Vitamins and Nutrition

Question 1

Vitamins

Answer 1

• Cofactors in enzyme reactions
• Fat soluble or Water-soluble

Question 2

Fat Soluble Vitamins, Storage

Answer 2

Stored in Liver or Adipose tissue and can accumulate to toxic levels

A, D, E, K

Question 3

Water Soluble Vitamins, Excretion

Answer 3

Easily lost in urine, generally do not accumulate

C and B Vitamins

Question 4

Retinol (A)

Answer 4

Deficiency causes drying, degeneration, risk of eye infections, night blindness

High levels can cause Liver disease

Carried in plasma by retinol binding protein and transthyretin then converted to Retinal in the eyes

Question 5

Vit D, Interactions with PTH and Ca

Answer 5

Proper skeletal formation (rickets, osteomalacia, osteoporosis), mineral/hemostasis, sun catalyzes formation

1. Interacts with PTH and Ca which regulates production in kidney, measured in parathyroid and cardiac disease
2. PTH stimulates renal release and activation of VitD, controlled by Ca levels and high VitD levels
3. Active hormone produced by kidney metabolism and stimulates reabsorption of Ca and P, overload can cause deposits in renal system
4. Circulates in plasma bound to VitD binding Alpha Globulin Protein
5. Secondary Controls of Bone Minerals (Calcitonin, Glucocorticoids, Estrogens), stimulates intestinal absorption of Ca and PO4

Question 6

Vitamin E

Answer 6

Antioxidant, defense against disease/aging, protects RBC membrane, deficiency causes hemolytic disease in premature neonates

Question 7

Vitamin K

Answer 7

Needed for Thrombin formation, lack of causes hemorrhage

Synthesized from dietary precursors by bacteria in Intestines or in Liver

Antibiotics can kill off the bacteria, Liver damage inhibits synthesis

Question 8

Vitamin K and Warfarin

Answer 8

Lipid soluble, oral administration

Inhibits VitK posttranslational modification and increases clotting time, crosses placenta and cannot be given during pregnancy

Effectiveness measured via prothrombin time

Question 9

Vitamin Sources

Answer 9

VitD related, PTH, VitD in dairy, Calcitonin in Salmon, Ca can be given via many methods

Question 10

Testing for VitD

Answer 10

For calcium homeostasis via immunoassay

Question 11

B1 (Thiamine)

Answer 11

Deficiency causes beriberi (severe peripheral nerve damage)

Coenzyme in carbohydrate/amino acid metabolism

Functional activity measured by RBC transketolase activity

Question 12

B2 (Riboflavin)

Answer 12

Deficiency causes photophobia

Cofactor for FAD needed for oxidation reactions

Body contains stores for 5 months of deficiency, deficiency indicated if glutathione reductase activity is greater then 40%

Question 13

B6 (Pyridoxine)

Answer 13

Deficiency causes Facial Seborrhea and hyperhomocystinemia

Question 14

Niacin (nicotinamide)

Answer 14

Deficiency causes Pellagra

Needed for NAD/NADH cofactors

Dosing lowers cholesterol levels

Question 15

Folic Acid/B12

Answer 15

Deficiency causes megaloblastic anemia

Cofactor for essential biochemical reactions (Methyl transfers in DNA synthesis, and Isomerization of L-methylmalonyl CoA with B12 deficeincy), extrinsic factor for cyanobalamin

Folate Supplementation in megaloblastic anemia, corrects anemia, prevents neural tube defects, prevents cardiovascular accidents with reduced homocysteine levels

Question 16

Megaloblastic Anemia

Answer 16

Large nucleated red cells with reduced RBC production, loss of absorption of B12 in GI (distal ileum)

Question 17

Pernicious Anemia

Answer 17

Lack of intrinsic factor which is required for B12 absorption

Question 18

Schilling Test

Answer 18

Patient is given radioactive B12 and 24hr urine is collected and measured for radioactivity

Question 19

Vitamin C

Answer 19

Deficiency causes scurvy, hemorrhagic disorders, anemia

Needed in collagen formation and mineral absorption

Measured via HPLC

Question 20

Clotting Cascade and Vit K

Answer 20

Anticoagulants, for treatment of patients at risk of vascular occlusions or increase clotting in clotting deficiencies

Drugs Facilitating clotting, replacement factors, VitK, Antiplasmin

Question 21

Essential Fatty Acids

Answer 21

Polyunsaturated fatty acids:

1. Omega 6
2. Omega 3

Testing Methods: GC, HPLC

Question 22

Omega 6

Answer 22

Platelet adhesion

Question 23

Omega 3

Answer 23

Form prostaglandins, leukotrienes, reduce inflamm., support immune system

Question 24

Crohns Disease

Answer 24

Fatty acid deficiency

Question 25

Nutritional Assessment

Answer 25

• Metabolic evaluation
• Recent weight changes
• Creatinine/height index
• Immune testing
• Protein Markers

Question 26

Recent weight changes in Nutritional Assessment

Answer 26

Unintentional weight loss of 10% or more

Question 27

Creatinine/height index in Nutritional Assessment

Answer 27

Measures lean body muscle mass

Question 28

Immune testing in Nutritional Assessment

Answer 28

Can be insensitive to determining cause

Question 29

Protein Markers in Nutritional Assessment

Answer 29

Prealbumin, albumin

Question 30

Decreases in Nitrogen Balance

Answer 30

During stress, burns, trauma

Question 31

Total Parental Nutrition

Answer 31

Intensive feeding through tubing giving appropriate intake of carbohydrates, proteins, essential fatty acids, minerals, lipids and trace elements

Question 32

Anemia Treatment

Answer 32

• Iron, VitB12, Folic Acid
• Microcytic hypochromic, Iron depletion
• Megaloblastic anemia, B12/Folic Acid
• Pernicious Anemia, Intrinsic Factor Loss
• Hemolytic Anemia, accumulation of iron stores

Question 33

Causes of Hematopoiesis Stimulation

Answer 33

Usually in BM

Anemia

Thrombocytopenia

Neutropenia

Question 34

Blood Cell Reference Values

Answer 34

WBC: 5000/uL Plts: 500,000/uL RBC: 5,000,000/uL

Question 35

RBC Indices

Answer 35

MCV: 80-90fL MCH: 27-32pg MCHC: 32-36g/dL