Please enable JavaScript.

Coggle requires JavaScript to display documents.

Vitamins - Coggle Diagram

- - - - Beriberi (i cannot, i cannot in latin)
        
        Weakness & lassitude
        
        Cardiac symptoms: tachycardia, pathogenic heart remodeling, congestive heart failure,
        
        Neuro symptoms
        
        weakness, apathy, nerve tingling, poor coordination, paralysis (B1 catalyzes pyruvate --> acetyl-coA rxn; acetyl coA is needed for acetylcholine
      - Wernicke-Korsakoff syndrome
        
        Linked to alcoholism
        
        psychosis
        
        Confusion
        
        memory problems
        
        coma
    - - Found in grains, legumes, & meat (also used to fortify cereals breads, & other baked goods)
  - - - Diet
        
        Mainly found in milk products & meat. (also found in whole & enriched grains & some vegetables)
      - deficiency
        
        Associated with alcoholism in the US, but globally where milk & meat consumption are low
        
        Ariboflavinosis
        
        Inflammation of the ...
        
        lips
        
        mouth
        
        skin (seborrheic dermatitis besoming red, scaly, & greasy
        
        tongue
        
        eyes
        
        influences iron absorption & mobilization (oxy-reduction of Fe2+/3+) thus can affect function of red blood cells
      - FAD & FMN are electron carriers
  - - - another important electron carrier
        
        Diet
        
        fish, meat, legumes, bran, peanuts
        
        Deficiencies
        
        Pellegra
        
        endemic in places where unfortified corn is the staple diet
        
        4 Ds
        
        Diarhhea
        
        Dermatitis
        
        Death (if untreated)
        
        Dementia
  - - - liver, egg yolks, yogurt, nuts (not rly found in fruits & meats/ very minimal)
    - - Rxns: Pyruvate Carboxylase (Gluconeogenesis), Acetyl-CoA Carboxylase (FA synthesis), catabolism of some amino acids ( proponyl-coA, carboxylase, ect ...)
    - - Brittle fingernails, hair loss, skin rashes, neurological deficits, & tingling extremities
  - - - found in everything
    - - acyl carrier, (eg. acetyl-CoA)
    - - very rare but found in WWII Pacific prisoners of war
      - may also contribute to generalized vitamin B deficiencies in alcoholics
      - numbness & painful burning & tingling in extremities
  - - - Diet
        
        both animal & plant products: meats, whole grains, brown rice, & some fruits & vegetables
      - Rxns
        
        involved in many rxns
      - deficiencies
        
        very rare except alcoholics
        
        Some drugs can inactivate B6 derivatives
        
        Take B6 along with these drugs
        
        Cycloserine - tuberculosis
        
        Isoniazid - tuberculosis
        
        Hydralazine - high blood pressure
        
        Theophylline - asthma
        
        Penicillamine - rheumatoid arthritis
        
        Monoamine oxidase inhibitors - depression
        
        Carbidopa, a drug used in treating Parkinson's may also lead to a vitamin B6 deficiency.
        
        Symptoms
        
        Neurological features of B6 deficiency are thought to relate to its role in neurotransmitter synthesis and include:
        
        Confusion
        
        Depression
        
        Headaches
        
        Numbness or tingling in extremities, and seizures.
        
        Anemia - microcytic anemia with ringed sideroblasts
        
        B6 is a coenzyme in one of the 1st steps of heme synthesis
        
        Seborrheic dermatitis
        
        Glossitis
        
        Cheilosis
        
        Neurological features - Infants consuming the formula where B6 was inactivated by heat as a major food source began displaying abdominal problems, convulsions and other neurological symptoms.
  - - - Lentils & green vegetables
      - In the United States, since 1998, refined grain products are fortified with folic acid
    - - Megaloblastic anemia
      - Neural tube defects
      - Elevated homocysteine
        
        elevated homocysteine is associated with cardiovascular disease
  - - - almost exclusively in animal products, therefore vegans need to obtain cobalamin through fortified foods or supplements
    - - only used in 2 rxns
        
        Methionine synthase - methyl-cobalamin is used to methylate homocysteine to methionine by the enzyme methionine synthase.
        
