Vitamins

Front 1

Vitamin B1 (thiamine)
source
function
population at risk

Back 1

source: pork, rice, legumes, cereals, yeast. inactive with high temperature and very acidic.
function: catalyst in oxidative carboxylation to make acetyl CoA, necessary for pentose phosphate pathway, and for intitiation of nerve impulse propagation
population: malnutrition, alcoholics

Front 2

Vitamin B1 (thiamine)
deficiencies and toxicities

Back 2

1. Beriberi: thiamine deficiency. baby: cardiomegaly, cyanosis, tachycardia, dyspnea, GI symptoms. adults: motor and sensory neuropathy, heart failure due to cardiomyopathy
2. Wernicke-Korsakoff: (alcoholics) wernicke's: nystagmus, ophthalmolegia, ataxia, confusion. Korsakoff: confabulation, short term memory disruption
3. Leigh's syndrome: mitochondrial disease causing demyelination within the CNS and PNS. ataxia, dysarthria, movement disorders, atrophy, wekness, areflexia.
No toxicity: excess is secreted by kidneys

Front 3

Vitamin B2 (Riboflavin)
source
function
population at risk

Back 3

source: fish, meat, milk, eggs, green vegetables, yeast, enriched food
function: flavin mononucleotide (FMN) and dinucleotide (FAD) are important in respiratory pathways, used in mitochondria for oxidation, reduction and electron transporter
population at risk: avoidance of dairy products (culture?), starvation, malabsorption disorders, rare genetic disorders of riboflain metabolism, barbituates (impair riboflavin's function)

Front 4

Vitamin B2 (riboflavin)
deficiencies and toxicities

Back 4

deficiency: beefy red tongue, soreness and burning of lips, tongue, mouth, and oral pharynx. dermatitis, photophobia, normocytic, normochromic anemia
toxicity is rare because GI absorption is limited.

Front 5

Vitamin B3 (Niacin)
source
function
population at risk

Back 5

source: beef, pork, chicken
function: NAD and NADP are used by liver, muscle and other tissues with high energy requirements, involved in the synthesis and metabolism of carbs, FA, proteins

Front 6

Vitamin B3 (Niacin)
deficiencies and toxicities

Back 6

pellagra: hyperpigmented rash, red tongue, diarrhea, insomnia, anxiety, delusions, dementia (dermatitis, diarrhea, demetia)
Other conditions affecting tryptophan prodcution and absorption result in pellagra: isoniazid reduce pyridoxal phosphate, an enzyme that increases trp production; Hartnup disease (AR) has reduced trp absorption; carcinoid syndrome shunts trp away from niacin production to serotonin.
toxicity: flushing, nausea, vomiting, pruritus, hives, liver injury

Front 7

Vitamin B5 (Panthothenic acid)
source
function
population at risk

Back 7

source: animal and plant food (part of CoA)
function: part of CoA, needed in TCA cycle and FA synthesis and breakdown, also for normal function of ACTH, synth of vitamins A and D, cholesterol, heme, steroids, amino acids, proteins.
population: severely malnourished

Front 8

Vitamin B5 (Panthothenic acid)`
deficiencies and toxicities

Back 8

deficiency: paresthesias, dysesthesias, gastrintestinal distress, poor wound healing.
no toxicity due to renal secretion

Front 9

Vitamin B7 (Biotin)
source
function
population at risk

Back 9

source: liver, egg yolk, soybeans, yeast, plants
function: cofactor for carboxylase reactions in carbohydrate and protein metabolism, DNA synthesis, cell replication
population: lots of raw eggs (raw egg whites have avidin, that bings biotina dn makes it unavailable). certain genetic deficiencies

Front 10

Vitamin B7 (Biotin)
deficiencies and toxicities

Back 10

deficiency: mental status changes, anorexia, nausea, myalgias, dysesthesias, dermatitis, alopecia, carboxylase deficiencies. neuro symptoms can become irreversible. screening is done at birth.

Front 11

Vitamin B6 (Pyridoxine)
source
function
population at risk

Back 11

source: bananas, navy beans
function: amino acid metabolism, sphingolipid and neurotransmitter synthesis, gluconeogenesis
population: genetic abnormalities of enzymes that need pyroxidine, eg cystathionine synthase (produces cystathionine).

