Vitamins Fat soluble

Question 1

Fat soluble vitamins

Answer 1

ADEK

“Fat people are food ADEKs”

Question 2

Vit A fxn

Answer 2

Photochemical basis for vision
- retinal signaling to brain visual cortex
Maintenance of conjunctiva and cornea
(epithelia of eye)

Question 3

Food sources for Vit A

Answer 3

1. Preformed retinal palmitate from animal sources
   - liver, dairy, egg yolk, fish oil
2. Precursor Beta-carotene
   - deep yellow and green veggies
   - spinach, carrots, broccoli, pumpkin

Question 4

Vit A deficiency findings

Answer 4

1. Eyes
   - xerophthalmia (dry eyes)
   - Bitot’s spots
   - night blindness
2. Epithelium
   - flat, dry, keratinized linings
3. Immune impairment

Question 5

Sx of Vit A toxicity

Answer 5

1. Vomiting, increased ICP, headache
2. Bone pain, osteopenia/porosis
3. liver dmg hepatitis –> fibrosis –> failure
4. Death
5. Birth defects

Question 6

Vit D fxn

Answer 6

Hormone

• PM and nuclear receptors
• Maintains intra/extracellular Ca2+
• Immune fxn
• Regulated Cell growth and differentiation

Question 7

Vit D Sources

Answer 7

(low in breast milk)

1. Conversion in Skin
   - UVB light –> Dehydrocholesterol precursor in skin –> cholecalciferol (D3)
2. Dietary
   - Fish liver oils, fatty fish, egg yolk
   - fortified milk and formula
3. Plant algae, yeast + UV –> D2 Ergocalciferol
4. Animal D3 Cholecalciferal –> more potent

Question 8

_____ soluble vitamins are more associated with toxicity with excess intake

Answer 8

Fat soluble

Question 9

Vit A toxicity is associated with which type of Vit A intake?

Answer 9

associated only with preformed Vit A (retinal palmitate ie: cod liver oil)

NOT with precursor beta-carotene
- babies cannot overdose on carrot purees

Question 10

How does Vit D help with immune fxn?

Answer 10

Innate:
- antimicrobial peptide generation in macrophages

Adaptive:
- modulation of cytokines

Question 11

Vit D metabolism

Answer 11

D2 or D3 is hydroxylated in LIVER
- 25 OH Vit D reflects body STORES

25 OH Vit D hydroxylated again in KIDNEY to active form 1,25 OH Vit D (Calcitriol)

Question 12

Childhood rickets

Answer 12

Vit D deficiency in kids

• failure of calcification
• Wide metaphyses (wrists, ‘rosary’)
• bone pain
• bowed legs
• fractures

Question 13

Is Vit D sufficient for breastfed infants >2 mo?

Answer 13

No, need supplements

Question 14

If indiv have liver or renal disease, which Fat soluble vit deficiency do you have to worry about them developing? What do you give them for supplements?

Answer 14

Vit D
- Hydroxylation step 1 and 2 affected

• need calcitriol Rx supp.

Question 15

Vit D Supplementation levels in:
Breastfed infants
Children
Adults

Answer 15

Breastfed infants
- 400 IU

Children
- 600 IU

Adults

• 600 IU
• 800 IU if >70

Question 16

Vit D toxicity findings

- risk

Answer 16

Hypercalcemia
Vomiting
Seizures
nephrocalcinosis
vascular + soft tissue calcinosis

• Risk: Sarcoidosis (granulomas activate Vit D)

Question 17

Vit E fxn

Answer 17

Antioxidant
Scavenges free radicals
Stabilizes cell membrane

Question 18

Vit E sources

Answer 18

Polyunsaturated fat rich vegetable oil
Corn
Nuts
Wheat germ

Question 19

Vit E toxicity

Answer 19

coagulopathy

- very lg doses inhibit Vit K dependent clotting factors

Question 20

Vit E deficiency sx

Answer 20

Neurologic degeneration (irreversible!)

1. loss of reflexes
2. Loss of coordination
3. Loss of vibration and position sense
4. Spinocerebellar ataxia
5. Neuropathy
6. Ophthalmoplegia

Hemolytic anemia

Question 21

Fxn of Vit K

Answer 21

Carboxylation of clotting factors
II, VII, IX, X
2, 7, 9, 10

Question 22

Sources of Vit K

Answer 22

Leafy greens
brocolli
fruits
seeds
beef liver

Question 23

Which vit def is associated with Newborns, antibiotics, poor diet?

Answer 23

Vit K

• all newborns need 0.5-1.0mg IM once

Question 24

Which vitamin def is associated with prematurity?

Answer 24

Vit E

Question 25

Which Vit is assoc. with dark pigment, obesity, breastfeeding, liver/kidney dx?

Answer 25

Vit D