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Vitamins and minerals mainly Zinc deficiency

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  1. 1. - Dr.Akif A.B
  2. 2.  What type of Anemia is seen in Vitamin B6 deficiency ??
  3. 3.  Microcytic hypochromic anemia  Vitamin B6 is involved in 1st step of heme synthesis (Aminolevulinate synthase)  Vitamin B6 is also required for conversion of Homocysteine to Cystathione.
  4. 4.  Burning feet syndrome is caused by which Vitamin deficiency ??
  5. 5.  Vitamin B5 (Pantothenic acid)
  6. 6.  Higher intake of which vitamin is associated with renal stones ??
  7. 7.  Vitamin C  >2gm/day  Vitamin C is metabolised to Oxalate and over intake can precipitate Renal stones  Formation of renal stones have been seen only if there is Primary renal disorder.  Can produce Iron overload due to increase Iron absorption
  8. 8.  Pseudotumour cerebri is caused due to which vitamin toxicity ??
  9. 9.  Chronic Vitamin A Toxicity
  10. 10.  Tea and coffee can lower levels of which Vitamin in body ??
  11. 11.  Thiamine B1  As tea and coffee contains Thiaminases, it can destroy Thiamine in body.  Raw fish and shell fish also contains Thiaminases.
  12. 12.  Vitamin K is required for activation of which Coagulation factors ??
  13. 13.  Factor 2,7,9,10  Protein C and S  Osteocalcin and matrix GLA protein
  14. 14.  Casal’s necklace is caused by which vitamin deficiency ??
  15. 15.  Niacin deficiency
  16. 16.  Riboflavin deficiency  Magenta Tongue, Angular cheilosis, Seborrhoea and cheilosis  Flavin Mononucleotide and Flavin Adenine Dinucleotide (FMN and FAD)  Coenzyme for metabolism of Carbohydrate, fats and proteins.
  17. 17.  Use of Antibiotic decreases levels of which Vitamin ??
  18. 18.  Vitamin K  Antibiotics inhibits bacteria of Gut which produces Menaquinone
  19. 19.  Keshan disease is caused by deficiency of which Mineral ??  Menky kinky hair disease ??
  20. 20.  Selenium  Cardiomyopathy  Menky’s disease : X-linked metabolic disturbances of copper metabolism characterised by Mental retardation, low copper levels and low ceruloplasmin levels.
  21. 21.  Triad of Wernicke’s Encephalopathy ??
  22. 22.  Ophthalmoplegia  Horizontal nystagmus  Cerebellar ataxia  Plus memory loss or confabulations : Korsakoff’s Psychosis
  23. 23.  Pellagra is caused by ??  What is Hartnup disease ??  Which Anti-TB drug can precipitate Pellagra ??  4 D’s of Pellagra ??
  24. 24.  Niacin deficiency  Hartnup disease is a congenital defect of Intestinal and kidney absorption of Tryptophan  Isoniazid is a structural analogue of Niacin  4 D’s of Pellagra : Diarrhoe + Dementia + Dermatitis + Death  Vitamin B6 and Riboflavin helps in conversion of Tryptophan to Niacin
  25. 25.  High output cardiac failure is caused due to which Vitamin deficiency ??
  26. 26.  Thiamine  Wet beri beri  Presents with Cardiac manifestations : High output cardiac failure, Cardiomegaly, Tachycardia  Dry Beri Beri  Presents with Peripheral neuropathy.
  27. 27.  Lab diagnosis of Thiamine deficiency ??
  28. 28.  Transketolase activity measured before and after administering Thiamine Pyrophosphate  >25% increase in activity is suggestive of Thiamine Deficiency.
  29. 29.  42-year-old woman  20-year history of Crohn's disease  presents with a complaint of low energy levels and hair loss.   Her Crohn's disease is moderately well controlled, with episodic diarrhoea and abdominal pain, and has not required intestinal resection.  The patient says that she does not feel like she is having a 'flare' of her Crohn's disease, and there are no rashes or other symptoms.  On physical examination, her hair is mildly thin, stomatitis is noted, but the physical examination is otherwise normal.
