Fat soluble vitamins

 Vitamin A
 Vitamin D
 Vitamin E
 Vitamin K

By: ShriHari. C
Vigneshwar Adhithiya. S
Vitamin A:
Active forms: Retinol, 11cis-Retinal, Retinoic acid.
Sources: Animal and Plant.
Richest source: Halibut liver oil (900000 RE)
Other forms: Pro-Vitamin A- Beta carotenes.
Non Pro-Vitamin As
RDA: 600 mcg retinol.
Metabolism: Absorption, Uptake and Storage.
Functions: Eye- Wald’s Visual Cycle.
Skin- Regulation of gene expression

Immunity- Cell differentiation

Deficiency: Night blindne

ss to total blindness.
Phrynoderma: follicular hyperkeratosis.
Gonadal dysfunction in males and sterility in
females.
Toxicity: Hypervitaminosis A and Carotenemia.
WALD’S VISUAL CYCLE
Vitamin A deficiency: Xerophthalmia
Population at risk: 6months to 6 years age.
Prevalence indicators: Night blindness, Bitot’s spots,
Corneal xerosis/ulceration/ keratomalacia, Serum
Retinol.
First symptom of Vit. A deficiency: Nyctylopia.
First sign of Vit. A deficiency: Conjunctival Xerosis.
Treatment: 2 doses on 2 consecutive days and 3rd dose 4
weeks later.
Prophylaxis: short term, medium term, long term.
Short term: 6-12 months: 1 lakh IU every 6 months.
1-6 years: 2 lakhs IU every 6 months.
Medium term: fortification of foods (vanaspathi ghee
and toned milk)
Long term:
 Intake of iodine rich foods.
 Immunization against measles.
 Breast feeding as long as possible.
 Prompt treatment of diarrhea and
associated infections.
Vitamin D: Active form- 1,25 (OH)2 Cholecalciferol.
Sources : Fish, Plant (Ergocalciferol)
Storage form: 25 (OH) cholecalciferol [liver]
RDA: 25 mcg calciferol / 100 IU
Metabolism:
Functions: Bone Health, Muscle, Immune function,
Inflammation.
Deficiency: Rickets-[ poor mineralization of bone]
Osteomalacia-[ demineralization of bone].
Toxicity: Hypervitaminosis D and Hypercalcemia.
Treatment: oral 50,000 IU/ week for 6-8 weeks followed
by maintenance of 800 U/day from foods and
supplements after achieving normal plasma levels. (>20
ng/ml of active form is sufficient for good bone health).
VITAMIN E :
Other names : Tocopherol; anti-infertility vitamin.
*Most potent biological anti-oxidant.
Sources : Wheat germ oil, Sunflower oil , Safflower oil,
Cotton seed oil.
Metabolism : Tocopherol is absorbed and transported
as Chylomicrons
RDA : 10 mg/ day (15mg = 33 IU)
Biochemical Role : Antioxidants,protects RBC’s from
hemolysis, boosts immunity,
reduces risk of atherosclerosis.
Deficiency : Not yet reported.
Can cause muscle weakness, Creatinuria.
Toxicity : >1000U/day can cause tendency to bleed.
Pharmacological Dose : 200-400 IU/day.
Vitamin K :
Sources : Green leafy vegetables, Intestinal bacteria.
RDA : 50-100 mg/day.
Absorption : In intestine along with Chylomicrons.
Bile salts are required; Stored in the Liver.
Functions : 1) Coagulation–Vitamin k dependant factors
 Factor II (Prothrombin)
 Factor VII ( SPCA)
 Factor IX ( Christmas Factor)
 Factor X ( Stuart Prower Factor)
 Protein S , Protein C , Protein Z.
2) As a co-factor in the synthesis of
Gamma carboxy glutamic acid.
3) Functional activity of Osteocalcin.
Causes of Deficiency : Malabsorption ,
Obstructive jaundice, Sprue,
Chronic Pancreatitis, GI infections,
Prolonged antibiotic therapy.
Deficiency : Hemorrhagic Disease of the Newborn,
Mucous membrane hemorrhage, Ecchymotic
patches, Post-traumatic bleeding,
Prolonged PT & Delayed CT ( characteristic).
Toxicity : Hemolysis, Hyperbilirubinemia, Kernicterus ,
Brain damage.