Vitamins and deficiency diseases by keerthi

IMPORTANT POINTS

1. VITAMINS AND DEFICIENCY DISEASES AISWARYA THOMAS 2 nd year Pharm D 1

2. INTRODUCTION Vitamins are organic compounds required in the diet in small quantities to perform biological functions . We obtain them from : foods we eat or via vitamin supplements. 2

3. HISTORY OF VITAMINS In 1749 the prevention of scurvy by citrus foods was first discovered by Scottish surgeon James Lind. In Orient: Beriberi was common due to polished white rice. In 1913 Funk coined the term “ VITAMINE ”. 3

4. VITAMINS According to solubility vitamins are of: Fat-soluble & Water-soluble Thirteen vitamins are known of which: Four are fat-soluble : Vitamins A , D , E ,K Nine are water- soluble. 4

5. Distinction between fat-soluble and water-soluble vitamins. Fat soluble vitamins are readily stored in the body. Not readily excreted in urine. Excess consumption can lead to their accumulation and toxic effects. 5

6. VITAMIN SUPPLEMENTS Synthetic or natural substances which can be purchased as pills, capsules, powders or liquids. Best when accompanied by a well balanced diet. Do not replace a healthy diet. Do not provide calories or energy. 6

7. RECOMMENDED DIETARY ALLOWANCES (RDA ) These are suggested levels of essential nutrients considered adequate to meet nutritional needs of healthy individuals. Requirements are influenced by physical characteristics , dietary habits, sex, pregnancy, lactation and age. 7

8. MULTIVITAMIN SUPPLEMENT A multivitamin should contain fat-soluble vitamins A,D,E ; water-soluble vitamins B1,B2,B6,B12 , niacin, biotin , folic acid , pantothenic acid and vitamin C. Contains minerals :zinc, magnesium, copper, and calcium. 8

9. VITAMINS Fat-soluble Water-soluble Vitamin A Non B- Complex B-Complex Vitamin D Vitamin C Thiamine (B1) Vitamin E Riboflavin(B2) Vitamin K Niacin (B3) Pantothenic acid(B5) Pyridoxine(B6) Biotin(B7) Folic acid (B9) Vitamin B12 9

10. FAT-SOLUBLE VITAMINS 10

11. VITAMIN- A It is the name given to a group of related compounds : Retinol (vitamin A alcohol) Retinal ( vitamin A aldehyde) Retinoic acid ( vitamin A acid) Its provitamin carotenes are found in plants. 11

12. SOURCES: Fish oil , liver, egg yolk, milk, cheese , butter. Vegetable sources contains provitamin A carotenes. Yellow and dark vegetables and fruits are sources of carotenes. Carrots mango papaya spinach. 12

13. FUNCTIONS OF VITAMIN A Maintenance of normal vision. Maintenance of normal cartilaginous and bone growth. Increased immunity against infections in children. Anti-proliferative effect. 13

14. VITAMIN- A DEFICIENCY May be due to : inadequate dietary intake impaired intestinal absorption Chronic alcoholism. Impaired vision – Night blindness. Extremely dry skin ,hair or nails. Epithelial metaplasia and keratinization. Xerophthalmia ( dry eye ). 14

15. WHO IS AT RISK ? Young children's. Children with inadequate health care. Adults with diseases of : pancreas liver intestine 15

16. Too Much Can Be Toxic !! Hypervitaminous A leads to toxic symptoms: Dry , itchy skin Hair loss Liver damage Skin coloration Loss of appetite Head ache and fatigue Blurred vision. 16

17. SIDE EFFECTS OF VITAMIN A Severe birth defects. women of child bearing age should not consume more than 8000 IU per day. Skin can take on yellow or orange glow. 17

18. VITAMIN D SUNSHINE VITAMIN. CALCITRIOL. Exists in two activated sterol forms: Vitamin D2 - CALCIFEROL Vitamin D3 - CHOLECALIFEROL. 18

19. SOURCES : Sunlight. Milk. Fish. Orange juice . Fortified cereals. 19

20. FUNCTIONS OF VITAMIN D Maintenance of adequate plasma levels of calcium and phosphorous. Metabolic functions. Bone mineralization. Neuromuscular transmission. 20

