vitamin deficiency and their normal daily intake

2. Definition
 Vitamins are essential organic compounds that are needed in small
amount in the diet, both to prevent deficiency and to support
optimal health.
Vitamins- Vital Amines
Vital- Essential for life
Amines-These compounds contain an amine functional group

3. Classification
Fat Soluble Vitamin
 Vitamin A
 Vitamin D
 Vitamin E
 Vitamin K
Water Soluble Vitamins
 Vitamin C
 Vitamin B Complex
 Thiamine B1
 Riboflavin B2
 Niacin B3
 Pyridoxine B6
 Folate B9
 Cobalmin B12
 Biotin B7
 Pantothenic acid B5

4. Facts About Vitamins
 Vitamins are found in almost everything you eat
 Processing affects vitamin content
 Dietary supplements can boost vitamin intake
 Not all of what you eat can be used by the body

5. Fat Soluble Vitamin

6. Vitamin A
Vitamin A is absorbed through lymphatic system into blood
stream along with fat and stored in large amount in liver.
Recommended Dietary Allowance
 for infants 300 µg, children 400-600 µg, adolescents 750 µg
Deficiency
 Lack of vitamin A is called as vitamin A deficiency
 Night blindness is one of the first sign of vitamin A deficiency
 Xerophthalmia and complete blindness can also occur

7. Causes
 Breast milk of mother with vitamin A deficiency contain little
vitamin A to baby
 Malabsorption
 Malnutrition
 Zinc deficiency- can impair absorption, transportation and
metabolism of vitamin A because it is essential for synthesis
 Iron deficiency
Clinical Feature
 Night blindness
 Xerophthalmia- eye fails to produce tears
 Xerosis cornea- dryness
 Bitot’s spot- grayish or white plaques
 Phrynoderma- the skin becomes rough, dry

8. Night blindness

9. Other feature
 Eyes-Blurred vision, bulging eye, cataract
 Skin- acne, bedsore, dry skin
 Hair and nails- dandruff, dry hair, hair loss
Management
1. Supplementation
 Mild to moderate cases should be given 10,00 µg/daily
 Sever cases should get 50,000 µg/daily for few weeks
2. Dietary consumption
 Consumption of yellow or orange fruits and vegetable
 Egg yolk
 Dairy products
 Carrots
 Oils extracted from shark and cod liver

10. Vitamin D
 It is absorbed in the presence of bile and fat through lymph and
is stored in liver
 Vitamin D is also referred a sunshine vitamin, synthesized by
body in sun
 lack of vitamin D leads to a disease called Rickets
Recommended Daily Allowance
 200IU in infants per day
 400IU in children’s per day
Risk Factors
 children age (3month – 3 years)
 lack of sun exposure
 inadequate dietary intake of vitamin D

11. Functions

12. Clinical features
 Rickets- characterized by bone deformities
 Formation of small round unossified areas in the bone of skull
 Delayed closure of anterior fontanels
 Frontal and partial bossing
 Delayed eruption of primary teeth
 Osteomalacia- bone deformities occur due to weight of the
body on weak pelvis.
 Other – muscle cramps, seizures, breathing difficulty, poor
growth

13. Ricketts

14. Osteoporosis

15. Diagnosis
 History
 Blood test for serum calcium and phosphorus level and vitamin D
level
 X -ray
Management
 Vitamin D is given in a dose of 1000-5000 IU orally for a month,
followed by 800IU daily for 6 month
 Providing enough vitamin D diet
 Exposure to sunlight
 Administration of vitamin D to Nourishing mothers (human milk
contain 30-40 IU per liter)

16. Vitamin E
 Vitamin E or tocopherol
is an antioxidant.
 Vitamin E is absorbed
with fat in intestine
 It is stored in liver,
muscle, and body fat

17. Recommended Dietary Allowance
 infants 0-6 months old - 4 milligrams daily
 infants 7-12 months - 5 milligrams daily
 for children 1-3 years - 6 milligrams daily
 4-8 years old - 7 milligrams daily
 9-13 years old - 11 milligrams daily

18. Clinical Features
 RBCs breakdown
 Anemia
 Neuropathy
 Weakness
 Difficulty in walking
Management
 Vitamin E supplementation
 Daily requirement of Vitamin E is 15IU
 Diet rich in vitamin E i.e. cereals germ oils, green leafy
vegetables and nuts.

19. Vitamin K
 Vitamin K is essential for synthesis of prothrombin, hence
is important for blood clotting
 Deficiency of vitamin k interferes with Childs normal
physiological changes.

