1. VITAMIN DEFICIENCY AND
EXCESS

2. vitamins
 Vitamins are the organic substances in food,
which are required in very small amounts and
are not synthesized by the body.
 They occur naturally in food and are essential
for good health.
 Vitamins are broadly categorized into two
forms
 Fat soluble vitamins –Vitamin A,D,E and K
 Water soluble –Vitamin B complex and
vitamin C

3. VITAMIN A(RETINOL)
 Liver is the richest source,fish,eggs
 Green leafy vegetables, carrots, and yellow fruits
 Plays an important role in vision. Retinaldehyde is the part of
the photoreceptors of rods in retina
 Vitamin A is also necessary for normal growth, fetal
development, fertility, haemopoiesis and immune function
 DEFICIENCY Causes-
 Nightblindness
 Xerophthalmia
 Bitot’s spots
 Corneal ulceration and necrosis
 Keratomalacia with scarring leading to blindness

4.  Deficiency is treated by a single large dose of
retinol as palmitate or acetate 200000 IU orally or
IM
 Xerophthalmia – 60mg of vit A in oily soln
 TOXICITY of vitamin A causes liver
damage,hyperostosis and teratogenicity.
 Acute overdose can cause nausea and headache,
raised intracranial pressure and skin
desquamation.
 Excessive intake of carotene causes
hypercarotenosis (pigmentation of skin)

5. VITAMIN D
 Natural form ofVitamin D is cholecalciferaol.
It is formed in the skin by the action of
ultraviolet rays on 7-dehydrocholesterol.
 Dietary sources are egg yolk , fish oil, butter
and milk.
 Cholecalciferol is not biologically active. It is
converted in the liver to 25-
hydroxycholecalciferol which is further
hydroxylated in kidneys to 1,25
dihydroxycholecalciferol.This is the active
form of vitamin D

6. Functions
 Vitamin D helps in uptake of calcium from the
gut and bone formation
 Maintains normal functioning of muscles,
immune function and inflammation.

7.  DEFICIENCY leads to poor bone
mineralization causing rickets in children and
osteomalacia in adults.
 Deficiency occurs due to malabsorption or
chronic renal disease
 TOXICITY leads to hypercalcaemia leading to
renalcolic ,polyuria,
polydipsia,lethargy,nausea, depression,
drowsiness

8. VITAMIN E
 α- tocopherol is the active form of vitamin E
in human body.
 FUNCTIONS
• The main function of vitamin E is anti oxidant. It
intercepts free radicals & prevents destruction of cell
membrane.
• It prevents the oxidation of PUFA by free radicles.
• It is involved in anti-inflammatoy and immune
systems.
• It inhibits platelets aggregation.
• It enhances vasodilatation.

9. Vitamin E Dietary Sources
 Vegetable oils
 Almonds & peanuts
 sunflower oil
 Spinach
 Carrots (least)

10. Vitamin E deficiency
•Severe vitamin E deficiency causes:
Neurological symptoms (impaired coordination)
& muscle weakness causing ataxia.
Increased risk of cardiovascular diseases
Visual scotomas
Deficiency occurs in severe PEM and fat
malabsorption syndrome
Deficiency is t/t by 800-1200mg of tocopherol/d

11. THERAPEUTIC USES
 Prevention of cardiovascular diseases
 Diabetes Mellitus
 Cancer prevention
 Boost immunity
 Dementia

12. TOXICITY
Excess vitamin E may cause:
 Impaired blood clotting leading to increased
risk of bleeding in some persons.
It is recommended that vitamin E supplements
to be stopped one month before elective
surgery.

13. VITAMIN K
The K is derived from the German word
Koagulation.
There are 2 naturally occurring forms of vitamin
K. Plants synthesize phylloquinone (vitamin K1) &
bacteria synthesize menaquinone-3 (vit K2).

14. FUNCTIONS
•Vitamin K is needed for production of
vitamin K-dependent coagulation factors in
the liver.
•Other functions include:
Assist in bone mineralization. The
mineral binding capacity of osteocalcin
requires vit K.

