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Nutritional Disorders 2 (Pediatrics) - Coggle Diagram
Nutritional Disorders 2
(Pediatrics)
Vitamin A
(Deficiencies and
Excess)
CHARACTERISTICS
Fat-soluble; heat stable destroyed
by oxidation, drying
SOURCES
Liver,
fish liver oils
Dairy products
Causes of Deficiencies
Chronic intestinal malabsorption or lipid malabsorption
Malnutrition, particularly protein nutrition
Inflammation
measles,cystic fibrosis
CLINICAL MANIFESTATIONS
Nyctalopia Photophobia, xerophthalmia, Bitot spots,conjunctivitis, keratomalacia leading to blindness
MOST characteristic and specific signs of vitamin A deficiency (Eye)
Hypervitaminosis
Toxicity
adults
More than15,000 μg/day
children
More than6,000 μg/day
Treatment
Daily supplement of 1,500 μg
with measles
30-60 mg of retinol (100,000- 200,000 IU) given once or twice
Xerophthalmia
1,500 μg/kg body weight
orally
for 5 days
IM
injection of 7,500 μg
Vitamin B complex
CHARACTERISTICS
water-soluble nutrients
thiamine (B1), riboflavin (B2), niacin (B3), pyridoxine (B6), folate, cobalamin (B12), biotin, and pantothenic acid
Thiamine
(vitamin B1)
BIOCHEMICAL ACTION
Coenzyme in carbohydrate metabolism
Nucleic acid synthesis
Neurotransmitter
synthesis
SOURCES
Pork,fish, & poultry ,rice, oat, wheat, legumes, Breast milk
CAUSES
Polished rice based diets Malabsorptive states
Severe malnutrition Malignancies
Alcoholism
EFFECTS OF
DEFICIENCY
Neurologic
(dry beriberi): irritability,peripheral
neuritis,muscle
tenderness,ataxiaCardiac (wet
beriberi):tachycardia,
edema,
cardiomegaly,
cardiac failure
Wernicke encephalopathy
TREATMENT
3-5 mg/day PO thiamine for 6 wk
Riboflavin
(vitamin B2)
CAUSES
Severe
malnutrition,Malabsorptive
states
Prolonged treatment with phenothiazines probenecid, or OCPs
EFFECTS OF
DEFICIENCY
Glossitis,photophobia,
lacrimation,corneal vascularization,vascularization,
poor growth,cheilosis
SOURCES
Milk, milk products, eggs,fortified
cereals,green
vegetables
TREATMENT
3-10 mg/day
PO riboflavin
BIOCHEMICAL ACTION
Constituent of flavoprotein enzymes important in redox reaction
Niacin
(vitamin B3)
SOURCES
Meat,fish,poultry,Cereals, legumes, green vegetables
CAUSES
Predominantly
maize-based diets
Anorexia nervosa
Carcinoid syndrome
TREATMENT
50-300 mg/day
PO niacin
EFFECTS OF
DEFICIENCY
Pellagra
manifesting as diarrhea,
symmetric scaly dermatitis in sun exposed areas, and neurologic
symptoms of
disorientation and
delirium
BIOCHEMICAL ACTION
Constituent of NAD and
NADP, important in respiratory chain, fatty acid synthesis, cell differentiation and DNA processing
Pyridoxine (vitamin B6)
BIOCHEMICAL ACTION
Constituent of coenzymes for amino acid and glycogen metabolism, heme synthesis steroid action, neurotransmitter synthesis
SOURCES
Fortified ready-to-eat cereals,meat, fish,poultry, liver,bananas, rice
CAUSES
Prolonged
treatment with INH,penicillamine,
OCPs
EFFECTS OF
DEFICIENCY
Irritability,
convulsions,
hypochromic
anemia,Failure to thrive Oxaluria
TREATMENT
5-25 mg/day PO for deficiency states 100 mg IM or IV for pyridoxine-dependent seizures
Pantothenic acid
(vitamin B5)
SOURCES
Beef, organ meats,poultry,seafood, egg yolk, Yeast,soybeans, mushroom
CAUSES
Isolated deficiency
extremely rare in humans
TREATMENT
:no_entry:
EFFECTS OF
DEFICIENCY
irritability,fatigue,numbness,
paresthesias(burning feet
syndrome),muscle cramps
BIOCHEMICAL ACTION
Component of coenzyme A
fatty acid metabolism
Folic acid
SOURCES
cereals, beans,leafy vegetables, citrus fruits,papaya
TREATMENT
0.5-1 mg/day PO folic acid
BIOCHEMICAL ACTION
Coenzymes in amino acid & nucleotide metabolism
EFFECTS OF
DEFICIENCY
Megaloblastic anemia Growth retardation
glossitis
Neural tube defects in
progeny
CAUSES
Malnutrition
Malabsorptive states Malignancies
Hemolytic anemias
Anticonvulsant
therapy
Biotin
CAUSES
Consumption of raw eggs for prolonged periods
Valproate therapy
EFFECTS OF
DEFICIENCY
Scaly periorificial dermatitis,conjunctivitis,
alopecia, lethargy,hypotonia, &
withdrawn behavior
SOURCES
Liver, organ
meats, fruit
TREATMENT
1-10 mg/day PO biotin
BIOCHEMICAL ACTION
