Vitamins, Minerals + Electrolytes

Question 1

Which vitamin should be avoided in pregnancy, what is It found in?

Answer 1

Vitamin A- found in liver products, fish liver oils, carrots, eggs

Vitamin A helps with eye sight

Question 2

What is vitamin B1, and what do we need it for?

Answer 2

Thiamine

Need it for nerves (hence why lack of it can cause Wernickes encephalopathy- biochemical lesions of the central nervous system causing memory loss and confusion)

Question 3

What is vitamin B6, what do we need it for?

Answer 3

Pyridoxine

Key role in the nervous system- decreases the risk of Neuropathy associated with Isoniazid use (TB drug)

Itself can cause neuropathy if used for long time at high doses!

Question 4

What is vitamin B12 and what does it cause in deficiency?

Answer 4

B12= Cobalamin

Deficiency = Pernicious Anaemia (a type of Megaloblastic anaemia- MCV high, Heamoglobin low)

Replacement= Hydroxycobalamin

Question 5

What is Ascorbic acid? What is it used to treat?

Answer 5

Vitamin C- in oranges, peppers, broccoli

Used to treat scurvy (bleeding and inflamed gums and opening of wounds)

Question 6

Name some of the Vitamin D analogues we give for vitamin D deficiency? What kind of conditions do you see these in?

Answer 6

For prevention of osteoporosis
Hypocalceamia
Rickets
They help promote calcium absorption

Ergocalciferol (vit D2 + calciferol)

Colecalciferol (Vit D3)

alfacalcidol (hydroxylated vit D)

Calcitriol (hydroxylated vit D)

Question 7

What forms of Vitamin D should be given in renal impairment, and why?

Answer 7

Vitamin D requires hydroxylation by the kidney into its active form. Therefore in renal impairment, hydroxylated vitamin D is given in the form of:

Alfacalcidol
Calcitriol

If not renally impaired, standard Egocalciferol or Colecalciferol (Non hydroxylated) can be used.

Question 8

What is the main function of Vitamin K? What foods is it found in?

Answer 8

Blood clotting- used for major bleeds with warfarin

It is found in green leafy vegetables- broccoli and spinach

Question 9

What is the name of the Vitamin K used to reverse warfarin overdose bleeding? When should a patient stop taking warfarin and receive this?

Answer 9

Phytomenadione by Slow IV injection

INR > 8, or any major bleeding: Stop taking- A & E- phytomenadione + dried prothrombin complex

INR > 8, minor bleeding: stop taking, A & E: Phytomenadione injection

INR > 8, No bleeding: stop taking, A & E, phytomenadione BY MOUTH

INR > 5: minor bleeding: stop warfarin, A & E: Phytomenadione BY MOUTH

INR > 5: no bleeding: Miss 1 or 2 doses of warfarin, reduce maintenance dose

Question 10

What are the synthetic derivatives of folate, and when do we use these?

Answer 10

Folic acid- used for prevention of NTD’s
Folic acid 400mcg in women of low risk
Folic acid 5mg for those at high risk

Folic acid 5mg for Megaloblastic anaemias

Folinic acid- given with methotrexate treatment to reduce methotrexates side effects

Question 11

What drugs can produce a folate deficiency? (4)

Answer 11

Methotrexate

Phenytoin

trimethoprim-sulfamethoxazole

sulfasalazine

Question 12

What kind of anaemia does folate deficiency cause?

Answer 12

Megaloblastic anaemia

High Mean Cell Volume, Low Heamoglobin level

Question 13

Can Vitamins be prescribed on NHS Rx’s as dietary supplements?

Answer 13

No- only for deficiency states

Question 14

What is the risk of injectable Iron?

Answer 14

Serious Hypersensitivity Reaction with injections

Question 15

What would be the signs of Magnesium deficiency?

Answer 15

Apathy (lack of enthusiasm) and muscle weakness

Question 16

Symptoms of Low potassium?

