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Function Anti-oxidant Vision (retinol) Embryonic development Tissue differentiation Growth Coenzyme in (1) Pyruvate dehydrogenase (2) -ketoglutarate dehydrogenase (TCA) (3) Transketolase (HMP shunt) (4) Branch-chain AA dehydrogenase
Storage, longevity
High risk for Deficiency Fat malabsorption Poor diet Smoking ( -carotene) Cystic fibrosis Alcoholics Poor diet IV glucose loading Genetic transketolase def. Gastric bypass surgery
Deficiency Symptoms
Notes Used to treat measles, deficiency increases risk for measles Cant overdose, but you turn orange Toxicity: arthralgia, fatigue, headaches, Distinguish hypercarotinemia from hyperbilirubinemia (jaundice) based on color of sclera icterus (seen in hyperbilirubinemia) Wernicke-Korsakoff: confusion, ophthalmoplegia, ataxia, confabulation, permanent memory loss Dry beri-beri peripheral neuropathy Wet beri-beri cardiomegaly, tachycardia, high-output CHF
Liver, +1year
Oculo-orogenital syndrome Vitamin B2 and B6 Deficiency Component of coenzymes NAD, NADP glycolysis, tissue respiration None, weeks Inadequate dietary niacin and tryptophan, alcohol Pellagra -3Ds diarrhea, dermatitis, dementia Pellagra Casals necklace, diarrhea, dermatitis, dementia Toxicity: flushing, nausea, vomiting, liver injury, diarrhea
B6 Pyridoxine
None
Polyneuropathy Oxalate stone formation Seborrheic dermatitis Angular stomatitis, cheilitis Glossitis, Cheilosis Sideroblastic anemia Macrocytic anemia (pernicious) Leukopenia Thrombocytopenia Stomatitis, glossitis Macrocytic anemia Leukopenia Thrombocytopenia Glossitis, Stomatitis Neural tube defects Scurvy Corkscrew hairs Perifollicular petechiae Ecchymoses Impaired wound healing Rickets (children) Osteomalacia (adults) Premature: hemolytic anemia, retinopathy, bronchopulonary dysplasia Malabsorption: neuropathy, myopathy with creatinuria Bleeding, increased PT, ecchymoses
Glossitis and cheilosis are nonspecific and can be caused by other Vit. B deficiences Longevity inversely related to protein intake *Pernicious anemia is an exception to the rule where vitamin deficiencies run in clusters. This is an autoimmune disease that can occur without other deficiencies *Check with Schillings test Give pregnant mothers folate supplements to reduce risk of neural tube defects Metabolism is linked to Vit. B12 metabolism so coexisting problems may occur Scurvy swollen gums, bruising, hemarthrosis, anemia, Poor wound healing collagen deficiency affects cartilage, bone, skin integrity Toxicity: Hypercalcemia, hypercalciuria, loss of appetite, stupor, fatigue, headache, vomiting, growth arrest in children Lab test: serum tocopherol Toxicity: higher risk of hemorrhagic stroke
B12 Cobalamin
Liver, months
Hydroxylation of proline/lysine in collagen synthesis, Antioxidant Enhances GI Iron absorption Inhibits copper absorption Facilitates calcium and phosphorus absorption and utilization,
None, 6 weeks
Smoking Physiologic stress from illness Chronic fat malabsorption Gastric bypass surgery Renal insufficiency, inadequate sun exposure Severe long term fat malabsorption, prematurity
Antioxidant, free radical scavenger (primarily in membranes Carboxylation of Glutamic acid residues in formation of clotting factors II, VII, IX,X
Iron
Months
Zinc
Essential for activity of 100+ enzymes Formation of zinc fingers (transcription factor motif)
Selenium
Antioxidant (glutathione peroxidase) Free radical scavenger, works with vitamin E to reduce lipid peroxidation
None, years
Anemia, Pallor, Fatigue Glossitis Microcytic, hypochromic anemia Tachycardia* Growth retardation Hypogonadism Impaired taste Delayed wound healing Scaling skin Acrodermatitis enteropathica (hereditary) Cardiomyopathy (Keshan Disease) Increased cancer rates
Zinc interferes with iron and copper metabolism Possible immune function impairment
When you have someone who is B12 deficient, often there is a coexiting folate deficiency. The thing I want to leave you with is, I want you to think of B12 and Folate together. If you give folic acid to someone who is vitamin B12 deficient, you will treat the macrocytic anemia, but you wont treat the posterior column signs (pneurologic symptoms: paresthesia, subacute combined degenration) due to abnormal myelin you find with B12 deficiency Iron deficiency is most common nutritional deficiency worldwide iron is absorbed in the duodenum ***high yield (enterocyte transport via ferroportin) requires pH