Vitamin

Deficiencies & Excesses

dr. Shirley L A, Sp.A

8 Maret 2011
Toxicity results from excessive intakes of
the fat-soluble vitamins A and D, but
toxicity from excessive intakes of the water
soluble vitamins is rare
Vitamin A
-Retinol (vitamin A1) ,
provitamin A
-Biochemical action :
component of retinal
pigments, rhodopsin &
iodopsin, for vision in dim
light
bone & tooth development
formation & maturation of
epithelia
D
e
f
i
c
i
e
n
c
y

Nyctalopia
Photophobia
Xerophtalmia
Faulty epiphyseal bone
formation
Defective tooth enamel
Keratinization of
mucous
membranes&skin
Retarted growth
Impaired resistance to
infection
E
x
c
e
s
s

Anorexia
Slow growth
Drying & cracking of
skin
Enlargement of liver
& spleen
Swelling & pain of
long bones
Increased
intracranial pressure
Alopecia
Carotenemia
Stadium klinis defisiensi vitamin A pada mata
Buta senja/ hemeralopia
Bercak bitot
Xerosis konyungtiva
Xerosis kornea
Ulkus kornea <1/3 luas permukaan kornea
Ulkus kornea > 1/3 luas permukaan kornea
Keratomalacia / prolapsus iridis
Corneal scar
Bitot spot
Corneal ulceration &
keratomalacia
Xerosis corneae
Prevention
Infants : at least 500 g
daily
Older children : 600
1500 g
6 11 mo : 30.000 g
(100.000 IU)
12 mo : 60.000 g
(200.000 IU)
Treatment
Xerofthalmia : 1500 g/kg
p.o x 5 days
followed by 7500 g IM
daily
Vitamin B complex
Thiamine (vitamin B1)

- water soluble
- functions as a coenzyme in carbohyrate metabolism,
required for synthesis of acetylcholine and deficiency
results in impaired nerve conduction
- Sources : breast milk, vegetables, cereals, fruits & eggs


Thiamine Deficiency

Clinical manifestations :
- early : fatigue, apathy, irritability, depression, poor mental
concentration, anorexia, nausea & abdominal discomfort

- progression : peripheral neuritis with tingling, burning,
paresthesias of toes and feet, decreased deep tendon
reflexes, loss of vibration sense, tenderness, crampings of
leg muscles

- Ptosis of eyelids and atrophy of the optic nerve

- Hoarseness or aphonia caused by paralysis of laryngeal
nerve characteristic sign

Full-blown deficiency state beriberi
Wet beriberi
Undernourished
Pale
Edematous with dyspnea
Vomiting
Tachycardia
Waxy skin
Urine contains albumin,
casts
Dry beriberi
Plump
Pale
Flabby
Dyspnea, tachycardia
Hepatomegaly
Death 2
0
to cardiac involvement

Thiamine Deficiency

Diagnosis
Measurement of urinary
thiamine excretion or
urinary excretion of its
metabolites after an oral
loading dose of thiamine,
clinical response to
administration
best test
Treatment
If breast fed infants develops
beriberi, not mother & child
should be treated with
Thiamine 10 mg (children), 50
mg (adults) daily oral
Children with cardiac failure :
IM or IV
Complete cure requires several
weeks of treatment
All other vitamins of the B
complex should be
administered



Vitamin B complex
Riboflavin (vitamin B2)

- essential for growth & tissue
respiration
- It may play a role in light
adaptation
- source : liver, kidney, milk,
cheese, eggs
- effects of deficiency :
photophobia, blurred vision,
burning & itching of eyes,
poor growth, cheilosis

Riboflavin (vitamin B2)
Diagnostic tests : urinary excretion of riboflavin < 30
g/24 hr

Treatment : oral riboflavin 3 10 mg daily.
If no response occurs within a few days, IM injections of
2 mg of riboflavin in saline may be given as often as 3
times daily
Generous supplements of other B complex vitamin
Niacin

Niacin deficiency Pellagra
Treatment : 50-300 mg of
niacin daily
Pyridoxine (vitamin B6)
Constituent of coenzymes for decarboxylation,
transamination, fatty acid metabolism

