VITAMINS SOURCES DEFICIENCY SIGNS AND SYMPTOMS TOXICITY NOTES

WATER-SOLUBLE VITAMINS
Vitamin B1 ✓ Meat/ fish BERI BERI NONE
THIAMINE ✓ Beans, nuts, - Severe thiamine deficiency syndrome found in areas where DRY Loss of appetite, weight loss,
yeast polished rice is the major component of the diet muscle wasting, peripheral

B1 ✓

✓
Wheat flour,
unpolished
rice
Liver, meat,
DRY

WET
Degeneration of peripheral nerves, thalamus,
mamillary bodies, and cerebellum (Peripheral
neuritis)
Cardiac Involvement WET
neuritis with numbness, tingling
sensations in the lower legs and
feet, and ataxic gait
Vasodilation, tachycardia, wide
eggs SOSHIN a more rapid form of wet beri beri follows inability of pulse pressure, sweating, warm
heart muscle to satisfy body’s demands because of skin → lactic acidosis → heart
RDA: its own injury (Acute fulminant CV beri beri) failure → orthopnea pulmonary
1-1.5 mg/day CEREBRAL In association with chronic alcoholism, due to dietary and peripheral edema →
insufficiency or impaired intestinal absorption of vasodilation → shock
thiamine (Wernicke- Karsakoff syndrome) SOSHIN Edema may not be present,
INFANTILE Due to low thiamine content of breast milk cyanosis of hands and feet,
tachycardia, distended neck
veins, restlessness, and anxiety
CEREBRAL Intelligence disturbance, ataxia,
double vision, nystagmus,
progresses to Wernicke-
Korsakoff psychosis
INFANTILE Anorexia, tachycardia, vomiting,
convulsions, edema

Vitamin B2 Milk – 1quart = 1.7 ARIBOFLAVINOSIS - Epithelial changes in the oral cavity: NONE Assay for riboflavin status:
RIBOFLAVIN mg - Causes: malnutrition, malabsorption, anorexia, chronic ➢ Cheilosis or perleche – fissuring of lips ERYTHROCYTE GSH REDUCTATSE
alcoholism ➢ Glossitis – magenta tongue ACTIVITY

B2
Vitamin B3
RDA:
A: 2 mg/day
C: 1.2 mg/day
✓ Enriched
- Pure riboflavin deficiency is rare

PELLAGRA - 3Ds
-
-
-
Corneal vascularization
Seborrheic dermatitis
Photophobia
Pellagra “rough skin”- 3Ds NONE
-

-
Plasma riboflavin
concentration tend to reflect
recent dietary intake
High doses of niacin used to
NIACIN grains - Disease involving the skin, gastrointestinal tract, and CNS - Dermatitis -skin exposed to sunlight treat hyperlipidemia
✓ Milk ➢ Casal’s necklace - TRYPTOPHAN can be

B3 ✓

RDA:
Lean meats
(liver)

A: 16-20 mg/day
-
-
-
➢ Gloves and stockings lesions
Diarrhea
Dementia
Severe cases: GIT hemorrhagic
converted to NAD
(60 mg Trp= 1mg niacin): milk
and eggs rich in Trp

C: 9-16 mg/day
I: 5-8 mg/day
Vitamin B5 ✓ Eggs Rare NONE
PANTOTHENIC ✓ Liver - Vitamin B5 is very widespread in natural foods
ACID ✓ Yeast - Most symptoms are vague and mimic those of other B vitamin
RDA: deficiencies

B5 A: 5-10 mg/day
C: 4-5 mg/day
I: 1-2 mg/day

BIOCHEMISTRY B: VITAMINS 1 SAMSON, A.C.B.

