Vitamin E: tocopherol

• Active form is alpha tocopherol

• good antioxidant: most feed antioxidants have vit E activity, but only 1/6 that of -tocopherol

• antioxidants used to prevent oxidation of lipids (mainly phospholipids)

• requirement is tied to selenium deficiency (Se is cofactor in glutathione peroxidase)

• sources: fish meal, rice bran, wheat, barley grains

Vitamin E

• Role of Vitamin E– Functions as an antioxidant– Protects cell membranes from free radicals– May help to prevent cancer, Alzheimer’s

Disease, coronary artery disease, and cataracts

Vitamin E Deficiency

• Secondary to:– Malabsorption– Abetalipoproteinemia (a genetic disorder)– Cystic fibrosis– Children with chronic cholestatic liver disease

or biliary atresia

Vitamin E Deficiency – Clinical Manifestations

• Decreased vibration sensation

• Impaired proprioception

• Loss of reflexes

• Gait disturbances

• Ophthalmoplegia

Vitamin E Deficiency - Treatment

• Parenteral Vitamin E in large doses is used for severe deficiency

• Optimum dose has not been established

• Antioxidant dosage is 100 – 400 units/day orally

Vitamin K

• Role of Vitamin K– Needed for the synthesis of coagulation factors II, VII,

IX, and X

• Def. Secondary to– Malnutrition

– Malabsorption

– Broad spectrum antibiotics which suppress colonic flora

– Medications (generics Phenobarbital, Phenytoin, Primidone and Cholestyramine, and mineral oil)

Vitamin K Deficiency – Clinical Manifestations

• Bleeding at any site

• Prothrombin time prolonged (PT)

• PTT may be prolonged to lesser degree

• Fibrinogen, thrombin time, platelet count are unaffected

Vitamin K Deficiency - Diagnosis

• Decreased levels of Vitamin K

• Decreased levels of coagulation factors II, VII, IX, and X

• Patient’s response to Vitamin K replacement can be diagnostic

Vitamin K Deficiency - Treatment

• 15 mg of subcutaneous Vitamin K

• A single dose will correct laboratory abnormalities within 12 – 24 hours

• Fresh frozen plasma is used to treat hemorrhage

WATER-SOLUBLE VITAMINS:

• VITAMIN B1 THIAMINE: – Function: Thiamine Pyrophosphate (TPP) it is phosphorylated

twice by ATP to get to its active form. Functions in active aldehyde transfers.

DEFICIENCY: – WERNICKE'S ENCEPHALOPATHY

– Classic Triad of Symptoms: » Ophthalmoplegia -- paralysis of eye muscles » Ataxia -- lost muscular coordination » Mental Confusion

– BERIBERI: • Nutritional deficiency of polyneuropathy, edema, and high CO failure.

– WET BERIBERI: Symptoms of edema and high output cardiac failure – DRY BERIBERI: Referring to polyneuropathy

RIBOFLAVINVITAMIN-B2

• Riboflavin, also called vitamin B2, is a water-soluble vitamin.

• Riboflavin deficiency occurs when the chronic failure to eat sufficient amounts of foods that contain riboflavin.

• produces lesions of the skin & smooth surface of digestive tract, & nervous disorders.

• RDA– The recommended daily allowance (RDA) for riboflavin is

1.7 mg/day for an adult man and 1.3 mg/day for an adult woman.

• The best sources of this vitamin are meat, dairy products, and dark green vegetables, especially broccoli. Grains and legumes (beans and peas) also contribute riboflavin to the diet.

• It is required for the processing of dietary fats, carbohydrates, and proteins for converting them into energy

• It is also used for the continual process of renewal and regeneration of all cells and tissues in the body.

• Riboflavin is sensitive to light. For this reason, commercially available milk is sometimes supplied in cartons, rather than in clear bottles.

• It is not rapidly destroyed by cooking. • Milk contains about 1.7 mg riboflavin/kg. Cheese

contains about 4.3 mg/kg, while beef has 2.4 mg/kg and broccoli has about 2.0 mg/kg.

• Apples, a food that is low in all nutrients, except water, contains only 0.1 mg riboflavin per kg.

SYMPTOMS

• Swelling and fissuring of the lips (cheilosis) • Ulceration and cracking of the angles of the mouth

(angular stomatitisis) • Oily, scaly skin rashes on the scrotum, vulva, or

area between the nose and lips • Inflammation of the tongue • Red, itchy eyes that are sensitive to light• The CNS symptoms of riboflavin deficiency include:

– numbness of the hands – decreased sensitivity to touch, temperature, and

vibration

• Treatment– Riboflavin deficiency can be treated with supplemental

riboflavin (0.5 mg/kg body weight per day) until the symptoms disappear.

