Vitamin Disorders

ADEK - fat soluble (↓ GI absorption ➔ deficiency)

Vitamin A (retinol) 

• Vitamin A (retinol) deficiency - Malnutrition (MCC)

  • ↓ night vision,  Bitot (gray spots on bulbar conjunctiva), immunosuppression

• Vitamin A toxicity

  • Acute: N/V, blurred vision, vertigo

  • Chronic: Liver dz, alopecia, arthralgia

  • Isotretinoin (Vit A derivative) is contraindicated in pregnancy

Vitamin E (tocopherol)

• Vitamin E deficiency - Fat malabsorption

  • Hemolytic anemia and neuro sx (similar sx to B12 but no ↑ MMA) 

• Vitamin A toxicity

  • ↑ risk of bleeding, ↑ clotting on warfarin 

Vitamin K (phytomenadione)

• Vitamin K deficiency - Cirrhosis, fat malabsorption, ABX (gut BX synthesize vit K)

  • ↑ bleeding (↑ PT/PTT)

Water soluble vitamins

B1 (thiamine)

• EToH abuse, malnutrition, bariatric surgery

  • Dry beriberi: symmetrical peripheral neuropathy, paralysis, confusion

  • Wet beriberi: cardiomegaly/high output HF

  • Wernicke encephalopathy (acute and reversible)

    • Confusion, oculomotor (nystagmus/diplopia) ataxia

  • Korsakoff syndrome (chronic and irreversible)

    • Amnesia with confabulation (fabricated memories) and ∆ personalty 

B2 (riboflavin)

• Corneal vascularization and angular cheilitis

B3 (niacin)

• Dermatitis, dementia, diarrhea

B6 (pyridoxine)

• From INH

  • Sideroblastic anemia, seizures/neuropathy

B12 (cobalamin) 

• Malabsorption - absorbed in stomach (pernicious anemia) and small intestine

  • Megaloblastic anemia (↑ MMA), hyper-segmented neutrophils

C (ascorbic acid)

• • Scurvy ➔ ↑ bleeding/anemia, ➔ petechial/perifollicular hemorrhages

  • Gingivitis ➔ loose teeth