  30. 30.  An 8-year-old boy from an underdeveloped rural community is seen by a health practitioner.  He is noted to be below the fifth percentile for height, and has been doing poorly in school.  On nutritional assessment the boy's mother reports that his diet consists mainly of locally produced grains and vegetables that are not fortified, and that meats are rarely available.  The mother also reports that he does not have much energy, but there are no other specific complaints and physical examination is unremarkable.  Review of the boy's growth chart shows that height had been stable at the thirtieth percentile until his last visit at the age of 4 years old.
  31. 31. Zinc Deficiency - Dr. Akif A.B
  32. 32.  10-40% is absorbed from small intestine.  Direct relationship with protein metabolism.  Absorption is inhibited by Phytates, fibres as well as dietary iron.  A RCT showed that standard iron supplements doesn’t interfere with Zinc absorption.
  33. 33.  0.5-1 mg/day is excreted in stools daily.  Serum Zinc concentration = 70-120mcg/dl  60% loosely bound to albumin  30% tightly bound to macroglobulin.  Primary store : Liver and Kidney  Mostly Intracellular bind to Metalloproteinases.
  34. 34.  11 mg/day for males  9mg/day for females
  35. 35.  Activates many enzyme system  Carbonic Anhydrases, Dehydrogenases, Alkaline phosphatases and Carboxypeptidases.  Plays a role in growth, Tissue repair, wound healing and synthesis of Testicular hormone.
  36. 36.  Impaired phagocytic function  Lymphocyte depletion  Decreased immunoglobulin production  Reduction in the T4+/T8+ ratio  Decreased interleukin (IL)-2 production
  37. 37.  Inhibits secretory effect of Cholera toxin and Heat labile enterotoxins  Direct inhibitory effect on Enteropathogenic E-coli
  38. 38.  Meat  Milk  Sea foods  Legumes  Nuts  Cereals Less available for absorption
  39. 39.  Inadequate intake  Breastfeeding : Breast milk has low zinc content.  Crohn’s Disease : Decreased absorption  Cystic fibrosis  Sickle cell anemia  Due to renal tubular damage leading to increased urinary excretion.
  40. 40.  Drugs  Penicillamine , Ethambutol, Thiazide and certain antibiotics.  Liver diseases  Due to Hypoalbuminemia
  41. 41.  Increased risk of infection.  Stomatitis : Non specific  Fatigue  GI Symptoms : Nausea, vomitings, diarrhoea  Short stature
  42. 42.  Bone fractures due to osteopenia  Impaired glucose tolerance  Hypogonadism  Alopecia  Hypogeusia
  43. 43.  Autosomal Recessive disease  Partial defect in Zinc absorption.  Due to mutation of SLC39A4 on chromosome 8.  Diarrhoea, Alopecia, Dermatitis, depression , irritability.  Growth retardation and delayed sexual maturation.  Frequent infections.  Characteristic erythematous vesico-bullous dermatitis.
  44. 44.  Serum Zinc levels : <60mcg/dl  May be low in hypoalbuminemia  Serum Zinc levels is very insensitive, as it can be normal in patients with mild Zinc Deficiency  Albumin level as poor correlation with Zinc levels, so if there is suspicion of Zinc deficiency and if Zinc levels are low , patient should be treated despite of Serum albumin levels.
  45. 45.  Zinc level in Lymphocyte or neutrophils is more sensitive.  Zinc level in either lymphocytes (<50 mcg/1010 cells)  Granulocytes (<42 mcg/1010 cells)  Depressed serum alkaline phosphatase
  46. 46.  Vitamin D or A deficiency  Hypothyroidism  Depression  Vitamin B12 or folate deficiency  Iron deficiency
  47. 47.  1-2mg/kg/day of elemental Zinc.  3mg/kg/day for Acrodermatitis Enteropathica.  Usual supplementation dose is : 20-40mg/day  Higher doses may be required in severe deficiency due to increased GI loss or malabsorption.
