Vitamins/Minerals Flashcards by Jaime Cramer

DRI

Requirement based on optimal health

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EAR

Base to develop what

Mets needs 50% of individuals - base to develop RDA

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RDA

Meets needs of 98% people - 2 SD above EAR if well defined

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Average observed intake to sustain nutrition state

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Be cautious of supplementing vitamin A in…

Liver failure

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Hyperkeratosis (thickening of skin), ‌Xerophthalmia (dry eyes), Night blindness, Bitots eye spots

Vitamin A

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Medications that decrease fat soluble vitamins

Cholestyramine, Lomitapide, Octreotide, Orlistat

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Steroids can decrease level of what vitamin?

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D2 vs D3

Both from diet; D3 from sun

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Best measure of Vit D status and what level is sufficient

Calcidiol, >30

More accurate to also look at PTH and Ca

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Osteomalacia, Tetany, Hypocalcemia, Rickets

Vitamin D deficiency

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Vitamin D may ___ effect of Digoxin

Increase

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Phenobarbitol and Phenytoin decrease level of

Vitamin D

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Age spots, vision changes/loss/patalysis, Ptosis, Neuro degeneration,

Vitamin E deficiency

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Hemolytic anemia in newborn

Vitamin E deficiency

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Vit C absorbed in

Ileum. Requires energy

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Capillary rupture, petechiae, corkscrew hair, bleeding gums, Scurvy

Vit C deficiency

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When supplementing Vitamin C, must be cautious of…

Kidney stones - vitamin C inhibits reabsorption of uric acid

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Dry beri-beri (neuropathy, paresthesia, weakness), encephalopathy, nystagmus (involuntary eye movement), wet beri-beri (cardiovascular problems)

Thiamin deficiency

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______ deficiency renders thiamin unusable

Magnesium deficiency

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_____ (2) meds can cause thiamin deficiency

Furosemide and digoxin

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Riboflavin dissociates using ____ and ____ increases absorption

HCl ; Bile salts

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Antidepressants and tetracycline decrease absorption of

Riboflavin

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Which vitamin helps synthesize/activate folate?

Riboflavin and Niacin

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Scaly dermatitis, visual impairment, photophobia, stomatitis, cheliosis (cracked corners of mouth), glossitis

Riboflavin

Cheliosis/Stomatitis and Glossitis

Riboflavin and B6

Pellagra (dermatitis, diarrhea, dementia), glossitis, peripheral neuritis, paralysis extremities

Niacin deficiency

Dermatitis, stomatitis/cheliosis, glossitis, convulsions, anemia

B6 deficiency

B12 is reabsorbed via

Enterohepatic circulation

Which vitamins helps convert homocysteine to other chemicals

B12, Folate, B6, Choline

Why B12 deficiency presents as folate deficiency

Low B12 traps folate in inactive form

Complications of high homocysteine levels

Increased risk heart disease, stroke, dementia, osteoporosis

____ and ____ levels may increase in B12 deficiency

MMA and Homocysteine

Glossitis, hand/feet paresthesia, AMS

B12 deficiency

Decrease B12 absorption (4)

Excess vitamin C, metformin, colchicine, PPI

Decreases absorption of folate (5)

``` Zinc deficiency Impaired bile secretion Estrogen, birth control Cholestyramine Metformin ```

Also check level of ___ and ____ in folate deficiency

B12 and homocysteine

Fatigue, pallor, neurological problems

Folate deficiency

Biotin/B7 synthesized by

Colon bacteria

Pallor, scaly dermatitis/face rash, alopecia

Biotin deficiency

____ excretion indicator of B5 deficiency

Urinary

Numbness/burning/paresthesia in extremities, neurological, muscle cramp

B5 deficiency

Risk for choline deficiency

Pregnant/lactating, post menopause, long term PN

Hepatis steatosis sign of ____ deficiency

Choline deficiency

Iron absorbed in

Duodenum/jejunum

Which trace element is recycled

Iron

Early phase iron deficiency | And if continues

Decrease transferrin saturation Decrease iron Increase plasma transferrin Decrease ferritin

Iron deficiency anemia labs

Decrease MCV and Hgb

Increased risk iron deficiency

Women child bear age, decreased gastric acid secretion, older adults, Roux en Y

Decreased absorption nonheme iron (7)

Phytic acid, oxalic acid, polyphenols, Ca, Zn, Mn, Chromium toxicity

Pallor, scoop nails, conjunctive pallor, glossitis, impaired cognition, poor capillary refill

Iron deficiency

Medications decrease absorption iron

Antacids, PPI, levothyroxine, caffeine, Phos binder

Low albumin can cause low ___

Zinc

Zinc is a ___ phase reactant | What to check

Positive | Check CRP

Decreases zinc absorption (2)

Phytic acid, calcium

Rash, alopecia, impaired night vision altered taste/smell, diarrhea

Zinc deficiency

___ and ___ compete with zinc absorption

Ca and Iron

High zinc supplementation may lead to ____ def

Copper

Decreased absorption Zinc (4)

Abx, Phos binder, Steroids, Birth control

Copper regulated by

Biliary excretion | Impaired biliary secretion can lead to Copper toxicity and damage to liver

Decrease Copper absorption

PPI and birth control

Don't supplement copper with

Liver dysfunction

Tremors, difficulty walking, and facial muscle spasms

Manganese toxicity

Selenium can cause

Altered thyroid hormone metabolism

Iodine is important for | Deficiency -->

Thyroid hormones | Increase TSH ---> Goiter

Lithium decreases

Thyroid hormone release

Iodine absorption altered by ____ and competes for absorption with ____

Selenium deficiency | Cruciferous vegetables

Increased excretion of Chromium in (2)

T2DM and pregnancy

Glycosuria, peripheral neuropathy, hyperglycemic

Chromium deficiency

Mottled teeth, convulsions, paralysis

Flouride toxicity

Long term PN toxicity (3)

Copper, Manganese, Chromium

Nutrients can be lost with storing EN at high temp and storing for >9 months

Thiamine, Riboflavin, A & E

Scaly dermatitis, alopecia, hepatomegaly, thrombocytopenia, fatty liver, anemia

EFAD deficiency

MCV > 100

Megaloblastic anemia | B12 and folate

Manganese toxicity

Headache, Parkinson's like abnormalities

Vitamin K toxicity

Jaundice

Vitamin E toxicity

Bleeding/prolonged clotting time

Zinc toxicity

N/V, metallic taste

Copper toxicity

N/v, abd pain, diarrhea

Aluminum toxicity (2)

Neuro problems/confusion, anemia

Selenium toxicity

Hair loss, dermatitis, garlic odor, brittle nails

When making PN, add ____ first and then ____ near the end

Phos first | Calcium near the end

Chromium Deficiency

Liver dysfunction, renal failure

Anemia, peripheral neuropathy, leukopeni

Copper deficiency

Check vitamin A status

Serum retinol

Symptoms hypocalcemia

Anorexia N/V Dehydration Neuromuscular irritability

Cheliosis seen in (4) deficiency

2, 3, 6, Iron

Vitamin D dependent type 2 rickets

Increased vitamin D level