 Vitamin B6 ✓ Whole grain Rare - Epileptiform seizures in infants YES - Deficiency can be induced by
PYRIDOXINE ✓ Poultry & fish - Mostly specific as nonspecific stomatitis, glossitis, irritability, - Pellagra-like skin lesions isoniazid sensory neuropathy
PYRIDOXAL ✓ Potatoes, eggs confusion, and depression, pellagra-like skin lesions and possibly - GIT involvement: distention, vomiting, occurs at high doses
PYRIDOXAMINE ✓ Organ meats peripheral neuropathy diarrhea
RDA: - Intake of isoniazid (isonicotinic acid hydrazide) - Anemia (hypochromic and microcytic)

B6
Vitamin B7
A: 2.2 mg/day
C: 1.2mg/day
I: 3 mg/day
✓ Almost all Rare
➢ Drug frequently used to treat tuberculosis, can induce a
vitamin B6 defieciency by forming an inactive der
- Acrodynia in rats

Men (rare) NONE

BIOTIN foods - Widely distributed in natural foods as biocytin (epsilon- amino- - Fine scaly skin desquamation
✓ Liver biotinyllysine), which is released on proteolysis. It is synthesized - Anorexia

B7 ✓ Milk
✓ Egg
✓ Yolk
RDA: 400 ug/day
-

-
by intestinal flora in excess of requirements
From synthesis of bacteria -deficiency is caused by defects in
utilization and not dietary
From long-term antibiotic treatment or excessive consumption of
-
-
-
-
Nausea
Lassitude
Muscle pains
Depression/ hallucination
raw egg - Alopecia
AVIDIN- a protein in raw egg white which combines very tightly with - Graying of hair
biotin, preventing its absorption leading to biotin deficiency
Vitamin B9 ✓ Green leafy MEGALOBLASTIC ANEMIA Symptoms of anemia NONE - Administration of high levels of
FOLIC ACID vegetables - Folic acid deficiency affects cells that are diving rapidly because - Yellowing eyes folate can mask vitamin B12
✓ Liver they have a large requirement for thymidine for DNA synthesis. - Skin paleness, coldness and yellowness deficiency

B9 ✓
✓
Lima beans
Whole grain
cereals -
Clinically this affects the bone marrow, leading to megaloblastic
anemia
Deficiency can be caused by:
➢ Increased demand, poor absorption caused by pathology of
-
-
-
-
Shortness of breath
Muscle weakness, fatigue, dizziness
Change in stool color
Low blood pressure
- METHOTREXATE – inhibits
dihydrofolate reductase used
in the conversion of Folate to
tetrahydrofolate, a folic acid
the small intestine, alcoholism - Palpitations analogue used to treat
➢ Treatment with drugs that are dihydrofolate reductase - Spleen enlargement psoriasis, rheumatoid arthritis,
inhibitors- for example METHOTREXATE - Severe anemia: chest pain, angina, fainting, neoplastic diseases, and acute
Neural tube defects (SPINA BIFIDA AND ANENCEPHALY) heart attack lymphocytic anemia in children
- Folic acid supplementation before conception and during the first - SULFONAMIDE – an anti-
trimester has been shown to significantly reduce the defects bacterial agent that inhibits
- RENI of 400 ug folate supplement for all women of child-bearing dihypteroate synthetase, used
age for the conversion of PABA to
Growth failure Folate
Vitamin B12 ✓ Liver, eggs PERNICIOUS ANEMIA Pernicious anemia: NONE - Pernicious anemia treated
COBALAMIN ✓ Whole milk - most commonly a result of an autoimmune destruction of the ➢ Megaloblastic or macrocytic anemia with IM or high dose oral
✓ Oysters gastric parietals cells that are responsible for the synthesis of ➢ Lesions of the nervous system vitamin B12

B12 ✓ Fresh shrimp

✓ Pork, Chicken
RDA:
A: 2 ug/day
-
intrinsic factor. Lack of intrinsic factor prevents the absorption of
vitamin B12, resulting to pernicious anemia
no healthy RBC
Abnormal fatty acid synthesis
➢ Mucosal atrophy and inflammation of
the tongue (glossitis), mouth
(stomatitis), and pharynx (pharyngitis)
Neuropsychiatric symptoms
C: 3ug/day Dementia
P/L: 4ug/day Spinal degeneration
Cell membrane defects/ neurological abnormalities
Vitamin C ✓ Citrus fruits SCURVY - sore, spongy gums NONE - benefits of supplementation
ASCORBIC ACID ✓ Tomatoes - Symptoms can be explained by a deficiency in the hydroxylation - loose teeth not established in controlled
✓ Green of collagen, resulting in defective connective tissue - poor wound healing trials