15. SOURCES OFVITAMIN K
Bacteria in large intestine produce vit K2
and supply 40-50% of human requirement.
Vegetable oils
Almonds & peanuts
Avocado & Broccoli
Spinach, Lettuce.

16. Vitamin K deficiency
 deficiency leads to delayed coagulation and
bleeding.
Is uncommon in adults. Only those with severe
liver disease (obst. Jaundice) chr. Small intn dis &
those on oral anticoagulants are at risk.
 Exclusively breast fed & premature babies are at
risk coz human milk is low in vitamin K.
 Hemorrhagic disease of the newborn is a serious
threat to life & routine vit k prophylaxis is
recommended.

17. VITAMIN C
 Humans, unlike other mammals, are unable to
make ascorbic acid & they get it from food.
 Rich dietary sources are citrus juices (orange,
grapefruit & lime), strawberry, Guava, tomato,
sweet red pepper & broccoli.
 Recommended daily intake is between
15-120 mg/day depending on age. Smokers &
lactating mother needs the higher range.

18. FUNCTIONS
 Collagen synthesis
 Antioxidant property
 promotes absorption of non-heme iron
Connective tissue metabolism

19. Vitamin C deficiency
 Severe deficiency leads to Scurvy with the
following manifestations:
Bleeding & bruising easily- swollen bleeding
gums, petechial h’ges,ecchymosis
Joint pain & swelling
Poor wound healing
Fatigue & lack of concentration

20. • Cardiovascular diseases
• Cataracts
• Diabetes Mellitus
• Cancer prevention
• Common cold
Treatment -250 mg vit C 8hrly
THERAPEUTIC USES

21. VITAMIN B Complex

22. Thiamine (Vit. B1)
 Known as B1 cause first identified.
 Function – important role in peripheral nerve
conduction.
 Food sources– pork, meat, yeast, beef,
legumes, whole grains, nuts.
 Deficiency – poor intake, chronic illness,
chronic alcoholism, hyperemesis, bariatric
surgery.

23.  Signs and symptoms – anorexia, irritability
and Beri Beri
Types of Beri Beri --- wet, dry and infantile
Wet type – Cardiovascular symptoms,
Cardiomegaly, tachycardia, CCF
Dry type – symmetrical peripheral neuropathy

24.  In alcoholics – chronic deficiency causes CNS
manifestations like horizontal nystagmus,
ophthalmoplegia, cerebellar ataxia, mental
impairment known as Wernicke’s
Encephalopathy.
 Wernicke’s Encephalopathy with loss of memory
and psychosis is known as Wernicke’s
Korsakoff’s syndrome
TREATMENT– acute deficiency
 100 mg/day IM for 7 days f/b 10 mg/day till
recovery.

25. Riboflavin (Vit. B2)
 Important for metabolism of CHO,fat,proteins
Deficiency causes-- Lesions of mucocutaneous
surface of oral cavity and skin, Corneal
vascularization, Anemia and Personality changes
Sources are-- Milk and dairy products, Enriched
breads, Cereals, Fish, Eggs, Broccoli and Legumes
Toxicity– not known becoz GI absorption is very
limited.

26. Niacin (Vit. B3)
 Refers to nicotinic acid nicotinamide and
derivatives.They are precursors of NAD and
NADP which are important in oxidation and
reduction reactions in the body.
 Sources—beans, milk, meat, eggs
 Deficiency causes Pellagra
 Common in corn eating
population, alcoholics Hartnup’s
disease, carcinoid syndrome

27. S/S of Pellagra
 Loss of appetite, gen weakness, irritability
abdominal pain and vomiting
 Red tongue
 Characteristic skin rash, pigmented and
scaling skin(rash known as Casal’s necklace)
 Diarrhea, dementia,depression,seizures