Front 12

Vitamin B6 (Pyridoxine)
deficiencies and toxicities

Back 12

deficiency: irritability, confusion, depression, stomatitis, glossitis, cheilosis. increases homocysteine, a risk factor for atherosclerosis

toxicity: dizziness, nausea, photosensitivity, peripheral neuropathy, rash

Front 13

Vitamin B9 (folic acid)
source
function
population at risk

Back 13

source: green leafy vegetables, meat, nuts, fruits, cereals
function: carbon donor for several reactions, RBCs and other short lived/high proliferation cells depend on folic acid
population: malabsorption, malnutrition, elderly, alcoholic, hemolytic anemia, excessive erythropoeisis, pregnancy

Front 14

Vitamin B9 (folic acid)
deficiencies and toxicities

Back 14

deficiency: GI symptoms (diarrhea, cheilosis, glossitis), megaloblastic anemia, neural tube defects

toxicity: malasie, somnolence, GI symptoms

Front 15

Vitamin B12 (Cobalamin)
source
function
population at risk

Back 15

source: animal products. absorption requires pepsin (frees B12 from albumin), R-binders (saliva), trypsin (separate B12 from R-binders), and intrinsic factor (binds B12 in duodenum). picked up by receptors in the terminal ileum. necessary for folate function.
population: strict vegans, atrophic gastritis, gastric resection, maldigestion/malabsorption due to bacterial overgrowth, pancreatic insufficiency, reduced distal ileum.

Front 16

Vitamin B12 (cobalamin)
deficiencies and toxicities

Back 16

deficiencies: GI symptoms (glossitis, anorexia, diarrhea), hematologic (macrocytic anemia, bone marry, polysegmented PMNs), neurologic (paresthesias, balance disturbance, cerebral dysfunction, dementia)

Front 17

Vitamin C (ascorbic acid)
source
function
population at risk

Back 17

source: fruits and vegetables
function: antioxidant, collagen formation, folic acid transport, dopamine synthesis, reducing agent, cofactor, cosubstrate, enzyme complement
population: alcoholics, drug abuse
population:

Front 18

vitamin C (ascorbic acid)
deficiencies and toxicities

Back 18

Scurvy: deficiency, improper collagen formation (impaired wound healing, ecchymoses, loose teeth, gingivitis, petechiae, hyperkeratosis of hair, corkscrew body hair, arthralgias, joing swelling, weakness, depression, vasomotor instability

toxicity: diarrhea, bloating, false negative stool guaiac testing. fatal cardiac arrhythmias with iron overload

Front 19

Vitamin A (Retinoic acids)
source
function
population at risk

Back 19

source: retinol (liver, kidney, egg yolk, butter), beta carotene (pigmented plants), carotenoids
function: vision, cellular differentiation (esp normal eye development), immune function

Front 20

Vitamin A (Retinoic acids)
deficiencies and toxicities

Back 20

deficiencies: (3rd most common deficiency worldwide), xerophthalmia, night blindness, complete blindness. childhood: Bitot's spots (sq cell and keratinization of the conjunctiva), corneal perforation, keratomalacia, punctuate keratopathy.

toxicities: 1. acute: N/V, malaise, vertigo, abortion. 2. chronic: visual problems, ataxia, alopecia, hyperlipidemia, bone and muscle pain, hepatotox (venooclusive, cirrhosis). 3. Teratogenic: spontaneous abortions, microcephaly, cardiac abnormalities

Front 21

Vitamin D
source
function
population at risk

Back 21

source: minimal light exposure, fatty fish, liver, butter, eggs, UV light.
function: depends on PTH (Ca homeostasis), also estrogen, GH and prolactin

Front 22

Vitamin D
deficiencies and toxicities

Back 22

deficiency: demineralization of bones to maintain Ca homeostasis. osteoporosis (adults) and rickets (children). hypophosphatemia, hypocalcemia, secondary hyperPTH. colon cancer

toxicity: hypercalcemia, hypercalciuria, polyuria, vomiting, muscle weakness, anorexia

Front 23

Vitamin E
source
function
population at risk

Back 23

source: vegetable oils, tocols, tocotrienols (alphatocopherol in man)
function: protects cell membranes from peroxidation, antioxidant, free radical scavenger.

Front 24

Vitamin E
deficiencies and toxicities

Back 24

deficiency: rare, causes neurologic, muscular and hematologic disturbances (spinocerellar ataxia, myopathy, retinopathy), shortened RBC lifespan, congenital hemolytic diseases

toxicities: N/V/D. increased bleeding risk, especially with warfarin, increased hemorrhagic strokes. stops other fat-soluble vitamin absorption. necrotizing enterocolitis in infants.

