CMN E1- Vitamins & Minerals

What do vitamins have a critical role in?

maintaining bone, blood, and muscle tissue, supporting the immune system, maintaining vision

What patient populations are most at risk for vitamin deficiencies?

elderly, vegans, alcohol-dependent individuals, pts w/ malabsorption disorders

What are the fat soluble vitamins?

A, D, E, K

What are the water soluble vitamins?

B, C

Retinol

Vitamin A

Calciferol

Vitamin D

Tocopherol

Vitamin E

Thiamine

Vitamin B1

Riboflavin

Vitamin B2

Niacin

Vitamin B3

Pantothenic acid

Vitamin B5

Pyridoxine

Vitamin B6

Biotin

Vitamin B7 or H

Folic acid

Vitamin B9

Cyanocobalamin

Vitamin B12

An overdose of which 2 vitamins can cause blood clotting defects or hemolytic anemia?

Vitamins E & K

What are the 2 types of Vitamin A?

Provitamin A (beta-carotene)

Preformed vitamin A (retinol, retinoic acid)

Where is Provitamin A found?

plants (red-yellow pigments), green leafy vegetables

What is the only form of vitamins to be metabolized in mammals to vitamin A?

Beta-carotene

What is the most active form of vitamin A?

Retinol/retinoic acid

Follicular hyperkeratosis results from what vitamin deficiency?

Vitamin A

What are sx of Vitamin A deficiency?

- Hyperkeratotic skin lesions

- Xerophthalmia --> corneal abrasion

- Night blindness (can’t make rhodopsin)

- Immune dysfunction

What drugs interfere with vitamin A absorption?

Mineral oil, Cholestyramine, Neomycin

Which vitamin can be teratogenic in consumed in excessive amounts during pregnancy?

Vitamin A

What are sx of vitamin A toxicity?

dry skin, cheilosis/glossitis, vomiting, alopecia, bone pain, hypercalcemia, inc ICP/papilledema

Rickets is dt a deficiency of which vitamin?

Vitamin D

What is the best lab indicator of Vitamin D adequacy?

Serum 25-OH Vitamin D

What is the physiologically active form of Vitamin D?

1,25(OH)2-Vitamin D

What are sx of vitamin D toxicity?

hypercalcemia, hypercalciuria, confusion, polyuria, polydipsia, anorexia/vomiting, muscle weakness, bone demineralization, bone pain, brain injury in children

What controls the conversion of Vitamin D into its active form?

PTH, serum Ca, phosphorous levels

What are sources of vitamin E?

sunflower/safflower oil, Soybean/corn oils, meats, nuts, cereal grains

What are sx of Vitamin E toxicity?

reduced plt aggregation, interferes with vitamin K metabolism, N/D, flatulence

What drug interaction should you be aware of w/ Vitamin E?

Warfarin

Phylloquinone, Vegetable and animal sources.

a. Vit K I

b. Vit K II

c. Vit K III

d. Vit K IV

Vit K I

What are the 2 natural forms of Vitamin K?

Vit K I (phylloquinone) & Vit K II (menaquinone)

Which form of vitamin K is chemically synthesized pro-vitamin, water-soluble, converted to Vit K II by the liver?

Vit K III

What are sources of Vitamin K?

green leafy vegetables, butter/margarine, liver, milk, ground beef, coffee, pears, olive/vegetable/soybean oil

What needs to be monitored in pts taking anti-coag meds?

intake of green leafy vegetables (careful increasing amount)

How is a diagnosis of Vitamin K deficiency made?

- Prolonged PT

- Reduced clotting factors

What patients are at risk of vitamin K deficiency?

Newborns, Cystic fibrosis, Fat malabsorption

What is the role of Vitamin B1?

energy production & peripheral nerve conduction

What contains thiaminases (destroy thiamine)?

tea, coffee, raw fish & shellfish

Who is most susceptible to thiamine (B1) deficiency in the US?

alcoholics & chronically ill (cancer)

What vitamin deficiency causes Beri-Beri?

Thiamine

Which type of beri-beri results in pain, paresthesias, and CV symptoms?

Wet

Which type of beri-beri results in symmetrical peripheral neuropathy of motor & sensory nerves?

Dry

Wernicke's encephalopathy is due to what vitamin deficiency?

Thiamine

What are sx of Wernicke's encephalopathy?

horizontal nystagmus, ophthalmoplegia, cerebellar ataxia, mental impairment

What are sx of Wernicke-Korsakoff syndrome?

confabulation (distorted memories), psychosis, additional memory loss, may persist for several months

What are sx of Vitamin B2 deficiency?

- Glossitis

- Angular cheilosis

- Cataracts, corneal abrasions, tearing, burning, pruritus

- Seborrheic dermatitis, delayed wound healing

What deficiency causes Pellagra?

