VITAMINS + VITAMIN DEFICIENCY

Question 1

IV nutrition

Answer 1

Given when adequate nutrition is not possible

Question 2

What are the two methods IV nutrition is given through?

Answer 2

• Supplemental parenteral nutrition: addition to ordinary feeding
• Total parenteral nutrition (TPN): sole source of nutrition
• Infused through a central venous catheter or a peripheral vein

Question 3

What does IV nutrition contain?

Answer 3

Contains amino acids, glucose, fat, electrolytes, trace elements, and vitamins

Question 4

IV nutrition - Protein

Answer 4

Protein given as synthetic L-amino acids - source of energy

Question 5

IV nutrition - Carb

Answer 5

Preferred carb: glucose (infused through a central venous catheter to avoid thrombosis)

Question 6

IV nutrition - Phosphate

Answer 6

Phosphate: for phosphorylation of glucose and preventing hypophosphataemia

Question 7

IV nutrition - Fructose and sorbitol

Answer 7

prevents hyperosmolar hyperglycaemic non-ketotic acidosis

Question 8

IV nutrition- Fat emulsions

Answer 8

high energy to fluid volume ratio (not to mix in additives)

Question 9

What are the fat soluble vitamins

Answer 9

• Vitamin A (retinol)
• Vitamin D (ergocalciferol[D2], colecalcifero|[D3], alfacalcidol, calcitriol)
• Vitamin E (tocopherol)
• Vitamin K (phytomenadione)

Question 10

What are the water-soluble vitamins

Answer 10

• Vitamin C (ascorbic acid)
• Vitamin B
• Folate

Question 11

Vitamin A - function

Answer 11

• Also known as Retinol
• Necessary for eyesight, colour and night vision
• They are also necessary for body tissues, growth and bone formation
• They also help with resistance to infection

Question 12

Vitamin A (retinol) - deficiency

Answer 12

• ocular defects
• increased risk of infections

Question 13

Vitamin A - pregnancy

Answer 13

Avoid in pregnancy (teratogenic)

Question 14

Vitamin A - foods

Answer 14

• CARROTS
• eggs
• oily fish
• milk
• yoghurt
• liver and liver products such as pâté
• peaches, apricots
• dark green leafy veg

Question 15

Vitamin B

Answer 15

B, (thiamine) → Wernicke’s encephalopathy
B2 (riboflavin) → Keeps skin, eyes and the nervous system healthy
B3 (Niacin/Nicotinic acid)
B (pyridoxine) → Treats peripheral neuropathy associated with isoniazid
B12 (Hydroxocobalamin) → Used in the treatment of megaloblastic anaemia

Question 16

Vitamin B1 (thiamine) →

Answer 16

Wernicke’s encephalopathy
- Vital for the functioning of all body cells, especially NERVES
- Alcoholics

Question 17

Signs of vitamin B1 deficiency

Answer 17

Always think of energy
- Fatigue
- Weight loss
- Weakness

Severe signs (could also be Wernicke’s encephalopathy):
- Mental confusion
- Muscular weakness
- paralysis of the extremities
- Loss of reflexes

Question 18

B1 foods

Answer 18

Think of energy sources from breakfast foods!
- Bread
- Cereals
- Peanut butter
- Oranges

Question 19

Vitamin B2 (riboflavin) →

Answer 19

• Keeps skin, eyes and the nervous system healthy
• Normal growth and development
• Production of hormones
• Formation of RBCs

Question 20

Signs of vitamin B2 deficiency

Answer 20

• Soreness of Mouth, lips and tongue
• Burning and itching of eyes
• Loss of vision and sensitivity to light
  Severe deficiency:
• Inside of the mouth, eyes and skin become inflamed
• Depression can develop

Question 21

B2 foods

Answer 21

Again think energy!
- Milk
- Cereals
- Meat
- Bread

Question 22

Vitamin B3 - functions

Answer 22

• Niacin or nicotinamide
• Essential for energy metabolism (like B1,2)
• Hormone production and formation of RBCs (like B2)

