NUTRITIONAL DEFICIENCIES

Dr. Karen Lee P. Alabado
A)

o

B)

VITAMIN A

Common in developing countries

Required for normal keratinisation of mucosa and
skin
Mortality from inflammatory disease of gut and lung—
diarrhea and pneumonia

Hypovitaminosis A
o
Phrynoderma or “toadskin”
o
Keratotic papules: extremities and
shoulders
o
Sparing of hands and feet
o
Dry, fine, scaling skin

Hypervitaminosis A

Similar to effects of retinoid tx

Excess ingestion

25000 IU daily

Children
o
Loss of hair, eyebrows,
coarseness
o
Exfoliative cheilitis
o
Generalized exfoliation and
pigmentation
o
Clubbing of fingers
o
Moderate widespread itching
o
Retarded bone growth
o
Hepato/splenomegaly, anemia, proteins
o
Pseudotumor cerebri

Adults
o
Dryness of lips and anorexia—early
signs
o
Joint and bone pain
o
Follicular hyperkeratosis
o
Skin desquamation
o
Fissuring of mouth and nostrils
o
Dryness, loss of scalp hair, eyebrows
o
Dystrophy of nails
o
Liver dse
VITAMIN D

Excess

o Hypercalcemia
o Metastatic calcification
Deficiency
o Alopecia

C)

VITAMIN K

Dec. in vit K-dependent clotting factors

Purpura

Hemorrhage

Ecchymosis

D)

VITAMIN B1

Beriberi

Edema

Peripheral neuropathy

E)

F)

G)

VITAMIN B2

In alcoholics

Oral-ocular-genital syndrome

Lips: angular cheilitis

Tongue: atrophic, magenta

Face: seborrheic-like dermatitis around nose

Genital dermatitis
VITAMIN B6

Seborrheic dermatitis-like eruption

Atrophic glossitis

Angular cheilitis
VITAMIN B12/FOLIC ACID

Glossitis
o Bright red, sore, atrophic
o Hyperpigmentation
o
Generalized
o
Accentuated in exposed areas

Canities
Megaloblastic anemia
Neurologic findings
H)

VITAMIN C

Scurvy

4 H’s
o Hemorrhagic signs

Hemorrhagic gingivitis
o
Teeth as loose
o
Bad breath
o
Epistaxis
o Hyperkeratosis of follicles
o
Anterior forearm, abdomen,
post. Thigh
o
Corkscrew hair
o Hypochondriasis
o Hematologic abnormalities
o
Ecchymosis, tender nodules
o
Subperiosteal hemorrhage
o Characteristic finding: perifollicular petechiae

I)

NIACIN DEFICIENCY

Pellagra

3 D’s
o Diarrhea
o Dementia
o Dermatitis
o 4 types of dermatitis

Photosensitive eruption
o
Most characteristic
o
Casal’s necklace
o
4x longer to recover

Perineal lesions

Thickening and pigmentation over bony
prominences

Seborheic dermatitis-like eruption
o
Usually on bridge of nose w/ fine,
yellow powdery scaled over orifices
o Tx
o Correct malnutrition
o 100 mg nicotinamide 4x a day

dysphagia. glossitis o Tx: FeSO4-325 mg TID N) PROTEN-ENERGCY MALNUTRITION  Marasmus o Wrinkled. and loose skin o “monkey facies” o Loss of subcutaneous fat o Kwashiorkwor  Edema. eroded lesions on face and groin  Alopecia  Candidiasis  Neurologic findings  Tx: 10 g biotin daily K) ZINC DEFICIENCY  Most common in infancy  Acral and periorifical distribution  Pustular and bullous  Growth retardation  Ophthalmic findings  Impaired wound healing  CNS manifestations  Dx: chronic diaper rash with diarrhea  Tx: zinc sulphate 1-2 mkd L) ESSENTIAL FATTY ACID DEFICIENCY  Similar to Zn and biotin deficiency  Generalized xerosis o Required for normal epidermal fxn o Make up stratum corneum M) IRON DEFICIENCY = common in women who have heavy menses  Koilonychia  Glossitis  Angular cheilitis  Pruritus  Telogen effluvium  Plummer-Vinson syndrome o Microcytic anemia. dry and lustreless  Flag sign  Flaky paint sign  Desquamating skin -END- .o Fluid and electrolyte replacement o Skin lesions begin to resolve in 24 hrs J) BIOTIN DEFECIENCY  Similar to zinc deficiency and essential fatty acid deficiency  Periorificial  Patchy. red. potbelly  Hypopigmented hair. dry.