Vitamins and Minerals

Question 1

What are the fat-soluble vitamins?

Answer 1

Vitamins A, D, E, and K

Question 2

What are the water-soluble vitamins?

Answer 2

Vitamins B (1, 2, 3, 5, 6, 7, 9, 12) and C

Question 3

Fat-Soluble Vitamins Characteristics

Answer 3

• Well-retained in body
• Stored in fatty tissue
• Takes time to become deficient
• Toxicity more likely due to slow clearance

Question 4

Water-Soluble Vitamins Characteristics

Answer 4

• Not well-retained in body (except B12)
• Less likely to cause toxicity (readily cleared from body)

Question 5

Vitamin A (Retinol) Signs of Deficiency

Answer 5

• Dermatitis
• Night blindness
• Bitot’s spots
• Poor wound healing

Question 6

Vitamin D Signs of Deficiency

Answer 6

• Osteomalacia
• Osteoporosis
• Rickets (weakening of bone when young)
• Muscle weakness
• Poor growth/development

Question 7

Vitamin E Signs of Deficiency

Answer 7

• Hemolysis
• Peripheral neuropathy
• Skeletal muscle atrophy

Question 8

Vitamin K Signs of Deficiency

Answer 8

• Bleeding
• Elevated prothrombin time

Question 9

Vitamin B (1, 6, 9, 12) Signs of Deficiency

Answer 9

Vitamin B1 (Thiamine)
- Early: anorexia, fatigue, depression, impaired memory
- Late: Paresthesia (burning/prickling of limbs), Wernicke’s encephalopathy

Vitamin B6 (Pyridoxine)
- Limb numbness, convulsions, microcytic anemia

Vitamin B9 (Folic acid)
- Macrocytic anemia, neural tube defects (of embryo)

Vitamin B12 (Cobalamin)
- Spinal cord degeneration, peripheral neuropathy, macrocytic anemia

Question 10

Vitamin C (Ascorbic Acid) Signs of Deficiency

Answer 10

• Scurvy (bleeding, poor wound healing)

Question 11

At Risk Populations for Mineral Deficiencies

Answer 11

1. Chronic illnesses
2. Elderly
3. Vegetarian/vegan diets
4. Pregnant women

Question 12

Hypocalcemia Signs

Answer 12

• Muscle cramps
• Weakness
• Tachycardia
• Seizures
• Osteopenia risk

Question 13

Hypercalcemia Signs

Answer 13

• Constipation
• N/V
• Weakness
• Confusion
• Kidney stones

Question 14

Calcium Correction Equation

Answer 14

Correct for calcium when albumin is low:

Ca corrected = Ca serum + (0.8 * (4-albumin))

Question 15

Hypomagnesemia Signs

Answer 15

Moderate
- Tremors
- Fatigue/weakness
- Hypokalemia

Severe
- Seizures
- Arrhythmias

Question 16

Hypermagnesemia Signs

Answer 16

Moderate
- Usually asymptomatic

Severe:
- Muscle weakness
- Dysrhythmias
- Delirium

Question 17

Hypokalemia Signs

Answer 17

• Muscle cramps
• Dysrhythmias

Question 18

Hyperkalemia Signs

Answer 18

• Usually asymptomatic
• Fatal EKG changes (vfib)

Question 19

Mg2+ and K+ Regulation

Answer 19

1. Correct hypomagnesemia FIRST
2. Then correct potassium

Question 20

Special Pop: Eating Disorders (Supplementation)

Answer 20

• Nutritional rehab (be cautious of refeeding syndrome)
• Restore weight gradually

Question 21

Special Pop: Alcohol Use Disorder (Supplementation)

Answer 21

• Replace fluids and electrolytes
• Restore fat-soluble vitamins (ADEK)
• Supplement thiamine (prevent Wernicke’s encephalopathy → IV>PO)
• Supplement folic acid (prevent macrocytic anemia)

Question 22

Special Pop: Pregnancy (Supplementation)

Answer 22

• ***Folic acid
• ***Iron (AE: constipation → use stool softener)
• Prenatal vitamin (calcium, vitamin D, iodine)

Question 23

Special Pop: Neonates (Supplementation)

Answer 23

• Breast milk preferred but doesn’t meet all nutritional requirements

If breastfed, supplement with…
- Vit D 400 IU/day
- Iron 1mg/kg/day

If fed Vit D and iron-fortified formula then you’re gucci

• Whole milk AE: GI bleeding, anemia, metabolic acidosis

Question 24

Special Pop: Elderly (Supplementation)

Answer 24

• Potassium
• Calcium
• Vit D
• Dietary fiber
• Vit B12 (important for cognitive function and RBC production)
• q monthly B12 inj available for people with poor PO adherence

Question 25

Special Pop: Macular Degeneration (Supplementation)

Answer 25

- Vitamin A (role in retinal pigment cells) - Vitamins C and E (antioxidants) AREDS - Vit C - Vit E - Zinc - Copper - Beta-carotene (vit A precursor) AREDS2 (slightly better than AREDS) - Same as above except lutein & zeaxanthin instead of beta-carotene Not omega-3 tho stay safe xD

Question 26

Drug-Nutrient Interactions w/ Vitamins

Answer 26

- Long-term Rx and OTCs can cause micronutrient deficiencies - Greatest risk in children and older adults Examples: 1. ABX x Vit K deficiency 2. H2A x Vit B12 and Ca2+ malabsorption 3. Isoniazid x B3 and B6 deficiency 4. Methotrexate x folic acid deficiency (supplement needed but DON'T TAKE ON THE SAME DAY) 5. PPI x B12, iron, and Ca2+ malabsorption 6. Diuretics x Mg2+, K+, Zn2+ losses