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Flashcards in Vitamins Deck (36):

Which water soluble vitamins are not easily washed out from the body

B9 (folate)


An 18-month-old female recently emigrated from India with her parents. She presents with a macular-papular skin rash and croup. Two days prior to eruption of her skin rash, her pediatrician noted the following small, red, irregularly-shaped spots with blue-white centers on her oral mucosa, shown in the figure. You diagnose her with a communicable disease. Which of the following vitamins should supplement her treatment?

Vitamin A

(diagnosis: measles)


Vitamin A deficiency

Night blindness
Bitot spot


Excess Vitamin A

Acute toxicity: nausea, vomiting, vertigo, and blurred vision

Chronic toxicity: alopecia, dry skin (e.g., scaliness), hepatic toxicity and enlargement, arthralgias, and pseudotumor cerebri

Teratogenic: cleft palate, cardiac abnormalities


A 73-year-old male presents to the clinic with lumbar pain and symmetrical bone pain in his legs and arms. He has trouble going up to his bedroom on the second floor and getting up from a chair. Past medical history reveals that he has had acid reflux for the past 5 years that is refractory to medications (PPIs & H2 antagonists); thus, he had decided to stay away from foods which have previously given him heartburn - red meats, whole milk, salmon, and has eaten a mainly vegetarian diet. Which of the following processes is most likely decreased in this male?

Bone Mineralization

(diagnosis: osteomalacia)


Forms of Vitamin D
- plants?
- animal?
- storage?
- active?

Vitamin D2 (ergocalciferol): ingested from plants

Vitamin D3 (cholecalciferol): consumed in milk, formed in sun-exposed skin (stratum basale)

25-hydroxy vitamin D3 (25-OH D3): storage form

1,25 dihydroxyvitamin D3 [1,25-(OH)2 D3 or calcitriol]: active form


A 19-year-old Congolese female refugee has been granted asylum in Stockholm, Sweden and has been living there for the past month. She arrived in Sweden with her 2-month-old infant, whom she exclusively breast feeds. Which of the following deficiencies is the infant most likely to develop?

Vitamin D


Vitamin D deficiency

Rickets (in children)
Osteomalacia (in adults)


Excess Vitamin D



A 37-year-old female presents to her primary care physician with constipation and abdominal pain. She notes that the pain has been present for several days and is not related to food. She also reports increased urinary frequency without incontinence, as well as increased thirst. She takes no medications, but notes taking vitamin supplements daily. Her vital signs are: BP 130/72 mmHg, HR 82 bpm, T 97.0 degrees F, and RR 12 bpm. Lab studies reveal: Na 139, K 4.1, Cl 104, HCO3 25, Cr 0.9, and Ca 12.4. Further studies show an increased ionized calcium, decreased PTH, and increased phosphate. What is the most likely cause of this patient's symptoms?

Vitamin overdose

(diagnosis: vit. D overdose)


Vitamin E functions


Enhance the effects of Warfarin


Vitamin E deficiency

Hemolytic anemia

Neurological presentation (similar to B12 deficiency)

Posterior column and cerebrocerebellar tract demyelination


You are counseling a pregnant woman who plans to breast-feed exclusively regarding her newborn's nutritional requirements. Which vitamins should be given to the newborn?

Vitamin K and Vitamin D


Vitamin K functions


Cofactor for gamma carboxylation of glutamic acids resides on clotting factors 2, 7, 8, 10, protein C, and protein S


Vitamin K antagonist



Vitamin K deficiency

Neonatal hemorrhage with increased PT but normal bleeding time

Can also occur with prolonged use of broad-spectrum antibiotics


B1 is the cofactor for

Dehydrogenase reactions

(pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase, transketolase, branched-chain ketoacid dehydrogenase)


B1 deficiency

- confusion, confabulation, ataxia, memory loss, personality change

Wet BeriBeri
- edema, cardiomyopathy

Dry BeriBeri
- muscle wasting, polyneuritis

Seen in alcoholism and malnutrition


A homeless woman presents with shortness of breath on exertion and pedal edema. Cardiac workup performed shows evidence of dilated cardiomyopathy and increased cardiac output. She also has decreased sensation over both extremities bilaterally. Which vitamin deficiency most likely caused these symptoms?