  48. 48.  Usually treatment is given for 3-6 months.  Acrodermatitis enteropathica  Requires life long supplementation  Stoppage has been associated with recurrence of disease  As skin manifestations are due to enzyme deficiency, topical Zinc has no role.  Monitor serum copper levels in long term therapy as Zinc competes with copper for absorption.
  49. 49.  WHO recommends zinc supplementation for infants and children with acute diarrhea in resource-limited countries .  The supplements are given at a dose of 20 mg/day for children  10 mg/day for infants younger than 6 months old, for 10 to 14 days.
  50. 50.  Intake of 10 times the normal supplementation doesn’t produce any symptoms.  Chronic ingestion of high dose Zinc can cause Copper deficiency.  Acute ingestion of 1-2 gm Zinc sulphate can cause nausea, vomiting, GI erosions and renal tubular necrosis.
  51. 51.  Prophylactic supplementation of Zinc to < 5years of age children has known to decrease chances of Pneumonia and diarrhoea when compared to placebo in many trials.
  52. 52.  Vitamin K1 - Phylloquinone : vegetable source  Vitamin K2 - Menaquinone : Bacterial source and Liver
  53. 53.  Required for post translation carboxylation of :  Factor 2,7,9,10  Protein C and S  Osteocalcin in bone  Matrix GLA protein of Vascular smooth muscle. Importance is not known
  54. 54.  Green leafy vegetables  Soyabean oil  Liver
  55. 55.  Hemorrhage  Neonates are more prone due to decreased fat stores , immaturity of Liver, poor placental transport and decrease content in breast milk.  Intracranial, skin and GI bleeding can occur 1-7days after birth.  Thus Vitamin K 0.5-1 mg is given I.M at birth
  56. 56.  Vitamin K deficiency can be present in small bowel disease, Small bowel resection and biliary obstruction.  Prolonged antibiotic therapy can decrease GI bacteria and cause decrease menaquinone levels.  Anti-obesity drug Orlistat can cause Vitamin K malabsorption.
  57. 57.  Causes prolonged Prothrombin time  Treated with 10mg Vitamin K .  In chronic deficiency 1-2mg/day oral intake or 1-2mg i.m weekly.

Descripción

Vitamins and minerals mainly Zinc deficiency

Transcripción

  1. 1. - Dr.Akif A.B
  2. 2.  What type of Anemia is seen in Vitamin B6 deficiency ??
  3. 3.  Microcytic hypochromic anemia  Vitamin B6 is involved in 1st step of heme synthesis (Aminolevulinate synthase)  Vitamin B6 is also required for conversion of Homocysteine to Cystathione.
  4. 4.  Burning feet syndrome is caused by which Vitamin deficiency ??
  5. 5.  Vitamin B5 (Pantothenic acid)
  6. 6.  Higher intake of which vitamin is associated with renal stones ??
  7. 7.  Vitamin C  >2gm/day  Vitamin C is metabolised to Oxalate and over intake can precipitate Renal stones  Formation of renal stones have been seen only if there is Primary renal disorder.  Can produce Iron overload due to increase Iron absorption
  8. 8.  Pseudotumour cerebri is caused due to which vitamin toxicity ??
  9. 9.  Chronic Vitamin A Toxicity
  10. 10.  Tea and coffee can lower levels of which Vitamin in body ??
  11. 11.  Thiamine B1  As tea and coffee contains Thiaminases, it can destroy Thiamine in body.  Raw fish and shell fish also contains Thiaminases.
  12. 12.  Vitamin K is required for activation of which Coagulation factors ??
  13. 13.  Factor 2,7,9,10  Protein C and S  Osteocalcin and matrix GLA protein
  14. 14.  Casal’s necklace is caused by which vitamin deficiency ??
  15. 15.  Niacin deficiency
  16. 16.  Riboflavin deficiency  Magenta Tongue, Angular cheilosis, Seborrhoea and cheilosis  Flavin Mononucleotide and Flavin Adenine Dinucleotide (FMN and FAD)  Coenzyme for metabolism of Carbohydrate, fats and proteins.
  17. 17.  Use of Antibiotic decreases levels of which Vitamin ??