Cofactor for carboxylases, important in gluconeogenesis
fatty acid and amino acid metabolism
Cobalamin
(vitamin B12)
CAUSES
Vegan diets Malabsorptive states
Crohn disease
EFFECTS OF
DEFICIENCY
Megaloblastic anemia, irritability,developmental
delay,
SOURCES
Organ meats, sea foods
poultry, egg yolk, milk,
fortified ready to-eat cereals
TREATMENT
1,000 µg IM vitamin B12
BIOCHEMICAL ACTION
acts as cofactor for lipid & carbohydrate metabolism
Ascorbic acid
(vitamin C)
CAUSES
Predominantly
milk-based
(non–human milk) diets
Severe malnutrition
EFFECTS OF
DEFICIENCY
Scurvy,tenderness &
swelling of legs,bleeding gums,petechiae,hyperkeratosis,poor wound healing
SOURCES
Citrus fruits ,fruit juices,peppers,berries, melons,tomatoes,cauliflower,leafy green vegetable
TREATMENT
100-200
mg/day PO
ascorbic acid
for up to 3 mo
BIOCHEMICAL ACTION
collagen synthesis,
metabolism of cholesterol & neurotransmitters
Antioxidant function
Vitamin D3
EFFECTS OF
EXCESS
Hypercalcemia,anorexia,
pancreatitis,hypertension,
arrhythmias,CNS effects,
polyuria,nephrolithiasis, renal failure
EFFECTS OF
DEFICIENCY
Rickets,Osteomalacia,
Hypocalcemia
Causes of Rickets
Vitamin D Disorders
Calcium Deficiency
Phosphorus Deficiency
Renal Losses
SOURCES
sunlight (UV light):fish oils,fatty fish,egg yolks,
and vitamin D–fortified
formula,milk,cereals,
bread
BIOCHEMICAL ACTION
GI absorption of calcium, absorption of phosphate
CHARACTERISTICS
Fat-soluble,stable to heat, acid, alkali, & oxidation
VITAMIN E
SOURCES
Vegetable oils, seeds,nuts, green leafy
vegetables,margarine
EFFECTS OF
EXCESS
Unknown
BIOCHEMICAL ACTION
Antioxidant
EFFECTS OF
DEFICIENCY
Red cell hemolysis, cerebellar dysfunction,
pigmentary,retinopathy
CHARACTERISTICS
Fat-soluble
VITAMIN K
SOURCES
Green leafy vegetables,liver,certain legumes and plant oils
EFFECTS OF
EXCESS
hemolytic anemia jaundice,kernicterus, death
BIOCHEMICAL ACTION
Vitamin K dependent
proteins include
coagulation factors II, VII, IX, and X
EFFECTS OF
DEFICIENCY
Hemorrhagic
CHARACTERISTICS
fat-soluble:e; stable to heat and reducing agents; labile to oxidizing agent, strong acids, alkali, light
Trace Elements
Iron
SOURCES
Meat
PHYSIOLOGY
Component of
hemoglobin, myoglobin,cytochromes
EFFECTS OF
DEFICIENCY
Anemia
EFFECTS OF EXCESS
vomiting, diarrhea,abdominal pain, and hypotension
Manganese
SOURCES
Nuts, meat,
grains, tea
EFFECTS OF
DEFICIENCY
Hypercholesterolemia,
PHYSIOLOGY
Enzyme cofactor
EFFECTS OF EXCESS
Neurologic
manifestations cholestatic jaundice
Iodine
SOURCES
Saltwater fish,
iodized salt
EFFECTS OF
DEFICIENCY
Hypothyroidism
PHYSIOLOGY
Component of thyroid
hormone
EFFECTS OF EXCESS
Hypothyroidism and
goiter
Copper
EFFECTS OF
DEFICIENCY
Microcytic anemia,osteoporosis,neutropenia, neurologic symptoms,depigmentation of hair and skin
PHYSIOLOGY
Absorbed via
specific intestinal transporter
Enzyme cofactor
EFFECTS OF EXCESS
Acute: nausea,emesis, abdominal pain, coma, and hepatic necrosis
Chronic toxicity
Wilson disease
SOURCES
Vegetables,
grains, nuts, liver,margarine,
legumes, corn oil
Chromium
EFFECTS OF
DEFICIENCY
Impaired glucose tolerance, peripheral
neuropathy,and encephalopathy
PHYSIOLOGY
action of insulin
EFFECTS OF EXCESS
Unknown
SOURCES
Meat, grains,fruits, and
vegetables
Fluoride
EFFECTS OF
DEFICIENCY
Dental caries
PHYSIOLOGY
Incorporated into bone
EFFECTS OF EXCESS
Chronic: dental fluorosis
SOURCES
Toothpaste,fluoridated water
Selenium
EFFECTS OF
DEFICIENCY
Cardiomyopathy (Keshan disease) myopathy
EFFECTS OF EXCESS
Nausea, diarrhea,
neurologic
manifestations,nail and
hair changes, garlic odor
SOURCES
Meat, seafood,whole grains,garlic
PHYSIOLOGY
Enzyme cofactor (prevents oxidative damage)
Zinc
SOURCES
Meat, shellfish,
whole grains,
legumes, cheese
EFFECTS OF
DEFICIENCY
Decreased growth,
poor wound healing,hypogonadism,
diarrhea
PHYSIOLOGY
Enzyme cofactor Constituent of zinc finger proteins
EFFECTS OF EXCESS
Abdominal pain,diarrhea, vomiting,
Molybdenum
SOURCES
Legumes, grains,liver
EFFECTS OF EXCESS
Hyperuricemia, gout
PHYSIOLOGY
Enzyme cofactor (xanthine oxidase)
EFFECTS OF
DEFICIENCY
Tachycardia, tachypnea, night blindness,irritability, coma