28.  Severe Pellagra--3Ds leading to death
dermatitis diarrhea dementia
 Treatment – 100 -200 mg of nicotinamide
TDS daily for 5 days

29. Pantothenic Acid (Vit. B5)
 Component of co-enzyme A
 Source– liver, yeast, egg yolk, whole grains,
vegetables
 Deficiency—GI disturbances, depression,
muscle cramps paresthesias, ataxia
 No toxicity known

30. Pyridoxine (Vit B6)
 It is a cofactor for many enzymes involved in
amino acid metabolism
 Synthesis of heme and neurotransmitters
 Metabolism of glycogen, lipids, steroids and
several vitamins.
 Sources– legumes, nuts, wheat bran, meat .
Bioavailability is more in animal sources.

31. Deficiency
 Epithelial changes,
 Depression, confusion
 Microcytic hypochromic anemia due to reduced
heme
 Hyperhomocystenemia -increased risk of CV
disease
 In infants diarrhea ,seizures
 Some drugs like INH ,penicillamine ,alpha dopa

32. Toxicity
 Sensory neuropathy
 Photosensitivity
Treatment
RDA--- 1.5-- 2 mg/day
100mg im daily for seizures

33. Folic Acid (Vitamin B9)
Functions:
1. Needed for RBC & DNA formation, cell multiplication esp.
GI cells
2. Newly discovered functions:
a. Prevents neural tube defects
b. Prevents heart disease (reduces homocysteine levels)
c. Prevents colon cancer
Etiology:
 Peak incidence 4-7 months
 Deficient dietary intake: goat’s milk deficient & powdered
milk poor source
 Sources are liver, green leafy veg, and fortified cereals.

34. DEFICIENCY
 Deficient absorption as in celiac
disease, achlorhydria, anticonvulsant
drugs and zinc deficiency
 hypothyroidism, drugs like trimethoprim
& alcoholism
 Increased requirement during rapid
growth & infection
 Asso with vitamin B12 deficiency &
chronic alcoholism
 Increased destruction possible in
cigarette smoking

35. Folic Acid Deficiency
Clinical Manifestations:
1.Megaloblastic anemia w/ irritability,
failure to gain wt & chronic diarrhea
2.Thrombocytopenic hemorrhages
advanced cases
RDA: 20-50mcg/24 hrs
Treatment:
1.Parenteral folic acid 2-5mg/24 hrs,
response in 72 hrs, therapy for 3-4 wks
2.Transfusions only when anemia severe

36. Cobalamine (Vitamin B12)
 Vitamin B12 is absorbed from the terminal ileum
in presence of intrinsic factor
 Deficiency occurs in elderly patients, alcoholics,
malabsorption, drugs like neomycin
Clinical Manifestations of deficiency:
1. Megaloblastic anemia
2. Neurological includes ataxia, paresthesias,
hyporeflexia, Babinski responses, clonus &
coma
3. Tongue smooth, red & painful

37. RDA: Infants 0.5 mcg/day
Older children & adults 3mcg/day
Treatment:
1. Prompt hematological response w/
parenteral vitamin B12 1-5mcg/24hrs
2. If there is neurological involvement
1mg IM daily for at least 2wks
3. Pernicious Anemia: Monthly vitamin
B12 1mg IM necessary throughout
patient’s life

38. TRACE ELEMENTS
CALCIUM
 Dietary sources – milk ,cheese, yoghurt, eggs,
fish, almonds, peanuts, peas and beans
 Calcium absorption is impaired in vit. D
deficiency, malabsorption and some foods
like spinach
 Deficiency causes impaired bone
mineralization in children and increased bone
loss in adults

39. phosphorus
 Dietary deficiency is rare
 Phosphates are added to processed foods
 Deficiency occurs in premature infants, renal
tubular phosphate loss.
 Deficiency causes hypophosphatemia and
muscle weakness