Effects of deficiency :
- irritability, convulsions, hypochromic anemia,
- peripheral neuritis in patients receiving isoniazid

Effects of excess : sensory neuropathy
Pyridoxine (vitamin B6)
Constituent of coenzymes for decarboxylation,
transamination, fatty acid metabolism

Effects of deficiency :
- irritability, convulsions, hypochromic anemia,
- peripheral neuritis in patients receiving isoniazid

Effects of excess : sensory neuropathy
Folic Acid
Effects of deficiency :
megaloblastic anemia usually is secondary to
malabsorption disease, glossitis, pharyngeal ulcers,
impaired immunity

Folate deficiency before becoming pregnant or during
pregnancy neurotube defects
Vitamin C (ascorbic acid)
Integrity and maintenance
of intercelluar material,
facilitates absorption of iron
and conversion of folic acid
to folinic acid, metabolisme
of tyrosine& phenylalanine

Effects of deficiency :
scurvy and poor wound
healing
Vitamin C deficiency
Scurvy :
- A condition in which
formation of collagen and
chondroitin sulfate
impaired

-Tendency to hemorrhage,
defective tooth dentin,
loosening of the teeth

Severe deficiency :
- degeneration of skeletal
muscles
- cardiac hypertrophy
- bone marrow depression
- adrenal atrophy

Treatment : 100-200 mg
oral/ IV daily
Scurvy : usual age of onset between 6-24 mo
Scorbutic rosary
Froglike position
Vitamin D
Regulates absorption and deposition of Ca and Ph by
affecting permeability of intestinal membrane

Regulates level of serum alkaline phosphate which is
believed to be concerned with Ca phophate deposition in
bones and teeth

Effects of deficiency : Rickets, infantile tetany, poor
growth, osteomalacia
Vitamin D deficiency
Clinical manifestations
Craniotabes, early signs of rickets
is caused by thinning of the outer table of the skull.
It can be detected by Ping-Pong ball sensation when
pressing firmly over the occiput or posterior parietal
bones
Palpable enlargement of the costochondral junctions
(rachitic rosary) pigeon breast deformity, harrison
groove
Thickening of the wrists and ankles
Vitamin D deficiency
Diagnosis

Based on a history of inadequate intake of Vit.D or
inadequate exposure to sunlight and characteristic signs
of the contidition
It is confirm chemically and by radiography examination
Serum Ca level of children with rickets may be normal or
low
Serum Phosphorus level almost always is < 4 mg/dL
Vitamin D deficiency
Prevention
- Exposure to ultraviolet
- Breast-fed infants whose
mothers are not exposed
to adequate sunlight
400 IU of vit. D daily
Treatment
o Daily administration of
50-150 g of Vit.D3

Hypervitaminosis D
Signs & symptoms similar to those of idioptahic
hypercalcemia
Symptoms develop 1-3 mo of excessive intake,
hypotonia, anorexia, irritability, constipation, polydipsia,
polyuria, and pallor
Hypercalcemia and hypercalciuria
Renal damage
Th/ discontinuing vit D intake and decreasing Ca intake
For severely affected infants, aluminium hydroxide can
be given by mouth
Vitamin E (-tocopherol)
Minimizes oxidation of carotene Vit.A and linoleic acid, stabilizes
membranes

Requirement related to polyunsaturated fat intake; red blood cell
hemolysis in premature infants; loos of nureal integrity

Diagnosis : serum ratio of -tocopherol to lipid <0.8 mg/g and/or
erythrocyte hemolysis in hydrogen peroxide of > 10%

Minimal daily requirement of vit. E are not known; 0,7 mg/g of
unsaturated fat in the diet appears adequate

Premature infants may be given up to 15-25 IU/day

Vitamin K (group of Naphthoquinones)
Prothrombin formation : coagulation factors II, VII, IX and X,
protein C,S,Z

Deficiency : hemorrhagic manifestations, bone metabolism

Prevention : all infants should receive a prophylactic dose
of vit.K at birth

Th/ :
mild prothrombin def. infant : 1-2 mg every 24 hr vit.K oral
severe 5 mg Vit. K1 every 24 hr parenterally
So sleepy