20. Recommended Dietary Allowance
Age Male Female Pregnancy Lactation
Birth to 6
months
2.0 mcg 2.0 mcg
7–12 months 2.5 mcg 2.5 mcg
1–3 years 30 mcg 30 mcg
4–8 years 55 mcg 55 mcg
9–13 years 60 mcg 60 mcg
14–18 years 75 mcg 75 mcg 75 mcg 75 mcg
19+ years 120 mcg 90 mcg 90 mcg 90 mcg

21. Causes
 Inadequate intake of vitamin K during pregnancy
 Reduced dietary intake of vitamin k
 Malabsorption- inadequate absorption, pyloric or intestinal
obstruction
Clinical features
 Abnormal bleeding even from small cut
 Spontaneous nose bleeding
 Bleeding gums
 Blood in urine and stool
Management
 Dietary intake of vitamin K rich food items like spinach,
cabbage, egg yolk, liver and fish
 Administration of oral suspension of vitamin K
 Injection vitamin k can be given IM

22. Water Soluble Vitamin

23. Vitamin C
 Vitamin C is ascorbic acid
 It has strong reducing properties
 It is absorbed from intestine and passed on through portal to
general circulation
 Scurvy is the disease which occur due to deficiency of ascorbic
acid
 Deficiency of vitamin C usually present between 6 moth to 7
years of life
Recommended Dietary Allowance
 for infants 30-40 mg
 for children 40-70 mg

24. Scurvy

25. Clinical Features
 Loss of appetite and listlessness
 Infant cries when arms and legs are moved
 Swelling is seen at the ends of long bone
 Hemorrhage may occur under the skin
 Gums are swollen
 Convulsion
Diagnosis
 X ray of limbs
 Vitamin C level in blood
 Vitamin C level in urine
Management
 Diet rich in vitamin C like citrus fruits, kiwi, mango, papaya,
 Infants are given ascorbic acid in a dose of 50 mg IM, twice daily
for 1 week, thereafter a dose of 100mg/day is given for 1 month

26. Sources of Vitamin C

27. Vitamin B Complex

28. Vitamin B1 (Thiamine)
 It is required for carbohydrate metabolism
 Deficiency causes disease Beri Beri
 The daily recommended dietary allowances (RDAs) of thiamine
is 0.4 mg/1000 kcal
 Very important vitamin to prevent Beriberi that was discovered in
the West Indies
 A Japanese surgeon in the navy found that beriberi on ships could
be avoided by adding meat and whole grains to the diet.

29. 1. Dry Beri-Beri- it is characterized by
 Loss of appetite
 Diminished abdominal reflexes
 Tingling and numbness of legs and hands
 Wasting of muscle pain and tenderness
 Peripheral neuropathy
2. Wet Beri-Beri
 Generalized edema
 Cardiac enlargement
 Palpitation
 Difficulty in breathing
3. Cerebral Beri-Beri
 Cerebral beri beri may lead to Wernicks Korsakoffs syndrome
 Foot drop
 Wrist drop
 Ataxia of gait
 Apathy

30. Diagnosis
 Clinical feature
 Blood and urine examination
 A positive diagnosed by measuring the activity of trance ketolase
in RBCs
Management
 Thiamine supplement is required
 5mg/week IM
 5mg/daily, orally for a month
 Diet rich in B1 like wheat germ and dried yeast, whole cereals

31. Sources of Thiamine

32. Vitamin B2 (Riboflvin)
 It is a flavoprotien which is widely distributed in plants.
 It is present in retina where it plays a part in light adaptation
Recommended Dietary Allowance
 It is based on calorie requirements
 0.4 mg/1000kcal for infants
 0.8-1.2 mg / 1000 kcal for children’s

33. Clinical features
 Oral and facial lesions- angular stomatitis, glossitis
 Scrotal lesions- scrotal dermatitis

34. Management
 Supplementation 1mg riboflavin three times daily for several
weeks, and infants respond to 0.5 mg twice daily
 Diet rich in yeast , milk, egg, meat, fish

35. Vitamin B3 (Niacin)
 Essential for the normal functioning of skin intestinal tract and
nervous system
 Deficiency of niacin leads to ‘Pellagra’
Recommended Dietary Allowance
 Requirements are expressed in terms of niacin equivalent (NE).
one NE equal to 1 mg of niacin, 6.4 to 8 NE/1000cal
Clinical features
 It is characterized by 4 D’s
 Dermatitis
 Dementia
 Diarrhea
 Death

36. Deficiency Of Niacin Or B3

37. Pellagra

38. Diagnosis
 Low serum niacin level
 Low urine level of N-Methylnicotinamide and pyridine
Management
 Administration of niacin rich food like milk, meat, nuts, green
leafy vegetables and whole grains
 Pharmacological management included administration of
niacin 50mg IM twice a week followed by oral dose of 100mg
twice a week for 2-3 weeks

39. Vitamin B6 (Pyridoxine)
 It is essential for fatty acid synthesis
 Pyridoxine is essential for marinating nerves in normal
condition
Clinical features
 Peripheral neuritis
 Impaired immune response due to impaired antibody
production
 Nerves lesions around eyes, nose, and mouth
Management
 VitaminB6 Supplementation is beneficial
 Dietary supplement which are rich in pyridoxine are yeast,
liver, egg yolk, rice polish.