        Cobalamine formed in this reaction is converted back to methyl-cobalamin by the same enzyme using N5-methyl-tetrahydrofolate as a methyl group donor.
        
        Since this is the only reaction where N5-methyl-tetrahydrofolate is converted to tetrahydrofolate and returned to the folate pool, this reaction forms the basis for the folate trap discussed above.
      - Methylmalony-CoA-Mutase - adenosyl-cobalamin: reaction where methylmalonyl-CoA is rearranged to succinyl-CoA in a late step in the catabolism of certain amino acids and odd-chain fatty acids (VOMIT).
    - - Causes
        
        autoimmune/ immune mediated malabsorption problems
        
        Pernicious anemia
        
        Autoimmune process destroys parietal cells involved in the synthesis of intrinsic factor needed for B12 absorption in the ileum.
        
        Atropic gastritis
        
        affects acid secretion in the stomach, which can affect the release of B12 from proteins in the diet, reducing absorption.
        
        Malabsorption syndromes such as celiac disease and tropical spruce
        
        surgical resection
        
        surgical resection of stomach or terminal ileum can result in the loss of cells secreting intrinsic factor or receptors for the intrinsic factor-B12
        
        Drug Interactions
        
        Proton pump inhibitors that reduce stomach acid can affect B12 absorption – prolonged use is generally necessary for B12 deficiency to develop.
        
        Nitrous oxide – Nitrous oxide inactivates B12 and can lead to symptoms of B12 deficiency.
        
        Metformin – metformin has an effect on B12 absorption by influencing levels of free calcium needed for uptake of the intrinsic factor-B12 complex.
        
        Tetracycline – tetracycline can interfere with the absorption of B12, so if supplements are taken they should be taken at different times than tetracycline.
        
        vegans
      - Clinical manifestatios
        
        Macrocytic anemia
        
        Homocystinuria
        
        methylmalonic aciduria
        
        Neurologic manifestations
        
        Mechanisms
        
        Folic acid crosses BBB as 5-methyl-THF
        
        Upon entering neurons 5-methyl-THF is converted to THF via the methionine synthase reaction, with cobalamin as an essential co-enzyme.
        
        The methyl group as part of methionine can then form S-adenosyl-methionine
        
        1 more item...
        
        symptoms
        
        numbness and tingling of hands and feet
        
        difficulty walking
        
        memory loss
        
        disorientation
        
        dementia
  - - - citrus fruits, & other fruits/ vegetables
    - - Hydroxylation
        
        Hydroxylation of proline and lysine in collagen
        
        Hydroxylation of dopamine to norepinephrine
        
        Hydroxylation of hypoxia inducible factor used as an oxygen sensor in angiogenesis
      - Antioxidant!
        
        protects the body from reactive oxygen species
    - - Hurts wound healing through disrupting collagen synthesis and supplying new blood flow
        
        Scurvy
        
        historically seen in sailors, now seen in the poor
        
        clinical findings
        
        Fragile blood vessels; pinpoint hemorrhages, bleeding gums, bruising
        
        Poor wound healing
        
        Bone fractures
        
        Loose teeth
        
        Joint pain and swelling
        
        Anemia
        
        caused by chronic bleeding due to weakened blood vessels. chronic bleeding leads to Fe+ deficiency
        
        Vit. C aids Fe+ absorption
        
        an effect of vitamin C on the conversion of folic acid to folate (could be a macrocytic anemia)
- - - - diet
        
        Preformed retinoids (more efficiently absorbed)
        
        liver, fish, egg yolks, dairy
        
        Carotinoids
        
        Vegetables & fruits w/ yellow & orange pigment
        
        eg. carrots
      - rxns
        
        visual cycle
        
        signal transduction (gene expression @ transcriptional level)
        
        Development – retinoic acid derivatives play critical roles in human development affecting the formation of the cardiovascular system, nervous system, respiratory system and skeletal growth.
        
        Immune system – retinoic acid derivatives control cell fate decisions during erythropoiesis.
        
        Epithelial tissue – retinoic acid plays a role in the differentiation of epithelial layers.
        
        Eyes – mucus secreting cells of the eye require retinoic acid signaling for appropriate function
        
        Skin - retinoic acid plays in important role in controlling the differentiation of hair follicles and mucus secreting glands.
        