  18. 18.  Vitamin K  Antibiotics inhibits bacteria of Gut which produces Menaquinone
  19. 19.  Keshan disease is caused by deficiency of which Mineral ??  Menky kinky hair disease ??
  20. 20.  Selenium  Cardiomyopathy  Menky’s disease : X-linked metabolic disturbances of copper metabolism characterised by Mental retardation, low copper levels and low ceruloplasmin levels.
  21. 21.  Triad of Wernicke’s Encephalopathy ??
  22. 22.  Ophthalmoplegia  Horizontal nystagmus  Cerebellar ataxia  Plus memory loss or confabulations : Korsakoff’s Psychosis
  23. 23.  Pellagra is caused by ??  What is Hartnup disease ??  Which Anti-TB drug can precipitate Pellagra ??  4 D’s of Pellagra ??
  24. 24.  Niacin deficiency  Hartnup disease is a congenital defect of Intestinal and kidney absorption of Tryptophan  Isoniazid is a structural analogue of Niacin  4 D’s of Pellagra : Diarrhoe + Dementia + Dermatitis + Death  Vitamin B6 and Riboflavin helps in conversion of Tryptophan to Niacin
  25. 25.  High output cardiac failure is caused due to which Vitamin deficiency ??
  26. 26.  Thiamine  Wet beri beri  Presents with Cardiac manifestations : High output cardiac failure, Cardiomegaly, Tachycardia  Dry Beri Beri  Presents with Peripheral neuropathy.
  27. 27.  Lab diagnosis of Thiamine deficiency ??
  28. 28.  Transketolase activity measured before and after administering Thiamine Pyrophosphate  >25% increase in activity is suggestive of Thiamine Deficiency.
  29. 29.  42-year-old woman  20-year history of Crohn's disease  presents with a complaint of low energy levels and hair loss.   Her Crohn's disease is moderately well controlled, with episodic diarrhoea and abdominal pain, and has not required intestinal resection.  The patient says that she does not feel like she is having a 'flare' of her Crohn's disease, and there are no rashes or other symptoms.  On physical examination, her hair is mildly thin, stomatitis is noted, but the physical examination is otherwise normal.
  30. 30.  An 8-year-old boy from an underdeveloped rural community is seen by a health practitioner.  He is noted to be below the fifth percentile for height, and has been doing poorly in school.  On nutritional assessment the boy's mother reports that his diet consists mainly of locally produced grains and vegetables that are not fortified, and that meats are rarely available.  The mother also reports that he does not have much energy, but there are no other specific complaints and physical examination is unremarkable.  Review of the boy's growth chart shows that height had been stable at the thirtieth percentile until his last visit at the age of 4 years old.
  31. 31. Zinc Deficiency - Dr. Akif A.B
  32. 32.  10-40% is absorbed from small intestine.  Direct relationship with protein metabolism.  Absorption is inhibited by Phytates, fibres as well as dietary iron.  A RCT showed that standard iron supplements doesn’t interfere with Zinc absorption.
  33. 33.  0.5-1 mg/day is excreted in stools daily.  Serum Zinc concentration = 70-120mcg/dl  60% loosely bound to albumin  30% tightly bound to macroglobulin.  Primary store : Liver and Kidney  Mostly Intracellular bind to Metalloproteinases.
  34. 34.  11 mg/day for males  9mg/day for females
  35. 35.  Activates many enzyme system  Carbonic Anhydrases, Dehydrogenases, Alkaline phosphatases and Carboxypeptidases.  Plays a role in growth, Tissue repair, wound healing and synthesis of Testicular hormone.
  36. 36.  Impaired phagocytic function  Lymphocyte depletion  Decreased immunoglobulin production  Reduction in the T4+/T8+ ratio  Decreased interleukin (IL)-2 production
  37. 37.  Inhibits secretory effect of Cholera toxin and Heat labile enterotoxins  Direct inhibitory effect on Enteropathogenic E-coli
  38. 38.  Meat  Milk  Sea foods  Legumes  Nuts  Cereals Less available for absorption
  39. 39.  Inadequate intake  Breastfeeding : Breast milk has low zinc content.  Crohn’s Disease : Decreased absorption  Cystic fibrosis  Sickle cell anemia  Due to renal tubular damage leading to increased urinary excretion.
