysine
Night blindness (nyctalopia), dry, scaly skin (xerosis cutis), corneal degeneration (keratomalacia), bitot spots on conjunctiva
Vit A deficiency
N/V, vertigo, blurred vision, alopecia, dry skin, hepatic toxicity and enlargement, arthalgias, pseudotumor cerebri (increased ICP), teratogenic
Vit A excess
Function of vit A
antioxidant, visual pigments (retinal), differentiation of epithelial cells
What diseases can be treated with Vit A?
acne, wrinkles, measles, AML-M3
Cofactor for pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase, transketolase, branched-chain ketoacid dehydrogenase
thiamine (Vitamin B1) - needed to be able to breakdown glucose for fuel for brain
activated form is thiamine pyrophosphate (TPP)
Presents as either dry beriberi, wet beriberi, or Wernicke-Korsakoff
Thiamine (B1) deficiency
encephalopathy/confusion, ataxia, ophthalmoplegia
Wernicke
-seen in malnourished or alcoholics
encephalopathy/confusion, ataxia, ophthalmoplegia + confabulation, personality changes, memory loss
Wernicke-Korsakoff syndrome
-most commonly seen in Alcoholics
What is damaged in Wernicke-Korsakoff syndrome?
medial dorsal nucleus of the thalamus, mammillary bodies (also see general cerebral atrophy)
Treatment for thiamine (B1) deficiency
thiamine supplemented followed by glucose - will see increase in RBC transketolase activity
polyneuritis, peripheral neuropathy, symmetrical muscle wasting in a malnourished person or alcoholic
Dry beriberi - affects nerves
high-output cardiac failure, dilated cardiomyopathy, peripheral vasodilation, edema in a malnourished person or alcoholic
Wet beriberi - affects heart
Cheilosis, glossitis, corneal vascularization
Vit B2 deficiency (riboflavin)
Cofactor for redox reactions (dehydrogenase rxn)
Vitamin B2 (riboflavin) - component of FAD and FMN Vitamin B3 (niacin) - component of NAD, NADP
Presents with dermatitis, diarrhea, dementia (pellegra)
Vitamin B3 deficiency (niacin)
Hartnup disease - deficiency of neutral AA transport (can’t absorb tryptophan)
Malignant carcinoid syndrome - increase tryp metabolism
Isoniazid
What vitamin is derived from tryptophan?
niacin
What is niacin used to treat and what is the main side effect?
hyperlipidemia - lowers LDL, raises HDL
SE = facial flushing
What vitamin is a component of coenzyme A?
Vitamin B5 (pantothenic acid)
deficiency - dermatitis, enteritis, alopecia, adrenal insufficiency
Presents with convulsions, hyperirritability, peripheral neuropathy, sideroblastic anemia, glossitis, cheilosis
Vitamin B6 deficiency (pyridoxine)
Cofactor for transamination and deaminations (transferring amino groups), needed by ALT/AST
Vitamin B6 - pyridoxal phosphate is active form
What compounds are synthesized by using Vitamin B6 (pyridoxal phosphate)?
GABA (def. leads to seizures), dopamine, NE, epi, serotonin, cystathione, heme, niacin, histamine
Cofactor for carboxylation (CO2 to add 1 carbon)
Vitamin B7 (biotin)
What two things can cause a biotin deficiency and dermatitis, alopecia, enteritis?
eating raw egg whites, antibiotic use
What vitamins are important for the synthesis of DNA and RNA?
Vitamin B9 (folate), Vitamin B12 (cobalamin)
What vitamin is needed for 1-carbon transfers/methylation, DNA and RNA synthesis by producing bases?
Vitamin B9 - folate (active form is tetrahydrofolic acid)
Most common vitamin deficiency in US
folate - found in green leafy vegetables
Megaloblastic anemia, hypersegmented neutrophils, glossitis, no neuro symptoms
folate deficiency - can be caused by drugs (phenytoin, SMP-TMX, Mtx) or pregnancy or alcoholism
Megaloblastic anemia, hypersegmented neutrophils, parathesias (degeneration of dorsal columns, lateral corticospinal tracts, spinocerebellar tracts)
Vitamin B12 (cobalamin) deficiency
prolonged def. can lead to irreversible nerve damage
What vitamins are made microbes?
Vitamin K (in our guts) Vitamin B12 (synthesized by microbes in animals)
Causes of Vitamin B12 deficiency
malabsorption in terminal ileum - celiac, enteritis, diphyllobothrium latum
lack of intrinsic factors (pernicious anemia, gastric bypass)
absence of terminal ileum (surgical resection for Chron’s)
insufficient intake (vegan)
What is diagnostic for pernicious anemia?
anti-intrinsic factor antibodies