21. VITAMIN -D DEFICIENCY May be due to: Limited exposure to sunlight Diet deficiency. Renal disorders. Rickets. Osteomalacia ( in adults). Hypocalcaemictetanydue to neuromuscular dysfunction. 21

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23. CAUSES Increased risk of: Cancers Autoimmune diseases Hypertension WHO IS AT RISK ? Covered and protected skin Elderly breast – fed infants 23

24. Too Much Vitamin D !!! High dose can cause accumulation in the liver. Produces symptoms of poisoning. Signs of toxicity include: excess calcium in the blood. nausea vomiting decreased appetite. 24

25. VITAMIN E Vitamin E describes a family of eight antioxidants: four tocopherols four tocotrienols. It is an antioxidant in cells. 25

26. SOURCES Vegetables: spinach carrot Egg Bread Almonds Peanuts. vegetable oils 26

27. FUNCTIONS OF VITAMIN- E Antioxidant. Inhibits platelets aggregation. Enhances vasodilation. Scavenger of free radicals. 27

28. VITAMIN -E DEFICIENCY Increased risk of cardiovascular diseases. Hemolytic anaemia in children. Neurological symptoms (impaired coordination and muscle relaxation). RISK FACTOR : fat malabsorption syndrome. 28

29. THERAPEUTIC USES DIABETES MELLITUS. CANCER PREVENTION. PREVENTION OF CARDIOVASCULAR DISEASES. 29

30. TOXICITY Excess vitamin E causes : Impaired blood clotting leading to risk of bleeding in some persons. Recommended that vitamin E supplements to be stopped one month before surgery. 30

31. VITAMIN K K derived from the German word KOAGULATION Two naturally occuring forms : Plants synthesize phylloquinone – Vitamin K1 Bacteria synthesize menaquinone-3 – Vitamin K2 31

32. SOURCES Vegetable oils Almonds Peanuts Spinach Body can produce its own(from bacteria in intestine). 32

33. FUNCTIONS OF VITAMIN -K Helps in clotting . Assist in bone mineralization. 33

34. VITAMIN K DEFICIENCY It is common in adults. Biliary obstruction . Due to antibiotic therapy. Due to malabsorption syndrome. Hemmorhage. Deficiency may appear in infants or in people. Who take anticoagulants such as Warfarin. 34

35. WATER-SOLUBLE VITAMINS 35

36. VITAMIN C Exist as L- ascorbic acid. Smokers and lactating mother needs higher range. 36

37. SOURCES Fruits Vegetables Tomato juice Sweet potato Citrus fruit Orange juice. 37

38. FUNCTIONS OF VITAMIN C Collagen synthesis. Body to fight against infections. Keep gum’s healthy. Aids in the prevention of heart disease and cancer. 38

39. VITAMIN C DEFICIENCY Leads to scurvy. Weight loss. Slow healing of wound and fractured bone. Fatigue and joint pain. Skin rash . Anaemia. 39

40. THERAPEUTIC USES Cardiovascular diseases. Cataracts. Diabetes mellitus. Cancer prevention. Common cold. Lead toxicity. 40

41. VITAMIN B Group of seven water-soluble vitamins : Thiamine Riboflavin Niacin Pyridoxine Cobalamin Biotin Pantothenic acid Folic acid 41

42. Biotin and pantothenic acid deficiencies are rare. As it is found in numerous foods. Biotin deficiency may occur with prolonged antibiotic therapy. 42

43. VITAMIN B1-THIAMINE SOURCES 43 Yeasts Cereals liver

44. FUNCTIONS OF THIAMINE ATP production. Stabilizing the appetite. Proper nerve function. 44

45. VITAMIN -B1 DEFICIENCY BERI-BERI. WERNICKE –KORSAKOFF SYNDROME. RISK OF THIAMIN DEFICIENCY Excessive loss: hemodialysis and diuretics. Low intake and alcoholism. 45

46. THERAPEUTIC USE CONGESTIVE HEART FAILURE. CANCER PREVENTION. ALZHEIMER’S DISEASE. 46

47. VITAMIN B2-RIBOFLAVIN Also called YELLOW RESPIRATORY ENZYME. Cytochrome oxidase enzyme. Rapidly absorbed from the bowel and stored in tissues. 47