        Bone growth and remodeling
      - Deficiencies
        
        Major problem for children in developing countries
        
        causes (other than reduced Vit A consumption)
        
        inadequate fat intake
        
        decreases solubility
        
        inadequate protein consumption
        
        --> dec substrate available for retinol binding protein synthesis
        
        inadequate zinc consump.
        
        clinical features
        
        Xerophthalmia
        
        eye problems including: night blindness, extreme dryness and softening of the cornea referred to as keratomalacia.
        
        nutritionally acquired immunodeficiency
        
        Follicular hyperkeratosis
        
        hard dry skin surfaces with lesions that appear on extremities, shoulders, and buttocks.
        
        Disruption of the skin barrier can lead to infections.
      - toxicities/ overdose clinical features
        
        Adults
        
        Adults Acute - nausea, headache, blurred vision, cerebral edema, and lack of muscle coordination
        Chronic – weight loss, muscle and joint pain, liver damage, bone abnormalities, visual defects, anemia, and skin rashes
        
        Infants
        
        bulging frontanels
        
        Pregnancy
        
        teratogens (especially preformed!)
      - Pharmaceutical uses: used to treat ...
        
        Acute promyelocytic leukemia
        
        Psoriasis
        
        Severe Acne/Acne Vugarus
        
        Retinitis pigmentosa
    - - diet
        
        naturally arises from animal derived products such as salmon, liver, & egg yolks
        
        In the US, major sources of vitamin D in the diet come from fortified milk and cereals.
      - rxns
        
        Ca2+ & phosphorus homeostasis
      - deficiencies
        
        causes/ risk factors
        
        exclusively breastfed infants (less fortified food eaten)
        
        darker skin (less UV rays get through)
        
        CKD, kidney cannot produce enzyme to activate Vitamin D
        
        fat malabsorption syndromes
        
        cystic fibrosis
        
        obesity
        
        vitamin D is stuck/ absorbed in body fat & not bioavailable for other functions
        
        elderly
        
        body enzymes less efficiency w/ age & nursing homes w/ reduced sunlight
        
        clinical findings
        
        Rickets (children
        
        narrow rib cages and bowed legs
        
        Osteomalacia
        
        weaken bones leading to fractures in weight-bearing bones; promote osteoporosis
      - toxicity from too much vitamin supplementation
        
        high blood calcium and calcium depositions in blood vessels, kidney and cardiovascular system.
      - drug interactions
        
        Cholesterol sequesterants should not be taken at the same time as vitamin D supplements.
        Drugs like phenytoin, carbamazepine and rifampin increase vitamin D catabolism.
    - - diet
        
        nuts & vegetable oils
      - rxns
        
        fat-soluble anti-oxidant
        
        especially protecting cell membranes especially of RBCs, nerves & immune system
      - deficiency (is rare)
        
        causes
        
        Fat malabsorption syndromes
        
        Genetics
        
        Birth – little transfer of vitamin E occurs from mother to fetus until late in pregnancy
        
        :Premature infants can have damaged red blood cell membranes and suffer from hemolytic anemia due to vitamin E deficiency
        
        symptoms
        
        Neurologic - impaired balance and coordination, damage to sensory nerves, muscle weakness, and damage to the eye (peripheral neuropathy, ataxia, and retinitis pigmentosa – classic symptoms)
        Hemolytic anemia – see discussion above regarding premature infants
    - - K for blood Koagulation!
        
        diet
        
        leafy green plants and vegetable oils.
        Some forms of vitamin K are also formed by bacteria within the digestive tract and absorbed
        
        rxns
        
        generating coagulation factors
        
        serve as an essential co-enzyme for γ-glutamyl carboxylase
        
        electron donor in this reaction
        
        targeted by warfarin
      - Deficiencies
        
        rare in adults, common in newborns!
        
        causes
        
        causes in newborns
        
        Most infants receive a vitamin K injection within 6 hours of birth
        
        little transfer of vitamin K from mother to fetus and the newborn GI tract is essentially free of bacteria
        
        Fat-malabsorption syndromes can affect vitamin K absorption
        
        Antibiotics that kill off GI bacteria coupled with a diet low in vitamin K can lead to vitamin K deficiency.