Vitamins 2

What is malnutrition?

Deficiencies, excesses, or imbalances in energy and/or nutrient intake.

What findings can indicate malnutrition?

Reduced intake, weight/fat/muscle loss, fluid accumulation, and reduced grip strength.

Why is enteral nutrition preferred?

It is more physiologic and uses the GI tract.

Where is enteral nutrition delivered?

Directly into the gut.

What important benefit does enteral nutrition provide to the gut?

It helps maintain the microbiome.

When is enteral nutrition discontinued before anesthesia in the lecture?

6 hours before anesthesia.

How is parenteral nutrition administered?

Into a vein.

When may parenteral nutrition be given through a PIV?

When providing <2,000 calories/day with an isotonic solution.

What glucose problem should be considered when parenteral nutrition is stopped?

Hypoglycemia.

Is parenteral nutrition continued perioperatively?

Yes.

What are major complications of parenteral nutrition?

Sepsis, fatty acid deficiency, glucose problems, liver disease, acidosis, hypercarbia, and catheter complications.

Why can parenteral nutrition cause hyperchloremic metabolic acidosis?

Amino acids may be delivered in chloride salt form.

Why can excess carbohydrates in parenteral nutrition cause hypercarbia?

They increase CO₂ production.

What central IV catheter complications can occur with parenteral nutrition?

Infection and thrombus formation.

What are the two major vitamin solubility groups?

Water-soluble and fat-soluble.

What is the best source of vitamins?

Food.

Which vitamins are water-soluble?

B-complex vitamins and vitamin C.

What is thiamine?

Vitamin B1.

What is the main role of vitamin B1?

Metabolism of carbohydrates, alcohol, and amino acids.

What can vitamin B1 deficiency cause?

Beriberi and Wernicke-Korsakoff syndrome.

What are the toxic effects of vitamin B1?

None listed in the lecture.

What is riboflavin?

Vitamin B2.

What is the main role of vitamin B2?

Cellular oxidation-reduction reactions.

What can vitamin B2 deficiency cause?

Dermatitis, stomatitis, and anemia.

What are the toxic effects of vitamin B2?

None listed in the lecture.

What is nicotinic acid also called?

Vitamin B3 or niacin.

What is the metabolic role of niacin (B3)?

Oxidative metabolism; decreases LDL and increases HDL.

What disease is caused by niacin (B3) deficiency?

Pellagra.

What are toxic effects of niacin (B3)?

Flushing, headache, pruritus, and hyperglycemia.

What tongue finding is associated with niacin deficiency in the lecture?

A beefy red tongue.

What is pantothenic acid?

Vitamin B5.

What is the role of vitamin B5?

It participates in multiple metabolic processes.

How common is vitamin B5 deficiency?

Rare.

What are the toxic effects of vitamin B5?

None listed in the lecture.

What is pyridoxine?

Vitamin B6.

What are the major roles of vitamin B6?

Amino acid metabolism, heme synthesis, and neuronal excitability.

What can vitamin B6 deficiency cause?

Anemia, cheilosis, and dermatitis.

What is the major toxicity of vitamin B6?

Neurotoxicity.

What is biotin?

Vitamin B7.

What are the roles of biotin (B7)?

Hair, skin, nails, and energy production.

What can biotin deficiency cause?

Hair loss, rashes, depression, and fatigue.

What are listed toxic effects of biotin?

Fatigue and rashes.

What important laboratory problem can biotin cause?

It can interfere with lab tests.

How can biotin affect thyroid testing?

It may produce falsely low/undetectable TSH and mimic hyperthyroidism.

What is folic acid?

Vitamin B9.

What is the main role of folic acid (B9)?

DNA synthesis.

What can folic acid deficiency cause?

Megaloblastic anemia and birth defects.

What are the toxic effects of folic acid?

None listed in the lecture.

What is cobalamin also called?

Vitamin B12 or cyanocobalamin.

What are the major roles of vitamin B12?

DNA synthesis and myelin synthesis.

What can vitamin B12 deficiency cause?

Megaloblastic anemia, pernicious anemia, and peripheral neuropathies.

What are the toxic effects of vitamin B12?

None listed in the lecture.

Which B vitamins are listed as non-essential/not currently recognized as vitamins?

B4, B8, B10, and B11.

What is B4 listed as in the lecture?

Adenine.

What is B8 listed as in the lecture?

Inositol.

What is B10 listed as in the lecture?

Para-aminobenzoic acid.

What is B11 listed as in the lecture?

Salicylic acid.

Why are B4, B8, B10, and B11 considered non-essential in the lecture?

The body makes them, so dietary inclusion is not required.

What is ascorbic acid?

Vitamin C.

What is the main metabolic role of vitamin C?

Collagen synthesis.

What deficiency disease is caused by vitamin C deficiency?

Scurvy.

What are toxic effects of excess vitamin C?

Nephrolithiasis and diarrhea.

What severe findings can occur with vitamin C deficiency?

Tooth/cartilage loss and hemorrhage due to impaired collagen.

What is retinol?

Vitamin A.

What are the major roles of vitamin A?

Vision and epithelial integrity.

What can vitamin A deficiency cause?

Night blindness and increased infection risk.

What are toxic effects of vitamin A?

Teratogenicity, hepatotoxicity, and cerebral edema with chronic overdose.

What is cholecalciferol?

Vitamin D.

What is the main role of vitamin D?

Promotes intestinal calcium absorption.

What can vitamin D deficiency cause?

Osteomalacia and rickets.

What is the major toxicity of vitamin D?

Hypercalcemia.

What is tocopherol?

Vitamin E.

What are major roles of vitamin E?

Atherosclerosis protection and decreased fatty-acid peroxidation.

How common is vitamin E deficiency?

Rare.

What is the major toxicity concern with vitamin E?

It antagonizes vitamin K and increases bleeding risk.

What is the main role of vitamin K?

Clotting factor synthesis.

Which clotting factors are listed as vitamin K-dependent in the lecture?

VII, IX, and X.

What can vitamin K deficiency cause?

Hemorrhagic diathesis or increased bleeding tendency.

What are the toxic effects of vitamin K?

None listed in the lecture.

What anticoagulant does vitamin K antagonize?

Warfarin.

What is black cohosh suggested for?

Menopausal symptoms.

What is the potential toxicity of black cohosh?

GI discomfort.

What is chaste tree berry suggested for?

Premenstrual symptoms.

What is the potential toxicity of chaste tree berry?

Pruritus.

What receptor interaction is listed for chaste tree berry?

Dopamine D2 receptor antagonism.

What is cranberry suggested for?

Urinary tract infections.

What is the potential toxicity of cranberry?

Nephrolithiasis.

What is dong quai suggested for?

Menopausal symptoms.

What drug interacts with dong quai?

Warfarin.

What is echinacea suggested for?

Upper respiratory infections.

What are potential toxicities of echinacea?

Hypersensitivity reactions and hepatic inflammation.

What is the preoperative discontinuation time for echinacea?

No data listed.

What is evening primrose suggested for?

Eczema, IBS, rheumatoid arthritis, and premenstrual symptoms.

What are potential toxicities of evening primrose?

Nausea/vomiting, diarrhea, and flatulence.

What drugs interact with evening primrose?

Antiepileptic drugs.

What neurologic concern is associated with evening primrose?

It may trigger seizures; evidence is weak.

What is feverfew suggested for?

Migraine prevention, arthritis, and allergies.

Why can feverfew increase bleeding risk?

It inhibits platelet activity.

What drug interacts with feverfew?

Warfarin.

What is garlic suggested for?

Hypertension and lowering triglycerides/cholesterol.