Question 23

Signs of B3 deficiency

Answer 23

• Weakness
• Loss of appetite
• Indigestion
• Skin inflammation
• Lethargy
  Severe deficiency
• Disease Pellagra
• Scaly skin
• Swollen tongue
• Tremors
• Damage to CNS

Question 24

B3 foods

Answer 24

Again, think energy!
- Meat
- Eggs
- Milk
- Wheat flour (for bread)

Question 25

Vitamin B6 (pyridoxine) →

Answer 25

Treats peripheral neuropathy associated with isoniazid

Question 26

Signs of B6 deficiency

Answer 26

- Skin and nerve inflammation - Anaemia - Vomiting - Nausea - Lethargy - Increased susceptibility to disease and infection

Question 27

B6 food

Answer 27

Think protein and energy - Chicken - Fish - Kidney - Liver - Egg - Peanut

Question 28

B7 - function

Answer 28

- Biotin - Energy

Question 29

B7 foods

Answer 29

- Liver - Egg yolk - Soy flour - Cereals - Yeasts

Question 30

Signs of B7 deficiency

Answer 30

- Skin inflammation - hair loss - conjunctivitis - elevated blood levels of cholesterol - Tingling and numbness in the hands and feet

Question 31

B12 foods

Answer 31

Foods that normally vegans lack... - Meat - Salmon - Cod - Milk - Cheese - Eggs

Question 32

Which medicines can cause B12 deficiency

Answer 32

metformin

Question 33

Signs of B12 deficiency

Answer 33

- Pernicious anaemia (low haemoglobin) - Neurological problems - Cracks around the mouth - **Pins and needles **

Question 34

Vitamin C (ascorbic acid) - deficiency

Answer 34

* Deficiency leads to scurvy * Helps with wound healing and maintains healthy skin, blood vessels, bone and cartilage

Question 35

Signs of vitamin C deficiency

Answer 35

- Scurvy (Bleeding gums) - Nose bleeds and wounds that heal slower than normal - Bleeding margins - Petechia of the skin

Question 36

Vitamin C - foods

Answer 36

Oranges, peppers, strawberries, blackcurrants, broccoli, sprouts and potatoes

Question 37

Types of Vitamin D

Answer 37

1. Ergocalfierol - Vitamin D2 (calciferol) 2. Cholecalciferol - Vitamin D3 3. Dihydrotachysterol 4. Alfacalcidol 5. Calcitriol

Question 38

Vitamin D - function

Answer 38

- Maintenance and formation of bones and teeth - Regulates absorption and use of Ca and Phosphorus

Question 39

Vitamin D deficiency

Answer 39

* Deficiency leads to rickets * Deficiency occurs in reduced sunlight and diet intake

Question 41

Vitamin D - normal dose

Answer 41

Normal dose is 10mcg (400Ul)

Question 42

Vitamin D - foods

Answer 42

Oily fish, red meat, liver, egg yolk, fortified foods such as cereals

Question 43

Which type of vitamin D is preferred in renal impairment?

Answer 43

Alfacalcidol

Question 44

Vitamin E - functions

Answer 44

- It can help protect fats and vitamin A in the body from destructive oxygen fragments - They are an antioxidant - They stabilise cell membranes and protect tissues that are found throughout the body

Question 45

Vitamin E (tocopherol) - deficiency

Answer 45

Deficiency leads to neuromuscular abnormalities

Question 46

Vitamin E - foods

Answer 46

Plant oils, nuts, seeds and margarine, beg

Question 47

Vitamin K (phytomenadione)

Answer 47

* Blood clotting factors - reversal agent for warfarin * Menadiol (water-soluble derivative) given orally in malabsorption syndromes

Question 48

Vitamin K deficiency

Answer 48

- Prolonged blood clotting - Higher tendency to bleed

Question 49

Vitamin K - foods

Answer 49

Green leafy vegetables, vegetable oils and cereal grains

Question 50

Why do we tell people on Warfarin to limit green leafy vegetables?

Answer 50

- Because they are good sources of Vitamin K!!