C RDA:
vegetables

A: 60 mg/day
C: 40 mg/day
Failure of steps in collagen synthesis results in:
-
-
-
Impaired wound healing
Defective tooth formation
Deficient osteoblasts and fibroblasts
-
-
-
-
fragile blood vessels
swollen joints
anemia
splinter hemorrhages in nails
- petechial, subcutaneous hemorrhages
- scorbutic rosary beads- swelling at the ends of
long bones

BIOCHEMISTRY B: VITAMINS 2 SAMSON, A.C.B.

 FAT-SOLUBLE VITAMINS
Vitamin A ✓ liver Night blindness - Increased visual threshold YES - Beta-carotene is not acutely
RETINOL ✓ kidney Xeropthalmia - Dryness of cornea toxic, but supplementation is
✓ cream Infertility not recommended

A ✓
✓
✓
butter
egg yolk
yellow and
dark green
Growth retardation - Excess vitamin A can increase
incidence of fractures
Retinoic acid as treatment:
- TRETINOIN (all-trans retinoic
vegetables acid)- topical application for
mild cases of acne, Darier
disease (keratosis follicularis),
and skin aging
- ISOTRETINOIN (13-cis retinoic
acid)- administered orally for
severe, recalcitrant, cystic acne
- Also used as treatment of
promyelocytic leukemia
Vitamin D ✓ Liver RICKETS (in children) - Soft, pliable bones YES - Vitamin D is not a true vitamin
CALCIFEROL ✓ Kidney - Inadequate calcification of cartilage and bone because it can be synthesized
✓ Fatty fish OSTEOMALACIA (in adults) – demineralization of bone in skin: application of

D ✓ Egg yolk
RDA:
A/C (>8 yrs of age):
100 mcg/day
-

-
Softening and weakening of the bones and may lead to
deformities and easy fracturability
Serum calcium is reduced and may also lead to tetany
-
-
TOXICITY
Moat toxic of all vitamins
CALCINOSIS – deposition of calcium in organs
and arteries, kidney stones
sunscreen lotions or presence
of dark skin color decreases
this synthesis

- Toxicity from too much Vitamin D is more

likely to occur from high intake of
supplements than from high intake of food
containing Vitamin D
- Excessive sun exposure does not cause vit D
toxicity
Vitamin E ✓ Vegetable oils Rare - Anemia, breakdown of red blood cells NONE - Benefits supplementation for
TOCOPHEROL ✓ Liver - Heart disease disease prevention not
✓ Eggs - Defective cell membranes TOXICITY established in controlled trials

E
Vitamin K
RDA:
15 mg/day

✓ Cabbage
-

Rare
Cataract formation -
-

-
Least toxic of the fat-soluble vitamins
No toxicity has been observed at doses of 300
mg/day
Bleeding RARE - Vitamin K produced by
MENADIONE ✓ Cauliflower - Rare because our own bacterial flora of the intestines supplies us intestinal bacteria
MENAQUINONE ✓ Spinach with vitamin K TOXICITY - IM treatment with vitamin K is
PHYLLOQUINONE ✓ Egg yolk - Can be hemorrhagic due to defective formation of clotting factors - Prolonged administration of vitamin K can recommended at birth
✓ Liver - Due to extensive use of antibiotics- sterilization of the GIT cause red blood cell fragility that leads to - WARFARIN – vitamin K

K RDA:
M: 120 ug/day
F: 90 ug/day
HEMORRHAGIC DISEASE OF NEWBORN
- Newborn infants are vulnerable to vitamin K deficiency because
the placenta dose not pass the vitamin to the fetus and the gut is
sterile immediately after birth
hemolytic anemia and jaundice antagonist that inhibits the
recycling of vitamin K at two
dithiol-dependent steps

BIOCHEMISTRY B: VITAMINS 3 SAMSON, A.C.B.