VITAMINS

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 Vitamins are divided into two groups- 

1.Fat soluble Vitamins- Vitamin A, D,E and K.

2.Water soluble Vitamins- Vitamin-B Group and C.

Vitamin-A 

- Most potent types of Vitamin A is Vitamin A1 or retinol.

- One international unit of vitamin A is equivalent to 0.3 microgram of retinol.

- Fish liver oil are the richest natural source of retinol.

- The cheapest sources of vitamin A is green leafy vegetables such as spinach and amaranth.

- Most important source of Vitamin A for a child in India is green leafy vegetables.

- The most important carotenoids is beta - carotene , Which has the highest vitamin A- Activity.

- Vitamin- A also occurs in green and yellow fruit and vegetable , papaya, mango, pumpkin, not present in potato.

Deficiency:

- Correct sequences of appearance of manifestation of Vitamin A deficiency are night blindness, conjunctival xerosis, Bitot's spots, corneal xerosis and keratomalacia.

(a) Night Blindness- The First symptoms of lack of Vitamin A is night blindness or, inability to see in dim light.

(b) Conjunctival xerosis - This is the first clinical sign of vitamin A deficiency. Conjunctiva becomes dry and non- wettable, appears muddy and wrinkle.

(c) Bitot's Spots 

(d) Corneal xerosis.

(e) Keratomalacia - Keratomalacia or, liquefaction of cornea is one of the major causes of blindness in India and is associated with PEM.

- Extra-ocular manifestations of Vitamin A : Follicular hyperkeratosis , anorexia and growth retardation.

Prevention of  Night Blindness- 

- For prevention of nutritional blindness , administer a single massive dose of 200000 IU of vitamin A in oil ( retinol palmitate) orally every 6 month to preschool children ( 1 year to 6 years) and half that dose (100000 IU) to children between 6 month and one years of age.

- Maximum vitamin A requirement in  lactation is 950 mg of retinol.

- Vitamin A requirement in infants of 0-12 month is 350 mcgm 

Toxicity of Vitamin A 

- Vitamin A toxicity is due to microtubular damage.

-Massive doses of vitamin A has teratogenic effects.

- Toxicity of Vitamin A causes :

1. Anorexia 

2. Sleep Disorders 

3. Pseudotumour cerebri 

4. Alopecia.


VITAMIN D 

- Vitamin D is metabolically inactive. It undergoes endogenous transformation into several active metabolites (e.g. 25, HCC and 1:25 HCC) first in the liver and later in the kidney.

- A Bald child with swollen abdomen hyperosteous bones, with mental retardation has hypervitaminosis-D. It is characterized by voracious appetite.

- Radiology is important in diagnosis of Rockets.

- Fish liver oil and Halibut liver oil are the richest source of vitamin D.


Deficiency of VITAMIN D 

- Deficiency of Vitamin D leads to rickets, observed in young children between age of six month and two years.

- In rickets , there is elevated concentration of alkaline phosphate in the serum.

- In adults, Vitamin D deficiency may result in osteomalacia. 

- Prevalence of ricket and osteomalacia have declined as a result of changes in social customs( e.g. purdah system).

Daily requirements of Vitamin D are: 

1. Adults - 100 IU (2.5mcg)

2. Infants and Children - 200 IU ( 5 mcg) higher quantity than adults.

3. Pregnancy and lactation - 400 IU ( 10 mcg)


VITAMIN E 

- Vitamin E is also called Tocoferol.

- Therapeutic use of vitamin E is prevention of retrolental fibroplasia.

- By far ,the richest sources of Vitamin E are vegetable oil, cotton seed, sunflower seed, egg yolk and butter.

- The current estimate of vitamin E requirement is about 0.8mg/GM of essential fatty acids( 15 I.U)


VITAMIN K 

- Cow's milk is richer source ( 60mcg/L).

- In vitamin K Deficiency , the prothrombin content of blood is decreased and the blood clotting time is prolonged.


WATER SOLUBLE VITAMINS

THIAMINE:

- It does not synthesize in the body.

- Important sources are whole grain cereals, wheat , gram, yeast.

- Dietary sources of thiamine:

(a) Wheat whole 0.45 mg /100 g 

(b) Rice ,milled (poorest) - 0.06 mg/ 100 g

(c) Bengal gram dhal 0.48/100 g 

(d) Ground nut - 0.90 mg / 100 g 

-The two Principal thiamine deficiency disease are beri-beri and wernickes encephalopathy.

-Daily requirement of thiamine is 0.5 mg per 1000 kcals of energy.

-The body content of thiamine is placed at 30 mg.

- Pyruvate is usually accumulated by dietary deficiency of Thiamine(B1).


RIBOFLAVIN

-Richest Sources of riboflavin is liver (1.70 mg / 100 gm).

- The most common lesion associated with riboflavin deficiency is angular - stomatitis.

- Daily requirements is 0.6 mg per 1000 kcal of energy intake.


NIACIN 

- Foods rich in niacin and or tryptophans are liver, kidney,meat ,poultry, fish, legumes and ground nuts. 

- About 60 mg of tryptophans is required to result in 1 mg of niacin.

- In maize , niacin occurs in 'bound form' un avilable to the consumer.

- Niacin deficiency results in pellagra.

- Casal's Collar is a pathgnomic skin lesion in the Deficiency of Niacin.

- The disease pellagra is characterized by three D's : Diarrhoea , Dermatitis and Dementia.

- High Incidence has been reported in India in the Telangana area of Andhra Pradesh.

- Excess of leucine is the cause of pellagra in both jowar and maize eaters.

- Excess of leucine appears to interfere in the conversion of tryptophans to niacin.

- The recommended daily allowance of niacin is 6.6 mg/ 1000 kcal of energy intake.


VITAMIN B6 OR PYRIDOXINE 

-INH , an anti tuberculous drug is a recognised antagonist and patient recieving INH is provided with a supplement of PYRIDOXINE.

-Requirement of PYRIDOXINE in adults is 2 mg/ day, during pregnancy and lactation 2.5 mg/ day.


PANTOTHENIC ACID 

- Human Blood normally contains 18 to 35 mg of pantothenic acid per 100 ml. Mostly present in cells as coenzymes-A.

- Burning feet syndrome is seen in deficiency of vitamin pantothenic acid. 


FOLATE 

- The richest source of folic acid is green leafy vegetables. The other sources are Liver,meat, dairy products ,eggs , milk fruits and cereals.

- folate deficiency occurs from poor diet.

- It is commonly found in pregnancy and lactation.

-It results in megaloblastic anemia, glossitis, chilosis and gastrointestinal disturbances.






































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