NutritionOh lordy. What do eat? KALE.AND LEGUMES.

VITAMINS YO.
The widespread use of vitamins as tonics is unnecessary and should be discouraged; toxicity from fat soluble vitamins isoccasionally seen.NameVitamin A/Retinol [Beta Carotene is a precursor]

RDA/RNINB 6 micrograms of Beta carotene= 1 of retinol- food labelling beware.

SourcesLIVER; milk, butter, cheese, egg yolk, fish oil, added to margarine in the UK. Beta-caroteneis found in green veg, carrots and other yellow andred fruits.

UsesRhodopsin/Iodopsin {cones} light= change to trans isomer- memb pot changebrain.
Control of cell proliferation
Cofactor in the synthesis of most gps containing MANNOSEBeta carotene acts as an antioxidant

Absorption/MetabolismBeta carotene- cleved in intestinal mucosa by carotene dioxygenaseRETINALDEHYDE[red to] retinol. 1/3 dietary vitA derived from retinoid direct.
Absorbed with LC f.as.
Liver stores [stellate cells in space of Disse?]
Plasma bound to retinol binding protein [alpha globulin]

Pathology- def and OD
http://webeye.ophth.uiowa.edu/eyeforum/atlas/photos/BitotsOD1964.jpg
https://www.mja.com.au/sites/default/files/issues/188_05_030308/kar11184_fm-1.jpgWW def is major cause of blindness in young people: XEROPTHALMIA- Imp adaptation followed by night blindness, then conjunctival xerosis [dryness and thickening].Bitots spot [3mg/d preg f inc incidence birth defects. DOES NOT INC BETA CAROTENE. In organogenesis, disrupts neural cell activity- brain/heart defects, microcephaly, hydrocephaly.

Foot noteOther carotenoids, lycopene, lutein are probably of little quantitative importance as dietary precursors of vitamin A, and although beta carotene is not teratogenic, it can cause cartodermia. No not use vitA for acne in pregnant females

See chapter 11allso for vitamin D. Links to C??NameVitamin K

RDA/RNI

SourcesLeafy greens, dairy, rapeseed and soya been oil.

UsesCoagulation: CF II, VII, IX, X of the EXTRINSIC P/W. protein C and S. P-s: Cofactor for P-c in inact of Va and VIIIa when free.
Bone: Osteocalcin [G1a residues bind to hydroxyapatitie, leading to bone mineralisation], matrix G1a protein, protein S- bone matrix formation.

Absorption/MetabolismIntestinal bacteria can synthesis another major form of vitK than can be utilised, in thterminal ileum. It is absorbed as a fat soluble vitamin in the upper small intestine, and the mannequinones [K2] bacteria produced must also be abs as this is the major form of vitK Found in the liver.

Pathology
http://healthfixit.com/wp-content/uploads/2013/03/Petechia-images.jpgDEF-> NN most prone- poor placentaltransfer, little in breast milk, no hepatic stores of menaquinone due to no S.I m.o. Leads to haemorrhagic disease of the nb; prophylactic phytomenadion 1mg i.m to all NN, as vitK def can occur at anyage but in NN they are most at risk of bleeding.
Cholestasis- red abs as is FAT SOLUBLE. E.g PBS, stone, stricture, chronic pancreatitis. anything than causes chronic cholestasis. BONE- seems to have no effect other than on rapidly growing bone; imp act of bone matrix protein osteocalcin and imp bone P by reducing OB func.
Mass blood transfusion can also cause def!
Deficiency presents differently in infants, but in adults vitK can go unnoticed until hypoprothrombinaemia occurs: Bleeding to minor trauma,epistaxis, petechiae, haematoma, gastrointestinal bleeding,menorrhagia, haematuria and bleeding from gums.
Hypervitaminosis K ofcourse would cause the opposite- thrombosis, and possible sudden death from clots to brain/1g/kg/day. Bruising, bleeding, raised PT, due to inhibition of vitK dependant carboxylase. Imp immunity with secondary necrotising enterocolitis hasbeen obs in premmies given vitE to prevent retrolental fibroplasia [a retinopathy leads to blindness]

DDxRare- Vitamin E is the vitamin in search of a deficiency as it is present in so many foods.

Inv and MxInv- alpha tocopherol levels and aclotting screen.
Prevent gross ataxia with vitE injections. Plasma or serum levels of aloha tocopherol [one of the forms of VITE] m. and corrected for lvl of plasma lipids- therefore vitE lvls expresses as milligrams PER MILLIGRAM OF PLASMA LIPID.
Hypervitaminosis- reversed by administering vitK.

