Nutrition – Goljan Rapid Review Pathology

Causes of vitamin D deficiency?
Renal failure – most common cause (decreased 1-alpha-OHase activity)
Inadequate sun exposure
Liver failure
Induction of the liver cytochrome P-450 system (eg alcohol) -> conversion of 25-OH-D into an inactive metabolite

Signs of vitamin D deficiency in adults vs children?
Children – rickets -> craniotabes and rachitic rosary
Adults – osteomalacia (soft bones only – no craniotabes or rachitic rosary)

Vitamin D function?
Increases Ca and phosphorus reabsorption in kidney and small bowel

Vitamin E functions?
Antioxidant that protects cells from free radical peroxidation
Prevents LDL oxidation, which is more atherogenic

Vitamin E deficiency?
Hemolytic anemia – free radical damage to the lipid in RBC membrane
Peripheral neuropathy and degeneration of posterior column (poor joint sensation) and spinocerebellar tracts (ataxia)
-Loss of deep tendon reflexes (degeneration of peripheral nerves)
Closely mimic neurological symptoms of Friedrich’s ataxia and VB12 deficiency

Vitamin E toxicity?
Vitamin E prevents the synthesis of Vitamin K-dependent coagulation factors (II, VII, IX, X) -> anti-coagulation!

***Board question: patients may mistakenly take vitamin E supplements with warfarin after an MI -> synergistic activity -> bleeding, prolonged INR and PT

Vitamin E sources?
Nuts, green leafy vegetables, olives

Vitamin K sources?
colonic bacteria (most common source)
dark green leafy vegetables

How is endogenous vitamin K activated?
It is activated by epoxide reductase in the liver

Causes of vitamin K deficiency?
Broad-spectrum antibiotics
Newborns: must be injected with IM vitamin K because bacterial colonization does not occur until 3-5 days
Rat poison is warfarin

vitamin K function?
gamma carboxylation of pro-coagulation and anti-coagulation factors

gamma carboxylation activates VK-dependent coagulation factors; allows them to bind calcium in fibrin clots

Mechanism of warfarin?
****Inactivates epoxide reductase

Vitamin K deficiency?
Hemorrhagic disease of the newborn (CNS issues, ecchymoses)

Vitamin B12 sources?
Animal products (only synthesized by microorganisms; very large reserve pool stored in the liver)

Vitamin B12 deficiency causes?
Insufficient uptake
lack of intrinsic factor (pernicious anemia, gastric bypass)
absence of terminal ileum (Crohn disease)

Vitamin B12 blood levels
Increased serum homocysteine and methylmalonic acid levels

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