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DEMS exam 2 part 2 > Fat Soluble Vitamins > Flashcards

Fat Soluble Vitamins Flashcards

1
Q

describe the physiology of Fat soluble vitamins:

.

A
  • accumulated “stores” in body;
  • require absorption of dietary fat and a carrier system for transport in blood;
  • potential for toxicity with excessive intake
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2
Q

what are 6 Situations that place a patient at risk for micronutrient deficiency

A
  1. Primary inadequate food intake and/or inadequate variety, esp w/ monotonous diet
  2. Increased nutrient requirements unmet by food selections
  3. Increased metabolic demands
  4. Maldigestion & malabsorption
  5. Drug-nutrient or medical treatment-nutrient interactions
  6. “Requirements” for pharmacologic doses (interactions
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3
Q

what is the function of vitamin A

A

essential in photochemical basis of vision (signals in retina to brain visual cortex); maintenance of conjunctival membranes & cornea; critical for epithelial cellular differentiation and proliferation

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4
Q

Preformed retinyl palmitate (vitamin A) can be consumed from these animal sources

A

Liver, dairy, egg yolk, fish oil

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5
Q

the Precursor to vitamin A, Beta-carotene can come from these food sources

A

Deep yellow and green vegetables

Spinach, carrots, broccoli, pumpkin

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6
Q

vitamin A deficiency can cause ______

A

EYES: xerophthalmia (corneal dryness) Bitot’s Spots, night blindness  total blindness

EPITHELIUM:
linings flat, dry,
and keratinized

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7
Q

Vitamin A deficiency can lead to Immune deficiency which is _____

A

dysregulation of immune response; effect depends on infectious agent & type of immune response it elicits;

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8
Q

supplementation to correct Vit A deficiency that causes immune deficiency in patients can ______

A

↓’s child mortality by 23-34%

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9
Q

what are Risks for Vit A deficiency:

A

1) low intake &/or low fat intake (fat < 5% of kcal);
2) fat malabsorption (liver disease & low bile salts; pancreatic insufficiency);
3) protein energy malnutrition

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10
Q

what are the sx’s of Toxicity from Vit A (only w/ preformed Vit A retinol, dose dependent) ex: cod liver oil consumption.
(You can’t get toxicity from beta carotene)

A

vomiting, increased intracranial pressure, headache, bone pain (periosteal proliferation), bone mineral loss (↑ fractures & ↑ osteoporosis), liver damage (hepatitis, fibrosis, liver failure), death; birth defects

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11
Q

what lab testing can you do for Vit A.

A

serum retinol (but levels remain WNL until liver stores nearly exhausted & ↓ w/ Acute Phase Reaction)

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12
Q

what are the functions of Vitamin D

A

Functions as a hormone; maintains intracellular & extracellular Ca++ w/in physiologic range; stimulates intestinal absorption Ca++and P, renal reabsorption of Ca++ and P, mobilization of Ca++ and P from bone; innate immune function (generation of toxic radicals), cellular growth and differentiation through nuclear and plasma membrane vitamin D receptors present in many types of cells,

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13
Q

the precursor to vitamin is in the skin and is called ________, it gets converted to cholecalciferol (Vit D3) by UV light

A

dehydrocholesterol

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14
Q

Dietary sources of vitamin D are :

A

a) Natural: fish liver oils, fatty fish, egg yolks;

b) fortified milk & formulas

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15
Q

D3 comes from ______ sources, D2 ergocalciferol from ______ sources; D3 activity 2-3x > D2

A

animal,

plant (algae)

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16
Q

Describe the metabolism of Vitamin D

A

Absorbed via chylomicrons; Vitamin D2 or D3 hydroxylated in liver, to 25-hydroxy-cholecalciferol and then in kidney to 1,25-dihydroxy-cholecalciferol (calcitriol) = active form

17
Q

what are the definitions of Vitamin D deficiency, insufficiency and sufficiency?

A

Deficient: 25OH-D <20 ng/mL (<50nmol/L)
Insufficient: 21-29 ng/mL (50-80 nmol/L)
Sufficient: >/= 30 ng/mL (>80 nmol/L)

18
Q

what can vitamin D deficiency cause in children

A

Rickets: (25OH-D <11ng/mL) failure of maturation of cartilage and calcification; “rachitic rosary” on ribs, bowed legs, widened metaphyses (esp at wrist), painful bones, fractures;

19
Q

what can vitamin D deficiency cause in adults

A

osteopenia/osteoperosis

20
Q

what are some Emerging Associations with Vit D insufficiency or deficiency (mostly epidemiological studies)

A 
Autoimmune Disorders (e.g. MS)
Neuromuscular function
Cardiovascular Disease
Cancer incidence
Overall Mortality
21
Q

what are risk factors for developing Vit D deficiency

A 
Low Sun exposure (NE winter)
Dark Pigmentation
Low dietary intake
Fat Malabsorption
Breastfed Infant (Needs supplement)
Obesity 
Fat sequestration, sedentary
Liver or Renal Disease (X-OH) (Need Calcitriol Rx supplementation)
22
Q

what are the vitamin D supplementation recommendations in breast fed infants

A

400IU D3 per day by 2 months,
Until 500ml/d (>16oz) formula or milk
Or formula fed taking <500ml/day

23
Q

what is RDA of Vit D for children

A

600 IU/d

24
Q

what is the Institute of Medicine recommendation for Vit D supplements in adults 18-70yrs

A

600IU per day

25
Q

what are the clinical and lab findings for Vit D toxicity

A

Lab: Hypercalcemia
Clinical: Vomiting, seizures, nephrocalcinosis, vascular and soft tissue calcinosis

26
Q

what are risk factors for Vit d toxicity

A

Sarcoidosis (granulomas activate D)
>10,000 IU/d for wks in child or during pregnancy
50-100,000 IU daily in adult >3wks

27
Q

what is the Function of vitamin E

A

Antioxidant, scavenges free radicals, stabilizes cell membranes

28
Q

what are the Sources of Vitamin E

A

Polyunsaturated fat rich vegetable oils (e.g. sunflower), corn, nuts, wheat germ

29
Q

Clinical presentation of Vitamin E deficiency

A 
1) Neurologic Degeneration IRREVERSIBLE
    Loss of reflexes (DTRs)
    Loss of coordination
    Loss of vibration and position sense
    Spinocerebellar ataxia
    Neuropathy
    Ophthalmoplegia  (paralysis or weakness of the eye muscles)
2) Hemolytic Anemia
30
Q

what are risks for developing Vit E deficiency

A

malnurishment
prematurity
fat malbsorption /short gut

31
Q

Vit E toxicity can cause _________

A

Coagulopathy

Very large doses inhibit Vit K dependent clotting factors

32
Q

what is the Function of Vit K

A

carboxylation of clotting factor proteins (II prothrombin, VII, IX, X)

33
Q

what are the Sources of Vit K

A

Diet: leafy greens, brocolli, fruits, seeds, beef liver

Synthesis by Intestinal Bacteria

34
Q

what are the findings of Vit K deficiency

A

prolonged coagulation time

Hemorrhagic disease of the newborn (Purpura, GI bleeds, CNS bleeds)

35
Q

what are the Risk factors for developing Vit K deficiency

A

Newborns – poor placental transport
2-12 wks breastfed untreated
Fat Malabsorption
Chronic Antibiotics

36
Q

what is the Prevention methods for Vit K defiency

A

all Newborns 0.5-1.0mg IM once

Adequate oral dosing has not been defined

DEMS exam 2 part 2 (17 decks)

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