NameThiamin/B1Riboflavin/B2

RDA/RNI0.4mg PER 1000KCAL NB more is required in ahigh carb diets

SourcesCereal, grains, beans, nuts, pork and duck.Dairy, offal and leafy vegetables

UsesEssential cofactorin carbohydrate metabolism in oxidative respiration [KC].Riboflavin is a flavoprotein that is a cofactor for many oxidative processes in cells

Absorption/MetabolismWater soluble. NB Water sol vits are non toxic and relatively cheap so can be given inlarge amts if deficiency present. Once absorbed, thiamine is found in many body tissues but is chiefly stored in the liver. HJowever body stores are small so a deficiency de3velops quickly with inadequate intake

PathologyDeficiency- Beriberi,Wernicke-Korsakoffs. Alcohol dependency is ass with deficiency of B vits chiefly, esp thiamine. Beriberi is pretty much confined to south east asia and is due to eating a diet of purely rice. It presents as dry beriberi with peripheral polyneuropathjy, orwet with oedemka.There is no definitive deficiency but it does tend to produce: angularstomatis or cheilosis [fissuring at the angles of the mouth], a red ifm tongue, seborrhoeic dermatitis est around nose, scrotum and vulva. Riboflavin 5mg/d can be prescribed for def, usually in compelx with other B vits

NameNiacinVit B6 [pyridoxine, pyridoxal,pyridoxamine]

RDA/RNI6.6mg per 1000 kcal15micrograms per gram of dietary protein

SourcesPlants, meat esp offal and fish, added toi cereal andwhite bread in developed world. Tryptophan 60mg can be converted to 1mg of niacin. Foods that contain tryptophan inc eggs, cheese and leafy green veg, and the enzymes for this conversion are riboflavin and B6 dependent, hence deficiency in these vitamins can also cause pellagra

UsesAct as hydrogen acceptors in many oxidative reactions and in their reduced forms- NADH and NADPH act as hydrogen donors in many reactions. Necesasary for hexose monophosphate shunt for generation of NADPH which is necessary for f.a synthesis.Cofactor in the metab of many a.a.

Absorption/Metabolism

PathologyPellagra- this is rare and usually only found in people who only eat maize such as in parts of Africa. Some of the symptoms of pellagra may be due to def in other vitamins and protein deficiency
Dermatitis in areas of skin exposed to sunlight; DIARRHOEA AND dementia. Be aware that pellagra can also occur rarely in generalised malabsorption; Isoniazid therapy, Hartnups disease[a rare inborn error where some essential a.a cannot be abs from the gut inc tryptophan, and the same a.a are los inm urine]m very low prot diets for renal ds, carcinoid syndrome and phaeochromocytoma.

Biotin and pantothenic acidBiotin involved in a number of carboxylase reactions,found in many foods, small dietary req so def extremely rare- people who consume rare eggs [as contains biotin antagonist]Vitamin c acts as an antioxidant- inactivate oxygen FRs that would otherwise damage dna, cell memb and cell structuresWater sol- B1,B2, B6, B12, C, FA and niacinVitamins are organic nut not synthesised by the body but are vital for normal metab and maintainance of growth, act as coenzymes. Do not provide energy or use as building materialsSummary table of vit defs:

VitaminsDeficiency StateSymptoms/Signs

Fat Soluble

A (Retinol)BlindnessNight-blindness

D (Cholecalciferol)Osteomalacia/ricketsProximal weakness of limbs

E (Tocopherol)Anaemia/neuropathyHaemolytic anaemia - jaundice

K (Phytomenadione)Defective clottingBruising

Water Soluble

B1 (Thiamine)Beri beriWet beri beri oedema, high output left ventricular failureDry beri beri motor/sensory neuropathy

B2 (Riboflavin)Sore tongue and mouth

B6 (Pyridoxine)Dermatitis/AnaemiaSkin rash affectingeye/nose and sore tongue

B12 (Cobalamin)Pernicious anaemiaTiredness/ fatigue/pale conjunctivae

C (ascorbate)ScurvyBent/coiled body hair, bruising, gingivitis

FolateMegaloblastic anaemiaTiredness/ fatigue/pale conjunctivae

NiacinPellagraDermatitis, fatigue, insomnia, glossitis, diarrhoea, hallucinations, psychosis