Vitamin/ Minerals

vitamin a

retinol (preformed): meat/dairy

beta-carotene (provitamin): veggies/ fruits

Vitamin a function

Essential for normal growth and reproduction, normal skeleton and tooth development AND specialized functions of most organs – NOTABLY the EYES

vitamin a deficiency cause

excessive excretion of vitamin a:

• celiac/ crohns

• pancreatic

• cancer

• chronic cortiscosterioids

vitamin a indication

• deficiency

• xerophthalmia (dry eye)

• nctalopia (night blindness; earliest sxs deficiency)

• age related macular degeneration 

• cataracts

• skin health antioxidant

Vitamin a dosing

UL: 3000 mcg

pregancy: avoid vit a above RDA

vitamin a clinical notes

AE: Yellow skin (beta-carotene) --harmless

AE: Hepatotoxicity

Birth defects (retinol)

Interactions: Avoid retinoid meds

Labels may combine retinol and beta-carotene (assume all retinol unless otherwise specified)

vitamin d

ergocalciferol, D₂: food additive

cholecalciferol, D3:

endogenous, synthesized from dietary cholesterol via sunlight (UV)

vitamin d deficiency causes

-    Meds (phenytoin, carbamazepine)

• suncreen…

vitamin d indication

Osteopenia

Osteoporosis (fall prevention)

Rickets (affects children -particularly who do not drink milk or breastfed by mothers who receive inadequate vit D)

vitamin D RDA/ dosing

1 mcg cholecalciferol = 40 IU vit D

vit D clinical notes

may need more than RDA of risk factors present or low vit d levels

vitamin e

Tocopherol/ tocotrienols: compounds occur naturally in plants

vitamin e indication

Possibly Effective:

Dementia

AMD

Tardive dyskinesia

 

May help with:

Peripheral neuropathies

Intermittent claudication

Muscle weakness

Hemolytic anemia

vitamin e clinical notes

AE: >400 IU/d increases bleeding risk (interferes w/vit K absorption/anticoagulation)

vitamin K

(phytonadione)

 

*Normal gut fora synthesize enough to supply a significant part of the body’s requirements

vitamin K indications

Reverses effects of warfarin (stops bleeding)

vitamin K clinical notes

lowers INR warfarin

fat soluble vitamins

A, D, E, K

water soluble vitamins

B complex, C

vitamin b1

thiamine

vitamin b1 deficiency

meds: diruetics: furosemide

vitamin b1 indication

Beriberi / Wernicke’s encephalopathy (seen in chronic alcohol abusers)

 

Korsakoff syndrome

vitamin b1 clinical notes

well tolerated

vitamin b2

riboflavin

vitamin b2 indication

migraine

cataracts

vitamin b3

niacin, active form: niacinamide

vitamin b3 indication

Lipids:

-         Increases HDL

-  Decreases TG, LDL

vitamin b3 RDA/ dosing

treatment cholesterol: 1-3 g/d (divided doses)

vitamin b6

pyridoxine

vitamin b6 deficiency cause

meds: antiepileptics, isoniazid

vitamin b6 indication

nausea/ vomiting (pregnancy)

migraine headaches

vitamin b 9

folate (food source)

folic acid (synthetic)

vitamin b9 function

cell division, DNA production, brain/ spinal cord development

vitamin b9 indication

Neural tube defects

Alcoholic dependency

Megaloblastic anemia: low B9 and/or low B12 – correct what’s low

Vit B12 is essential for metabolism of folates

vitamin b9 RDA/ dosing

pregnancy (prevention of neural tube defects): 600-800 mcg DFE/d

vitamin b12

cyanocobalamin

vitamin b12 function

requires intrinsic factors for absorption

vitamin b12 deficiency cause

meds (metformin)

vitamin b12 dosing

Patients underwent bariatric surgery require LIFELONG vit B12 supplementation

vitamin b12 indication

Most at risk:

-    >50yo: secondary to reduced gastric acidity (decreases the release of food bound B12)

 

-    Vegetarians do not consume animal products

 

Pernicious anemia (B12 deficient)vs. folic acid or iron deficiency anemia

vitamin c

ascorbic acid

fresh food (fruit/veg)

vitamin c function

Assist in absorption of nonheme iron from food (reduces ferric to ferrous iron in stomach)

vitamin c indication

immunity

iron absorption

wound healing

calcium deficiency cause

meds: anticonvulsant

calcium indication

osteoporsis

calcium clincal notes

Separate: calcium interferes with abx absorption (fluoroquinolones, tetracycline), levothyroxine

Better absorption with CITRATE when taking GI meds (PPI and H2RAs) – lowers acid production (more basic environment)

fe (iron) deficient state

20-30% absorbed

iron function

stored primairly as ferritin (20-25%) - liver, spleen, intestinal mucosa, bone marroq

iron deficiency cause

major mechnism: BLOOD loss, menstruation, hemorrhagic loss

iron indication

Iron-deficiency anemia (most common form): result of inadequate intake or from increased demands

Most at risk:

-      Children <2y: inadequate intake

-      Adolescences: menstruation/rapid growth

-      Pregnancy/post-partum: expanding blood volume

Older adults (>65y): inadequate intake & compromised absorption

iron RDA

absorption… normal vs iron deficiency anemia

iron dosing

Ferrous sulfate: 325mg = 65mg
(20% elemental Fe) = 12mg absorbed
(20% absorbed)

Need at least 36-48mg/d elemental iron (divided doses – usually TID)

iron clinical notes

Ascorbic acid (vitamin C, OJ) increases iron absorption

preferred empty stomach (think how much that burns, so acidic, so absorbing)

Acid suppressors (antacids, PPIs, H2 blockers) decrease Fe absorption

Separate: iron with abx (fluoroquinolones, tetracycline), bisphosphonates, levothyroxine

magnesium deficiency cause

meds: diuretics, chronic PPIs

magnesium indication

constipation

migraines/ headaches

magnesium clinical notes

separate: magnesium interferes with abx absorption (fluoroquinolones, tetracycline)

zinc indication

common cold

wound healing

AMD

zinc clinical notes

Separate abx by 3 hours (cephalosporins, fluoroquinolones, tetracyclines)

Separate from iron supplements