48. SOURCES Eggs. Meat. Leafy green vegetables. Milk 48

49. FUNCTIONS OF RIBOFLAVIN Energy production. Cell respiration. Maintenance of good vision ,skin ,nails. Carbohydrate ,fat and protein metabolism. 49

50. RIBOFLAVIN DEFICIENCY Itching and burning eyes. Oily skin. Dermatitis. Digestive disturbances. Cracks and sores in mouth and lips. 50

51. WHO’S AT RISK ? Alcoholics People with cataracts. People with sickle-cell anemia. 51

52. VITAMIN B3 - NIACIN Includes biologically active derivative: NICOTINAMIDE Essential for the formation of two oxidative coenzymes ( dehydrogenases ). NAD ( Nicotinamide adenine dinucleotide ) NADP. 52

53. SOURCES Liver Kidney Meat Green vegetables Grain cereals. 53

54. FUNCTIONS OF NIACIN Energy production. Improves circulation. Maintenance of skin and tongue. Maintenance of nervous system. 54

55. VITAMIN B3 DEFICIENCY Pellagra – rare in Western societies. Nervousness . irritability Fatigue . Head ache. Insomnia. Mental depression. 55

56. VITAMIN B5-PANTOTHENIC ACID FUNCTIONS Produces energy. SOURCES Fruits ,meats, poultry ,legumes . 56

57. VITAMIN B6-PYRIDOXINE Related to two naturally occuring substance: pyridoxine , pyridoxal , pyridoxamine. SOURCES Meat Eggs Green vegetables 57

58. FUNCTIONS OF VITAMIN B6 Production of red blood cells. Nervous system function. Immunity. Reducing muscle spasm , cramps and numbness. Maintaining proper balance of sodium and phosphorous. 58

59. DEFICIENCY OF VITAMIN B6 Nervousness , Insomnia Skin lesions Loss of muscle control, muscle weakness. Arm and leg cramps. 59

60. VITAMIN B7 - BIOTIN SOURCES Meat Egg yolk Soya bean s 60

61. FUNCTIONS OF VITAMIN B7 Produce energy. Helps produce body chemicals (insulin). In gene expression. 61

62. VITAMIN-B7 DEFICIENCY Nausea. Anorexia. Mental and neurological symptoms : Hallucination Depression 62

63. VITAMIN B9-FOLIC ACID SOURCES Yeasts leafy vegetables FUNCTION Synthesis of nucleic acids 63

64. FOLIC ACID DEFICIENCY Neural tube defects. Anaemia. THERAPEUTIC USE: Chronic hemolytic anaemia. 64

65. VITAMIN B12- COBALAMIN FUNCTIONS Proper nerve function. Production of red blood cells. DNA reproduction. Prevention of anaemia. Metabolizing fats and proteins. 65

66. VITAMIN- B12 DEFICIENCY Anemia nerve damage hypersensitive skin. 66

67. WHO’S AT RISK ? Pernicious anemia. B12 injection often taken regularly. HIV Chronic fatigue syndrome. 67

68. ROLE OF PHARMACIST IN VITAMIN DEFICIENCY DISORDES 68

69. Pharmacist by counselling patients provides safe consumption of vitamins. Counselling on vitamin supplements is a part of their role in pharmaceutical care. Provides responses to specific knowledge questions such as: Interaction of vitamins with drugs or the recommended dietary allowance of vitamins for infants , children , pregnant women. 69

70. Provides consequences of vitamin consumption. Informs the patients that: beat ways to meet nutrient needs is by consuming appropriate foods . Vitamins supplementation is only suggested for: individuals with chronic diarrhoea. Pregnant and breast-feeding women. 70

71. Food allergies. Food intolerance. Surgical removal Too much calcium leads to kidney stones. Excess vitamin D can damage heart. 71

72. REFERENCE TEXTBOOK OF PATHOPHYSIOLOGY - HARSH MOHAN. TEXTBOOK OF BIOCHEMISTRY - U. SATYANARAYANA. aggie-horiculture.tamu.edu 72

73. THANK YOU 73