Vitamin B1


B2 functions and reactions

Used as cofactors in redox reactions

Required for B3


B2 deficiency

Cheilosis (inflammation of lips, scaling, and fissures at the corners of the mouth)


B3 functions

Nad and NADP
used in REDOX reactions

needs B2 and B6


A 12-year-old boy presents to the pediatrician for the dermatological changes that began two weeks ago after he began his first day of football practice. The skin eruptions appeared to be localized solely to sun exposed areas. The boy notes that he has also had diarrhea, headaches, and confusion appearing at the same time. On examination, the pediatrician notes ataxia and tremors in the boy. A urinalysis revealed elevated levels of tyrosine, leucine, valine, isoleucine, tryptophan, glycine, alanine, and phenylalanine. Which of the following vitamin deficiencies would produce a similar clinical presentation?

Niacin (B3)

(or could be B2 or B6, if Niacin is not an option)


B3 deficiency

Hartnup Disease

- diarrhea, dementia, dermatitis (broad-collar rash), death


B5 cofactor & deficiency

cofactor: CoA

Burning foot syndrome, dermatitis, enteritis, alopecia, adrenal insufficiency


B6 cofactor & deficiency

PLP cofactor: decarboxylation and transamination

Peripheral Neuropathy
Sideroblastic Anemia


B7 cofactor & deficiency

cofactor: for carboxylation (pyruvate carboxylase, acetyl CoA carboxylase, propionyl CoA carboxylase)

Dermatitis, Alopecia


B9 cofactor, absorption, & deficiency

cofactor: THF, important for synthesis of nitrogenous bases in DNA and RNA

absorbed in the jejunum

Macrocytic megaloblastic anemia

seen in alcoholism and pregnancy


B12 cofactor, absorption, & deficiency

cofactor: for homocysteine methyltransferase

Absorbed in terminal ileum, Requires intrinsic factor

Macrocytic megaloblastic anemia, Hypersegmented neutrophils, Paresthesias and subacute combined degeneration


A 62-year-old woman presents to her doctor complaining of painful tingling and burning in her feet for the past year. Careful physical exam demonstrates that she has poor position sense in her bilateral lower extremities. Lab results reveal elevated urine and plasma methylmalonic acid concentrations. Which vitamin deficiency is this woman most likely suffering from?

Vitamin B12

(because of neurological features)


A 59-year-old female presents to your office with complaints of progressive numbness and tingling in her fingers and toes over the last several months. She also reports "feeling weak" in her arms and legs. The patient's past medical history is significant for hypertension and Crohn's disease, which has been well-controlled since undergoing an ileocolectomy 7 years ago. Physical examination is significant for the following findings: decreased sensation to light touch, temperature, and vibration in the bilateral lower extremities; ataxia; positive Romberg sign. Deficiency of which of the following is most likely responsible for this patient's symptoms?

Vitamin B12

(because ileocolectomy)


A 29-year-old female presents to her psychiatrist with concerns that she may be "OCD." She explains that she has become extremely obsessed with making sure that her fruits and vegetables are completely sanitized by first rinsing with water for exactly 60 seconds and then boiling for exactly 60 minutes. She refuses to eat any fruits or vegetables that did not undergo this process, which she began doing about 3 months ago. Which of the following vitamin deficiencies is she most likely to develop?

Vitamin C

(because vitamin c is water soluble)


Vitamin C functions & deficiency

required for hydroxylation

- swollen and bleeding gums, anemia, poor wound healing, hemorrhages, corkscrew hair


Zinc deficiency

Delayed wound healing, Hypogonadism, ↓ adult hair (axillary, facial, pubic, Acrodermatitis enteropathica



protein deficient

small child with swollen abdomen



total calorie deficient

tissue and muscle wasting