Vitamin B3 (niacin)

What are sx of Pellagra?

diarrhea, dementia, dermatitis, death (if untreated)

What is a common SE of niacin (B3)?

flushing

High doses of vitamin B3 (niacin) are used for what disease?

Hyperlipidemia

What is the water soluble form of vitamin B9 that occurs naturally in food?

Folate

What is the synthetic form of vitamin B9?

Folic acid

What vitamin helps produce & maintain new cells particularly during infancy & pregnancy → prevention of neural tube defects?

Vitamin B9 (folate)

What patients have an increased need for folate?

pregnancy/lactation, alcoholism, malabsorption, kidney dialysis, liver disease, anemia

What are sx of vitamin B9 (folate) deficiency?

neural tube defects, elevated homocysteine levels, slow growth rate

Which vitamin is essential for DNA synthesis & neurological function and is found naturally in animal products?

Vitamin B12 (cobalamin)

What form of vitamin B12 is its active form used for bodily function and energy production?

Methylcobalamin & Adenosylcobalamin

What form of Vitamin B12 is synthetic?

Cyanocobalamin

What form of Vitamin B12 is injectable?

Hydroxocobalamin

What are the RF for Vitamin B12 deficiency?

vegan or vegetarian diet (no animal sources), GI disorders (pernicious anemia, celiac, Crohn’s), post-GI surgery (gastric bypass)

What are sx of Vitamin B12 deficiency?

megaloblastic anemia, glossitis, mood disturbance, elevated MMA, peripheral numbness/tingling, confusion

Ascorbic acid

Vitamin C

What is an important action of Vitamin C?

promotes non-heme iron absorption

What inc the amount of Vitamin C requirement?

smoking, hemodialysis, stress (infection, trauma)

What are sx of Scurvy (vitamin C deficiency)?

- impaired connective tissue formation

- petechiae, ecchymosis

- inflamed, bleeding gums

- bleeding into joints

- in peds, impaired bone growth

Consuming how much Vitamin C can cause a false negative guaiac reaction?

> 1 g/day

What are the functions of minerals?

fluid regulation, bone/blood health, rid body of harmful chemicals

What is a chemical element essential to physiology of plants & animals, not broken down by digestion, not destroyed by heat or light?

Minerals

How much of major minerals do we need a day?

>100 mg/day

What are the major minerals?

Ca, Phosphorus, Na, Chloride, Magnesium, Potassium, Sulfur

What are the trace minerals?

iron, zinc, copper, manganese, fluoride, chromium, selenium, iodine

What is the most abundant mineral in the body?

Calcium

What are the uses of Calcium in the body?

- muscle contraction

- vasodilation & contraction

- bone health

- secretion of hormones & enzymes

- transmitting nerve impulses

What are the 2 main forms of calcium supplements?

Carbonate & Citrate

Calcium absorption is best with what doses?

doses < 500mg

*best to take BID to max absorption

What can bind to and inhibit calcium absorption?

*Vit D improves absorption

Oxalic acid & Phytic acid

Calcium decreases the absorption of what 4 drugs?

Digoxin, Phenytoin, Tetracycline, Quinolones

Calcium should NOT be taken with what meds?

meds that need to be taken on an empty stomach

What are sx of Calcium deficiency?

- Paresthesias to fingers

- Tetany

- Muscle cramps

- Convulsions

- Lethargy

- Poor appetite

- Dysrhythmias

- Death if untreated

What is the female athlete triad?

*RF for Ca deficiency

disordered eating, amenorrhea, osteoporosis

Who is at risk of calcium deficiency?

postmenopausal women, amenorrheic women, female athletes, lactose intolerance, vegetarians

What is Magnesium used for?

- muscle & nerve function

- heart rate & rhythm

- immune system

- bone health

- regulates blood sugar levels

- normalizes BP

- involved in energy metabolism & protein synthesis

What is the most abundant extracellular cation?

Sodium

What is the maximum amount of Sodium we can consume for chronic disease reduction?

2,300 mg/day

What is the most abundant intracellular cation?

Potassium

Which mineral has the opposite of effect of sodium?

Potassium

What is the role of Iron in the body?

- oxygen transport

- regulation of cell growth & differentiation

What are the 2 forms of iron?

Heme & non-heme

Which form of iron is found in animal foods?

Heme

What is the #1 nutritional disorder in the world?

Iron deficiency

What patients are at risk for iron deficiency?

women of childbearing age, pregnant women, preterm/low birth weight, teenage girls, women with heavy menses, kidney failure, chronic malabsorption

What are sx of Iron deficiency?

- fatigue, weakness

- difficulty maintaining body temp

- dec immune function

- glossitis

- poor school/work performance

- pica

What can iron overload cause?

damaged intestinal lining, changes in body pH, shock, and liver failure → Hemochromatosis

What mineral is an essential component of thyroid hormones (T3 & T4)?

Iodine

What are the most common sources of fluoride?

fluoridated water, tea, bone-in fish, topical toothpaste