Vitamins ii

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Vitamins ii

  1. 1. VITAMIN DEFICIENCY AND EXCESS
  2. 2. vitamins  Vitamins are the organic substances in food, which are required in very small amounts and are not synthesized by the body.  They occur naturally in food and are essential for good health.  Vitamins are broadly categorized into two forms  Fat soluble vitamins –Vitamin A,D,E and K  Water soluble –Vitamin B complex and vitamin C
  3. 3. VITAMIN A(RETINOL)  Liver is the richest source,fish,eggs  Green leafy vegetables, carrots, and yellow fruits  Plays an important role in vision. Retinaldehyde is the part of the photoreceptors of rods in retina  Vitamin A is also necessary for normal growth, fetal development, fertility, haemopoiesis and immune function  DEFICIENCY Causes-  Nightblindness  Xerophthalmia  Bitot’s spots  Corneal ulceration and necrosis  Keratomalacia with scarring leading to blindness
  4. 4.  Deficiency is treated by a single large dose of retinol as palmitate or acetate 200000 IU orally or IM  Xerophthalmia – 60mg of vit A in oily soln  TOXICITY of vitamin A causes liver damage,hyperostosis and teratogenicity.  Acute overdose can cause nausea and headache, raised intracranial pressure and skin desquamation.  Excessive intake of carotene causes hypercarotenosis (pigmentation of skin)
  5. 5. VITAMIN D  Natural form ofVitamin D is cholecalciferaol. It is formed in the skin by the action of ultraviolet rays on 7-dehydrocholesterol.  Dietary sources are egg yolk , fish oil, butter and milk.  Cholecalciferol is not biologically active. It is converted in the liver to 25- hydroxycholecalciferol which is further hydroxylated in kidneys to 1,25 dihydroxycholecalciferol.This is the active form of vitamin D
  6. 6. Functions  Vitamin D helps in uptake of calcium from the gut and bone formation  Maintains normal functioning of muscles, immune function and inflammation.
  7. 7.  DEFICIENCY leads to poor bone mineralization causing rickets in children and osteomalacia in adults.  Deficiency occurs due to malabsorption or chronic renal disease  TOXICITY leads to hypercalcaemia leading to renalcolic ,polyuria, polydipsia,lethargy,nausea, depression, drowsiness
  8. 8. VITAMIN E  α- tocopherol is the active form of vitamin E in human body.  FUNCTIONS • The main function of vitamin E is anti oxidant. It intercepts free radicals & prevents destruction of cell membrane. • It prevents the oxidation of PUFA by free radicles. • It is involved in anti-inflammatoy and immune systems. • It inhibits platelets aggregation. • It enhances vasodilatation.
  9. 9. Vitamin E Dietary Sources  Vegetable oils  Almonds & peanuts  sunflower oil  Spinach  Carrots (least)
  10. 10. Vitamin E deficiency •Severe vitamin E deficiency causes: Neurological symptoms (impaired coordination) & muscle weakness causing ataxia. Increased risk of cardiovascular diseases Visual scotomas Deficiency occurs in severe PEM and fat malabsorption syndrome Deficiency is t/t by 800-1200mg of tocopherol/d
  11. 11. THERAPEUTIC USES  Prevention of cardiovascular diseases  Diabetes Mellitus  Cancer prevention  Boost immunity  Dementia
  12. 12. TOXICITY Excess vitamin E may cause:  Impaired blood clotting leading to increased risk of bleeding in some persons. It is recommended that vitamin E supplements to be stopped one month before elective surgery.
  13. 13. VITAMIN K The K is derived from the German word Koagulation. There are 2 naturally occurring forms of vitamin K. Plants synthesize phylloquinone (vitamin K1) & bacteria synthesize menaquinone-3 (vit K2).
  14. 14. FUNCTIONS •Vitamin K is needed for production of vitamin K-dependent coagulation factors in the liver. •Other functions include: Assist in bone mineralization. The mineral binding capacity of osteocalcin requires vit K.
  15. 15. SOURCES OFVITAMIN K Bacteria in large intestine produce vit K2 and supply 40-50% of human requirement. Vegetable oils Almonds & peanuts Avocado & Broccoli Spinach, Lettuce.
  16. 16. Vitamin K deficiency  deficiency leads to delayed coagulation and bleeding. Is uncommon in adults. Only those with severe liver disease (obst. Jaundice) chr. Small intn dis & those on oral anticoagulants are at risk.  Exclusively breast fed & premature babies are at risk coz human milk is low in vitamin K.  Hemorrhagic disease of the newborn is a serious threat to life & routine vit k prophylaxis is recommended.
  17. 17. VITAMIN C  Humans, unlike other mammals, are unable to make ascorbic acid & they get it from food.  Rich dietary sources are citrus juices (orange, grapefruit & lime), strawberry, Guava, tomato, sweet red pepper & broccoli.  Recommended daily intake is between 15-120 mg/day depending on age. Smokers & lactating mother needs the higher range.