41. Folate or Vitamin B9
 Folate is derived from Latin word means leaf because dark
leafy vegetables are the best source for folate
Recommended Dietary Allowance
 RDA for adults is 400 μg / day
Deficiency of Folate
 Reduced ability to double DNA
 Anemia

42. Folic acid function

43. Sources

44. Vitamin B12 (Cobalmin)
 It promote maturation of RBCs
 It contains cobalt (4-5%)
 B12 deficiency causes permanent damage to nervous tissue, if
untreated
Recommended Dietary Allowance
 For infants is 0.3μg/day.
 For children 0. 5 to 1.5μg/day.
 For adolescents is 2.0μg/day
Causes
 Low intestinal B12 uptake
 Impaired absorption
 Surgical removal of small bowel
 Strict vegetarian

45. Clinical Features
 Deficiency of vitamin B12 leads to Biermer’s disease or
pernicious anemia characterized by following symptoms
 Megaloblastic anemia
 Numbness
 Tingling in extremities
 Absent of reflex
 Impaired perception of touch
 Ataxia
 Fatigue
 Difficulty in breathing

46. Diagnosis
 Serum B12 level
 CSF
 Schilling test
Management
 Vitamin B12 is supplemented in form of oral pills, sublingual
and liquid
 Dose of supplementation is 100μg tow times in a week
 Diet like meat, fish, liver, and kidney.

47. Vitamin B7 (Biotin)
 Biotin contains fused imidazole and thiophene
 It is synthesized by intestinal flora
Clinical feature
 Fine scaly disquamation of skin without pruritis
 Mild depression
 Extreme lassitude
 Muscle pain
 Anorexia with nausea
Management
 Dietary supplementation of biotin are yeast, egg yolk, milk,
tomato, peanuts, liver, whole cereals

48. Vitamin B5 (Pantothenic)
 Part of Coenzyme A which plays an important role in
energy metabolism.
 Is essential for the formation of ATP from the breakdown
of carbohydrates, protein, fat and alcohol.
Recommended Dietary Allowance
 RDA for adults is 5 mg / day

49. Clinical feature
 Headache
 Fatigue
 Impaired muscle coordination
 GI tract disorders
Sources of Pantothenic
 Meat
 Milk
 Mushrooms
 Liver
 Peanuts
 Eggs
 yeast

50. Research
Sunscreens may cause vitamin D deficiency: study
 May 2, 2017 |The Indian Express
 Kim Pfotenhauer, assistant professor at Touro University California in the US
 The findings were published in The Journal of the American Osteopathic
Association
 Applying sunscreen may make you deficient in vitamin D, increasing your
risk of muscle weakness and bone fractures, new research warns.
 Researchers from Touro University California in the US found that nearly 1
billion people worldwide may have deficient or insufficient levels of vitamin
D due to chronic disease and inadequate sun exposure related to sunscreen
use.
 "People are spending less time outside and, when they do go out, they are
typically wearing sunscreen, which essentially nullifies the bodys ability to
produce vitamin D,"

51.  "While we want people to protect themselves against skin cancer,
there are healthy, moderate levels of unprotected sun exposure that
can be very helpful in boosting vitamin D," Pfotenhauer said.
 Chronic diseases like Type 2 Diabetes and those related to
malabsorption, including kidney disease, Crohns and celiac disease
greatly inhibit the bodys ability to metabolise vitamin D from food
sources.
 Vitamin D receptors are found in virtually every cell in the human
body. As a result, it plays a wide role in the bodys functions,
including cell growth modulation, neuromuscular and immune
function and inflammation reduction.
 Increasing and maintaining healthy vitamin D levels can be as easy as
spending 5-30 minutes in midday sun twice per week, researchers
said."You do not need to go sunbathing at the beach to get the
benefits. A simple walk with arms and legs exposed is enough for
most people," Pfotenhauer said.

52. Bibliography
 Ghai OP, Gupta P, Paul VK. Ghai essential pediatrics. 7th
ed. New Dehli: CBS Publishers; 2010. Page no 78-1
 Achar ST. Achar's textbook of pediatrics. bhat SR, editor.
Fourth ed .hyderabad, A.P: universities press; 2012. Page
no 54-4
 Sharma R. Essential of Pediatric Nursing. first ed. New
Delhi: Jaypee Publication;2013 page no.281-04
 John S, Jasmine D. Essential of Nutrition and Dietetics for
Nursing. Second ed. Wolters Kluwer Publisher;2012.Page
No.66-7