Usually when potassium falls below 2.5 mmol/ L

Answer 16

Weakness, drowsiness
Muscle cramps
Low BP (dizziness)
Palpitations (arrhythmias)
tingling/ numbness
Confusion
Constipation!!

Question 17

Symptoms of Low sodium (Hyponatreamia)?

Answer 17

CONFUSION
drowsiness
Nausea & Vomiting
Personality changes
Muscle cramps
Weakness

Question 18

What is a benefit of using potassium sparing diuretics over potassium salts to correct potassium levels?

Answer 18

Potassium salts can cause nausea and vomitting

Question 19

What is the normal potassium range?

What is classed as severe Hyperkaleamia?

Answer 19

3.5 - 5.3 mmol/ L

Severe: > 6.5 mmol/ L (risk of cardiac arrest- treat with calcium gluconate then insulin or bicarbonate)

Question 20

Symptoms of Hyperkaleamia?

Answer 20

V similar to Hypokaleamia:
Arrhythmias
muscle weakness, 
tingling sensations,  
nausea

Question 21

What is the normal sodium range?

Answer 21

133 - 146 mmol/L

Question 22

What drugs may cause Hypernatreamia? (3)

Answer 22

Corticosteroids
Phenytoin
Lithium

Question 23

What drugs may cause Hyponatreamia? (5)

Answer 23

Diuretics- thiazide & Loop
SSRI's
Vasopressin (used in diabetes insipidus)
Carbamazepine
Sulfonylureas

Question 24

What is the rationale behind Oral Rehydration salts?

Answer 24

Intestinal absorption of sodium and water is enhanced by Glucose.
There ORT contains sodium, potassium and glucose/ another carbohydrate (RICE) to replenish electrolytes lost in diarrhoea.

Question 25

What can too rapid injection of Calcium salts cause?

Answer 25

Arrhythimas

Question 26

What can magnesium salts cause and therefore be used as?

Answer 26

Diarrhoea
Used as osmotic laxative

Also used for seizures in pre-eclampsia and eclampsia (hypertension in pregnancy (pre-eclampsia) leading to convulsions- eclampsia)

Question 27

What are acute prophoryias?

Answer 27

A hereditary disorder of Haem biosynthesis- list of drugs in the BNF that are unsafe in this condition eg HRT, COC’s, POP’s

Question 28

Drugs causing Hypokaleamia (4)?

Answer 28

Thiazide & related diuretics
Loop diuretics (e.g. furosemide)
Beta 2 agonists (e.g. salbutamol)
Insulin

Question 29

Drugs causing Hyperkaleamia (5)?

Answer 29

K sparing diuretics (e.g. amiloride, Triamterene) + Aldosterone agonists (e.g. spironolactone, eplerenone)
ACE inhibitors confusion, muscle twitching or spasms,
NSAIDs
Heparin

Question 30

Drugs causing Hypermagnesaemia?

Answer 30

Antacids
Mg supplements
Remember Mg may cause diarrhoea

Question 31

Drugs cause Hypomagnesaemia? (4)

Answer 31

Thiazide and related diuretics
Loop diuretics (e.g. furosemide)
Digoxin
Aminoglycosides (e.g. gent, vanc)

Question 32

Hypernatreamia- symptoms?

Answer 32

Major symptom= thirst
confusion
muscle twitching/ spasms,

Question 33

What electrolyte disturbance can long term PPI therapy (3 months- 1 year) cause ?

Answer 33

HypoMAGNESAEMIA

Question 34

What can we use to correct Hypercalcaemia?

Answer 34

Bisphosphonates- they bind calcium! e.g. pamidronate

Question 35

Vitamin C deficiency signs?

Answer 35

swollen gums, bleeding gums, gum hyperplasia

Question 36

Vitamin B12 deficiency signs?

Answer 36

Cracked mouth
Mouth sores
Extreme tiredness
Headaches