  40. 40.  Drugs  Penicillamine , Ethambutol, Thiazide and certain antibiotics.  Liver diseases  Due to Hypoalbuminemia
  41. 41.  Increased risk of infection.  Stomatitis : Non specific  Fatigue  GI Symptoms : Nausea, vomitings, diarrhoea  Short stature
  42. 42.  Bone fractures due to osteopenia  Impaired glucose tolerance  Hypogonadism  Alopecia  Hypogeusia
  43. 43.  Autosomal Recessive disease  Partial defect in Zinc absorption.  Due to mutation of SLC39A4 on chromosome 8.  Diarrhoea, Alopecia, Dermatitis, depression , irritability.  Growth retardation and delayed sexual maturation.  Frequent infections.  Characteristic erythematous vesico-bullous dermatitis.
  44. 44.  Serum Zinc levels : <60mcg/dl  May be low in hypoalbuminemia  Serum Zinc levels is very insensitive, as it can be normal in patients with mild Zinc Deficiency  Albumin level as poor correlation with Zinc levels, so if there is suspicion of Zinc deficiency and if Zinc levels are low , patient should be treated despite of Serum albumin levels.
  45. 45.  Zinc level in Lymphocyte or neutrophils is more sensitive.  Zinc level in either lymphocytes (<50 mcg/1010 cells)  Granulocytes (<42 mcg/1010 cells)  Depressed serum alkaline phosphatase
  46. 46.  Vitamin D or A deficiency  Hypothyroidism  Depression  Vitamin B12 or folate deficiency  Iron deficiency
  47. 47.  1-2mg/kg/day of elemental Zinc.  3mg/kg/day for Acrodermatitis Enteropathica.  Usual supplementation dose is : 20-40mg/day  Higher doses may be required in severe deficiency due to increased GI loss or malabsorption.
  48. 48.  Usually treatment is given for 3-6 months.  Acrodermatitis enteropathica  Requires life long supplementation  Stoppage has been associated with recurrence of disease  As skin manifestations are due to enzyme deficiency, topical Zinc has no role.  Monitor serum copper levels in long term therapy as Zinc competes with copper for absorption.
  49. 49.  WHO recommends zinc supplementation for infants and children with acute diarrhea in resource-limited countries .  The supplements are given at a dose of 20 mg/day for children  10 mg/day for infants younger than 6 months old, for 10 to 14 days.
  50. 50.  Intake of 10 times the normal supplementation doesn’t produce any symptoms.  Chronic ingestion of high dose Zinc can cause Copper deficiency.  Acute ingestion of 1-2 gm Zinc sulphate can cause nausea, vomiting, GI erosions and renal tubular necrosis.
  51. 51.  Prophylactic supplementation of Zinc to < 5years of age children has known to decrease chances of Pneumonia and diarrhoea when compared to placebo in many trials.
  52. 52.  Vitamin K1 - Phylloquinone : vegetable source  Vitamin K2 - Menaquinone : Bacterial source and Liver
  53. 53.  Required for post translation carboxylation of :  Factor 2,7,9,10  Protein C and S  Osteocalcin in bone  Matrix GLA protein of Vascular smooth muscle. Importance is not known
  54. 54.  Green leafy vegetables  Soyabean oil  Liver
  55. 55.  Hemorrhage  Neonates are more prone due to decreased fat stores , immaturity of Liver, poor placental transport and decrease content in breast milk.  Intracranial, skin and GI bleeding can occur 1-7days after birth.  Thus Vitamin K 0.5-1 mg is given I.M at birth
  56. 56.  Vitamin K deficiency can be present in small bowel disease, Small bowel resection and biliary obstruction.  Prolonged antibiotic therapy can decrease GI bacteria and cause decrease menaquinone levels.  Anti-obesity drug Orlistat can cause Vitamin K malabsorption.
  57. 57.  Causes prolonged Prothrombin time  Treated with 10mg Vitamin K .  In chronic deficiency 1-2mg/day oral intake or 1-2mg i.m weekly.

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