Nutrition

Peanut/tree nut allergy

IgE mediated allergic rxn

Who are at risk for vitamin B1 (Thiamine) deficiency?

alcoholics (~80%)

Where is vitamin B1 (Thiamine) absorbed

small intestine

What is infantile beriberi?

infants who are breastfed by mom with a B1 deficient diet

What are symptoms of beriberi?

cardiomegaly, tachycardia, loud piercing cry or soundless cry, cyanosis

What is adult beriberi?

extreme thiamine deficiency

What is wet beriberi?

affects heart and circulatory system

What is dry beriberi?

Affects nervous system — can lead to decreased muscle strength and eventually muscle paralysis

What is Wernicke Encephalopathy?

ophthalmoplegia, ataxia, global confusion

What is Korsakoff’s Syndrome?

Untreated Wernicke’s encephalopathy — anterograde and retrograde amnesias and confabulation

When do you need to give vitamin B1 in the hospital and why?

When giving IV glucose you must give this supplement prior to infusion to prevent Wernicke’s encephalopathy

What do you need to make sure is also replenish with vitamin B1 and why?

If someone is Mg deficient thiamine is essentially unusable

What happens with vitamin B2 (Riboflavin) deficiency?

Ariboflavinosis — sore throat, edema of mucous membranes, cheilitis, stomatitis, glossitis, seb derm

What does vitamin B2 interact with?

Barbiturates (Phenobarbital), TCAs, tetracycline, abx, ETOH

What happens when you have vitamin B3 (Niacin) deficiency?

Pellagra (“raw skin”) — the 3 “D’s” — Diarrhea, Dermatitis, Dementia

Who are at risk for vitamin B3 (Niacin) deficiency?

alcoholics and patients on isoniazid (TB)

What can happen with patients deficient in vitamin B5 (Pantothenic acid)?

“Burning Feet Syndrome” or impaired heme synthesis → anemia

What can happen to people deficient in vitamin B6 (Pyridoxine)?

peripheral neuropathy, stomatitis, confusion, depression, seizure

Who are at risk for vitamin B6 deficiency?

alcoholics, dialysis pts

What happens to people deficient in vitamin B7 (Biotin)?

dermatitis around the eyes, nose, mouth; conjunctivitis, alopecia, AMS

Who are at risk for vitamin B7 deficiency?

TPN patients and those that eat a lot of egg whites

What happens to people who are deficient in vitamin B9 (Folate)?

megaloblastic or macrocytic anemia, cheilosis, diarrhea

Who are at risk for vitamin B9 (Folate) deficiency?

binge drinkers and those on MTX

What can happen during pregnancy if mother is deficient in vitamin B9 (Folate)?

neural tube defects, spina bifida, premature delivery, low birth weight

Who is prone to getting vitamin B12 deficiency?

ETOH, Crohn’s, celiac, gastric bypass, taking PPIs, pernicious anemia

What happens with vitamin B12 deficiency?

macrocytic anemia (low Hgb, MCV >100) — CP, SOB, organ ischemia, glossitis, neuropsych changes

What happens with vitamin C deficiency?

The “H’s” — hyperkeratosis, hemorrhage, hematologic (anemia)

How do you treat vitamin C deficiency?

absorbed acid supplement

What happens with vitamin E deficiency?

hemolytic anemia, NM disorders, vision changes

What does vitamin E do?

protects cells, reduces plaque formations, helps immune system

What happens with vitamin A excess?

blurred vision, nausea, intracranial HTN, teratogenic, alopecia, vision changes, hepatotoxic

What happens with vitamin K deficiency?

uncontrolled bleeding

What does vitamin K do?

synthesis of blood proteins in clotting

What do you see with vitamin K deficiency?

elevated PTT/INR

Who needs more vitamin C?

smokers

What does vitamin C do?

Assists in absorption of iron

What happens with vitamin D deficiency?

rickets — bowed legs — softening of bones
osteomalacia — rickets in adults — brittle bones

What happens with vitamin A deficiency?

Bitot’s spots — abnormal squamous cell and keratinization in conjunctiva
Xerophthalmia — dryness of conjunctiva and cornea

What are fat soluble vitamins?

A, D, E, and K