  18. 18. FUNCTIONS  Collagen synthesis  Antioxidant property  promotes absorption of non-heme iron Connective tissue metabolism
  19. 19. Vitamin C deficiency  Severe deficiency leads to Scurvy with the following manifestations: Bleeding & bruising easily- swollen bleeding gums, petechial h’ges,ecchymosis Joint pain & swelling Poor wound healing Fatigue & lack of concentration
  20. 20. • Cardiovascular diseases • Cataracts • Diabetes Mellitus • Cancer prevention • Common cold Treatment -250 mg vit C 8hrly THERAPEUTIC USES
  21. 21. VITAMIN B Complex
  22. 22. Thiamine (Vit. B1)  Known as B1 cause first identified.  Function – important role in peripheral nerve conduction.  Food sources– pork, meat, yeast, beef, legumes, whole grains, nuts.  Deficiency – poor intake, chronic illness, chronic alcoholism, hyperemesis, bariatric surgery.
  23. 23.  Signs and symptoms – anorexia, irritability and Beri Beri Types of Beri Beri --- wet, dry and infantile Wet type – Cardiovascular symptoms, Cardiomegaly, tachycardia, CCF Dry type – symmetrical peripheral neuropathy
  24. 24.  In alcoholics – chronic deficiency causes CNS manifestations like horizontal nystagmus, ophthalmoplegia, cerebellar ataxia, mental impairment known as Wernicke’s Encephalopathy.  Wernicke’s Encephalopathy with loss of memory and psychosis is known as Wernicke’s Korsakoff’s syndrome TREATMENT– acute deficiency  100 mg/day IM for 7 days f/b 10 mg/day till recovery.
  25. 25. Riboflavin (Vit. B2)  Important for metabolism of CHO,fat,proteins Deficiency causes-- Lesions of mucocutaneous surface of oral cavity and skin, Corneal vascularization, Anemia and Personality changes Sources are-- Milk and dairy products, Enriched breads, Cereals, Fish, Eggs, Broccoli and Legumes Toxicity– not known becoz GI absorption is very limited.
  26. 26. Niacin (Vit. B3)  Refers to nicotinic acid nicotinamide and derivatives.They are precursors of NAD and NADP which are important in oxidation and reduction reactions in the body.  Sources—beans, milk, meat, eggs  Deficiency causes Pellagra  Common in corn eating population, alcoholics Hartnup’s disease, carcinoid syndrome
  27. 27. S/S of Pellagra  Loss of appetite, gen weakness, irritability abdominal pain and vomiting  Red tongue  Characteristic skin rash, pigmented and scaling skin(rash known as Casal’s necklace)  Diarrhea, dementia,depression,seizures
  28. 28.  Severe Pellagra--3Ds leading to death dermatitis diarrhea dementia  Treatment – 100 -200 mg of nicotinamide TDS daily for 5 days
  29. 29. Pantothenic Acid (Vit. B5)  Component of co-enzyme A  Source– liver, yeast, egg yolk, whole grains, vegetables  Deficiency—GI disturbances, depression, muscle cramps paresthesias, ataxia  No toxicity known
  30. 30. Pyridoxine (Vit B6)  It is a cofactor for many enzymes involved in amino acid metabolism  Synthesis of heme and neurotransmitters  Metabolism of glycogen, lipids, steroids and several vitamins.  Sources– legumes, nuts, wheat bran, meat . Bioavailability is more in animal sources.
  31. 31. Deficiency  Epithelial changes,  Depression, confusion  Microcytic hypochromic anemia due to reduced heme  Hyperhomocystenemia -increased risk of CV disease  In infants diarrhea ,seizures  Some drugs like INH ,penicillamine ,alpha dopa
  32. 32. Toxicity  Sensory neuropathy  Photosensitivity Treatment RDA--- 1.5-- 2 mg/day 100mg im daily for seizures
  33. 33. Folic Acid (Vitamin B9) Functions: 1. Needed for RBC & DNA formation, cell multiplication esp. GI cells 2. Newly discovered functions: a. Prevents neural tube defects b. Prevents heart disease (reduces homocysteine levels) c. Prevents colon cancer Etiology:  Peak incidence 4-7 months  Deficient dietary intake: goat’s milk deficient & powdered milk poor source  Sources are liver, green leafy veg, and fortified cereals.