• Prognosis– The prognosis for correcting riboflavin deficiency is

excellent.

• Prevention– Riboflavin deficiency can be prevented by including milk,

cheese, yogurt, meat, and/or certain vegetables in the daily diet. Of the vegetables, broccoli, asparagus, and spinach are highest in riboflavin. These vegetables have a riboflavin content that is similar to that of milk, yogurt, or meat.

Niacin; Nicotinic acid • Niacin is a water-soluble vitamin necessary for many aspects

of health, growth, and reproduction. It is part of the vitamin B complex.

• Function    • Niacin assists in the functioning of the digestive system, skin,

and nerves. It is also important for the conversion of food to energy.

• Food Sources    • Niacin (also known as vitamin B-3) is found in dairy products,

poultry, fish, lean meats, nuts, and eggs. Legumes and enriched breads and cereals also supply some niacin.

NIACIN B3

• A deficiency of niacin causes pellagra. The symptoms include inflamed skin, digestive problems, and mental impairment.

• Large doses of niacin can cause liver damage, peptic ulcers, and skin rashes. Even normal doses can be associated with skin flushing.

• It is also used to treat high cholesterol and other types of lipid disorders, but with medical supervision due to its severe side effects.

• It is readily absorbed through the upper portion of the small intestine. Its absorbancy is increased in an acid environment.

• B6 is a family of biologically active chemical entities called pyridoxine, pyridoxamine, and pyridoxol.

• It is stored mostly in the muscles. • Pyridoxine has numerous functions in the body and is of

primary importance in the proper action of more than 60 enzymes

• It assists in metabolism of amino acids and other protein related compounds like hemoglobin, serotonin, prostaglandins, and various hormones.

• B6 is involved in many amino acid reactions including amination, deamination, decarboxylation, etc.

PYRIDOXINE B6

• B6 also aids in – Synthesis and degradation of carbohydrates, fats, and proteins– Conversion of tryptophan to niacin – Cholesterol metabolism, – proper development of RBC – synthesizing NT like dopamine, histamine, and serotonin.

• decrease PMS symptoms • morning sickness in pregnancy. • treating epilepsy and depression (by producing NT)

• The RDA for vitamin B6 varies by age and sex. For men and women under the age of 50, the RDA is 1.3 mg per day. After age 50 women are recommended to take 1.5 mg of vitamin B6, and men should be getting 1.7 mg every day. Vitamin B6 is found in avocadoes, bananas, chickpeas, potatoes, fish and meats.

• Therapeutic doses, which are given for the treatment and prevention of disease, range from 50-100 mg per day. It is not recommended to take such high doses without medical supervision.

• 50% of all women are mildly deficient oral contraceptives has been linked to a decrease in vitamin B6 found in the body.

• Mild B6 deficiency High homocysteine heart diseases

• Severe vitamin B6 deficiency – neurological disorders, such as depression,

epileptic seizures, abnormal brain waves, and even insomnia.

Common symptoms– Stress and anxiety – skin disorders, such as inflammation, acne and

mouth sores.

Pernicious Anemia: autoimmune parietal cell destruction results in insufficient intrinsic factor production

Elderly with atrophic Gastritis (10-30% over age 60) cannot absorb Vitamin B12 bound to protein. However can absorb crystalline Vitamin B12 normally

Malabsorption Crohn's Disease Zollinger-Ellison Syndrome (Gastrinoma) Whipple's Disease Intestinal infection (e.g. parasite or Tapeworm) Blind Loop Syndrome (Gastrectomy and ileal resection) • Inadequate Vitamin B12 intake

– Vegan – Elderly – Alcoholism

VITAMIN B12

Symptoms • Initial: Generalized weakness & Paresthesias • Next: Leg stiffness & Ataxia • Late: Memory Impairment, Personality change & Depressed mood

Mnemonic: "The 5 P's" – Pancytopenia – Papillary atrophy of Tongue (Atrophic Glossitis)– Pyramidal tract signs – Peripheral Neuropathy – Posterior spinal column Neuropathy

• Dorsal Column Degeneration • Decreased proprioception • Decreased vibration sense • Ataxia • Hyporeflexia (e.g. decreased ankle jerk)

Other changes – Dementia – Major Depression – Psychosis – Optic Neuritis – Anorexia