Front 25

vitamin K
source
function
population at risk

Back 25

source: animal and plant foods, synthesized by gut bacteria
function: clotting factors II, VII, IX, X, anticoagulants C, Z, S, M.
population: liver disease, disrupted gut flora (Abx), inherited deficiency.

Front 26

Vitamin K
deficiency and toxicity

Back 26

eficiency: coagulopathy, bruising, petechiae, spontaneous bleeding, GI/urologic bleeding. in infants, can cause hemorrhagic disease of the skin, GI and CNS.

toxicity: rare

Front 27

Iron
source
function
population at risk

Back 27

source: meat, vegetables, liver, eggs (10% of oral Fe is absorbed).
function: hemoglobin
population: vegans, femalehood

Front 28

Iron
deficiency and toxicity

Back 28

deficiency: pallor, fatigue, SOB, tachycardia, microcytic anemia, thrombocytosis, cheilosis, brittle nails, smooth tongue, Plummer-Vinson syndrome (esophageal web), pica (craving for ice/ starch)

toxicity: not mentioned-- think hemochromocytosis

Front 29

Zinc
source
function
population at risk

Back 29

source: red meat, shellfish, whole grain cereal
function: protein and lipid syntehsis, insulin activity, protects membranes from free radicals, cofactor in transcription, stabilizes DNA, RNA and ribosomes.
population: alcoholic, TPN, malabsorption, malnutrition, chronic diarrhea, pregnancy

Front 30

Zinc
deficiency and toxicity

Back 30

deficiency: acrodermatitis (skin rash), glucose intolerance, impaired wound healing, impaired growth, depression, alopecia, immune dysfunction, impaired taste. congenital acrodermatitis enteropathica is found after breastfeeding stops.

toxicity: rare, GI symptoms (N/V/D, abd pain), copper deficiency (hence it's used for Wilson's disease).

Front 31

Selenium
source
function
population at risk

Back 31

source: seafood, organ meats, plants (if soil has Se)
function: glutathione peroxidases
population: rural China with low soil Se, TPN, malnourished

Front 32

Selenium
deficiency and toxicity

Back 32

deficiency: Keshan disease (heart and collagen deficiency disorder, cardiomyopathy (esp in China)). increased risk for malignancies.

toxicity: N/V, delirium, peripheral neuropathy, alopecia, nail changes

Front 33

Iodide
source
function
population at risk

Back 33

source: seafood, water, ocean mist in coastal areas. iodized salt, bread, dairy products.
function: thyroid hormone
population: far from sea with no iodized foods, malnourished

Front 34

Iodide
deficiency and toxicity

Back 34

deficiency: goiter, hypothyroid

Front 35

Copper
source
function
population at risk

Back 35

source: organ meats, seeds, nuts, legumes, seafood, binds ceruloplasmin
function: MAO, collagen, cytochron C (mitochondrial transport), ferroxidase for erythropoeisis, NE synthesis), taste
population: TPN, prematurity, peritoneal dialysis, chrnoic diarrhea

Front 36

Copper
deficiencies and toxicities

Back 36

deficiencies: anemia, impaired taste, neutropenia, bone demineralization, CNS (ataxia, tremore, rigidity, cognitiv, psychiatric), reproductive failure, abnormal pigmentation, myocardial failure.

toxicity: Wilson's (genetic disorder, impaired ceruloplasmin formation and secretion, so Cu not excreted in bile). Gi symptoms (N/V, abd pain), liver necrosis/failure, coma, renal failure, death

Front 37

Chromium
source
function
population at risk

Back 37

source: grains, cereals, fruits, vegetables, processed meats
function: coenzyme for protein, lipid and carb metabolism
population: TPN, malnutrition, decreased absorption witha ntacids and NSAIDs

Front 38

Chromium
deficiency and toxicity

Back 38

deficiency: glucose intolerance, CNS and peripheral neurologic symptoms

no toxicity described (limited GI absorption)

Front 39

Manganese
source
function
population at risk

Back 39

source: whole grains, cereals, fruits, vegetables
function: fatty acid, cholesterol, mucopolysaccharid syntehsis

Front 40

Manganese
deficiency and toxicity

Back 40

deficiency: very rare, elevated prothrombin time unresponsive to vitamin K, thinned lightened hair, skeletal, CNS and gonadal abnormalities.

toxicity: neuropsychiatric symptoms