40. IRON
 Needed in formation of Hb, and involved in
many enzymatic reactions.
 Dietary sources are red meat, liver, fish,
shellfish,oatmeal, legumes, nuts, dried fruits
 Normal daily loss is 1 mg by desquamated
surface cells and intestinal loss.
 30 mg of iron is lost in menstruation
 Daily intake of 8 mg
 Vitamin C enhances iron absorption
 Overload of iron leads to haemochromatosis and
liver cirrhosis

41. IODINE
 Sources are sea fish, seaweed and plants
grown near the sea.
 Deficient in mountainous regions.
 Deficiency cause IDD, goitre is common,
congenital hypothyroidism, deafness, poor
reflexes and poor learning

42. ZINC
 Present in meat, shellfish, nuts and legumes
 Zn helps in synth and stabilization of protiens
 Deficiency is seen in PEM, malabsorption
syndromes, alcoholics and alcoholic liver disease.
 Deficiency is characterized by growth
retardation, hair loss, chronic diarrhea ,muscle
wasting and, mental apathy.
 Zn promotes general well being, healing of skin
lesions and improves appetite

43. SELENIUM
 Prevents free radical damage to the cells.
 Takes part in conversion of thyroxin to
triiodothyronine in liver
 Deficiency – hypothyroidism,
cardiomyopathy in children and myopathy in
adults

44. FLUORIDE
 Prevents dental caries.
 Deficiency is seen where people consume soft
water.
 Excess fluoride cause increase bone
density, calcification of ligaments and
tendons, also affects the dental enamel and
causes mottling, pitting and pigmentation.

45. COPPER
 DEFICIENCY can cause microcytic
hypochromic anemia, neutropenia, retarded
growth in children, skeletal rarefaction and
dermatosis
 Abnormal copper metabolism is seen in
wilson’s disease
 Deficiency occurs in PEM or prolonged
parenteral nutrition

46. THANKYOU

47. Clinical finding of vit defi
Nutrient Clinical Finding
Thiamine Beriberi: neuropathy, muscle weakness and wasting, cardiomegaly, edema,
ophthalmoplegia, confabulation
Riboflavin Magenta tongue, angular stomatitis, seborrhea, cheilosis
Niacin Pellagra: pigmented rash of sun-exposed areas, bright red tongue, diarrhea,
apathy, memory loss, disorientation
Vitamin B6 Seborrhea, glossitis, convulsions, neuropathy, depression, confusion,
microcytic anemia
Folate Megaloblastic anemia, atrophic glossitis, depression, homocysteine

48. nutrient
Clinical finding
Vitamin B12 Megaloblastic anemia, loss of vibratory and position sense, abnormal
gait, dementia, impotence, loss of bladder and bowel control,
homocysteine, methylmalonic acid
Vitamin C Scurvy: petechiae, ecchymosis, coiled hairs, inflamed and bleeding
gums, joint effusion, poor wound healing, fatigue
VitaminA Xerophthalmia, night blindness, Bitot's spots, follicular hyperkeratosis,
impaired embryonic development, immune dysfunction
Vitamin D Rickets: skeletal deformation, rachitic rosary, bowed legs; osteomalacia
Vitamin E Peripheral neuropathy, spinocerebellar ataxia, skeletal muscle atrophy,
retinopathy
Vitamin K Elevated prothrombin time, bleeding

49. Element Deficiency Toxicity
Boron No biologic function
determined
Developmental defects, male
sterility, testicular atrophy
Calcium Reduced bone mass,
osteoporosis
Renal insufficiency (milk-alkali
syndrome), nephrolithiasis,
impaired iron absorption
Copper Anemia, growth retardation,
defective keratinization and
pigmentation of hair,
hypothermia, degenerative
changes in aortic elastin,
osteopenia, mental
deterioration
Nausea, vomiting, diarrhea,
hepatic failure, tremor, mental
deterioration, hemolytic
anemia, renal dysfunction
Chromium Impaired glucose tolerance Occupational: renal failure,
dermatitis, pulmonary cancer
Fluoride Dental caries Dental and skeletal fluorosis,
osteosclerosis