  34. 34. DEFICIENCY  Deficient absorption as in celiac disease, achlorhydria, anticonvulsant drugs and zinc deficiency  hypothyroidism, drugs like trimethoprim & alcoholism  Increased requirement during rapid growth & infection  Asso with vitamin B12 deficiency & chronic alcoholism  Increased destruction possible in cigarette smoking
  35. 35. Folic Acid Deficiency Clinical Manifestations: 1.Megaloblastic anemia w/ irritability, failure to gain wt & chronic diarrhea 2.Thrombocytopenic hemorrhages advanced cases RDA: 20-50mcg/24 hrs Treatment: 1.Parenteral folic acid 2-5mg/24 hrs, response in 72 hrs, therapy for 3-4 wks 2.Transfusions only when anemia severe
  36. 36. Cobalamine (Vitamin B12)  Vitamin B12 is absorbed from the terminal ileum in presence of intrinsic factor  Deficiency occurs in elderly patients, alcoholics, malabsorption, drugs like neomycin Clinical Manifestations of deficiency: 1. Megaloblastic anemia 2. Neurological includes ataxia, paresthesias, hyporeflexia, Babinski responses, clonus & coma 3. Tongue smooth, red & painful
  37. 37. RDA: Infants 0.5 mcg/day Older children & adults 3mcg/day Treatment: 1. Prompt hematological response w/ parenteral vitamin B12 1-5mcg/24hrs 2. If there is neurological involvement 1mg IM daily for at least 2wks 3. Pernicious Anemia: Monthly vitamin B12 1mg IM necessary throughout patient’s life
  38. 38. TRACE ELEMENTS CALCIUM  Dietary sources – milk ,cheese, yoghurt, eggs, fish, almonds, peanuts, peas and beans  Calcium absorption is impaired in vit. D deficiency, malabsorption and some foods like spinach  Deficiency causes impaired bone mineralization in children and increased bone loss in adults
  39. 39. phosphorus  Dietary deficiency is rare  Phosphates are added to processed foods  Deficiency occurs in premature infants, renal tubular phosphate loss.  Deficiency causes hypophosphatemia and muscle weakness
  40. 40. IRON  Needed in formation of Hb, and involved in many enzymatic reactions.  Dietary sources are red meat, liver, fish, shellfish,oatmeal, legumes, nuts, dried fruits  Normal daily loss is 1 mg by desquamated surface cells and intestinal loss.  30 mg of iron is lost in menstruation  Daily intake of 8 mg  Vitamin C enhances iron absorption  Overload of iron leads to haemochromatosis and liver cirrhosis
  41. 41. IODINE  Sources are sea fish, seaweed and plants grown near the sea.  Deficient in mountainous regions.  Deficiency cause IDD, goitre is common, congenital hypothyroidism, deafness, poor reflexes and poor learning
  42. 42. ZINC  Present in meat, shellfish, nuts and legumes  Zn helps in synth and stabilization of protiens  Deficiency is seen in PEM, malabsorption syndromes, alcoholics and alcoholic liver disease.  Deficiency is characterized by growth retardation, hair loss, chronic diarrhea ,muscle wasting and, mental apathy.  Zn promotes general well being, healing of skin lesions and improves appetite
  43. 43. SELENIUM  Prevents free radical damage to the cells.  Takes part in conversion of thyroxin to triiodothyronine in liver  Deficiency – hypothyroidism, cardiomyopathy in children and myopathy in adults
  44. 44. FLUORIDE  Prevents dental caries.  Deficiency is seen where people consume soft water.  Excess fluoride cause increase bone density, calcification of ligaments and tendons, also affects the dental enamel and causes mottling, pitting and pigmentation.
  45. 45. COPPER  DEFICIENCY can cause microcytic hypochromic anemia, neutropenia, retarded growth in children, skeletal rarefaction and dermatosis  Abnormal copper metabolism is seen in wilson’s disease  Deficiency occurs in PEM or prolonged parenteral nutrition
  46. 46. THANKYOU
  47. 47. Clinical finding of vit defi Nutrient Clinical Finding Thiamine Beriberi: neuropathy, muscle weakness and wasting, cardiomegaly, edema, ophthalmoplegia, confabulation Riboflavin Magenta tongue, angular stomatitis, seborrhea, cheilosis Niacin Pellagra: pigmented rash of sun-exposed areas, bright red tongue, diarrhea, apathy, memory loss, disorientation Vitamin B6 Seborrhea, glossitis, convulsions, neuropathy, depression, confusion, microcytic anemia Folate Megaloblastic anemia, atrophic glossitis, depression, homocysteine
  48. 48. nutrient Clinical finding Vitamin B12 Megaloblastic anemia, loss of vibratory and position sense, abnormal gait, dementia, impotence, loss of bladder and bowel control, homocysteine, methylmalonic acid Vitamin C Scurvy: petechiae, ecchymosis, coiled hairs, inflamed and bleeding gums, joint effusion, poor wound healing, fatigue VitaminA Xerophthalmia, night blindness, Bitot's spots, follicular hyperkeratosis, impaired embryonic development, immune dysfunction Vitamin D Rickets: skeletal deformation, rachitic rosary, bowed legs; osteomalacia Vitamin E Peripheral neuropathy, spinocerebellar ataxia, skeletal muscle atrophy, retinopathy Vitamin K Elevated prothrombin time, bleeding
  49. 49. Element Deficiency Toxicity Boron No biologic function determined Developmental defects, male sterility, testicular atrophy Calcium Reduced bone mass, osteoporosis Renal insufficiency (milk-alkali syndrome), nephrolithiasis, impaired iron absorption Copper Anemia, growth retardation, defective keratinization and pigmentation of hair, hypothermia, degenerative changes in aortic elastin, osteopenia, mental deterioration Nausea, vomiting, diarrhea, hepatic failure, tremor, mental deterioration, hemolytic anemia, renal dysfunction Chromium Impaired glucose tolerance Occupational: renal failure, dermatitis, pulmonary cancer Fluoride Dental caries Dental and skeletal fluorosis, osteosclerosis

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