I – fat soluble vitamins

1-Vitamin A (Retinol)

*precursor: B caroten
* uses :
A-psoriasis
b- Acne vulgaris (retinoic acid)
c- Night blindness
d- Skin disease

N.B: vit A does not cross the placenta & it is essential for mucous epithelial cell
production (Category X in pregnancy)

*deficiency:
a- night blindness
b- Keratinization of the epithelial cells of the cornea & all mucous membrane
c- Loss of appetite

*toxicity:
-hyperstoses (bone hypertrophy) in children
- peeling of the skin
- Headache
- Lymph node enlargement

*daily requirements: orally or IM

Child 1300- 2600 IU
Adults 3000 IU

N.B:- Zn is essential for 1- maintenance of vit A in plasma

2-mobilization of vit A from the liver
- Administration of vit E with vit A increase absorption & tissue storage
- vit A must not exceed 10000 iu
- vit A is imp for vision , growth & reproduction

2-VIT D: (calciferol)
*precursor: 7- dehydro ergosterol U.V cholecalciferol D3
Ergosterol u.v calciferol VIT D2

*uses:
Has parathyroid hormone like action

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 -increase GIT absorption of Ca++
-increase tubular reabsorption of Ca++
- decrease mobilization of Ca++ from bone to blood

*deficiency: due to diet deficiency or inadequate exposure to sun light

In children rickets
In adults osteomalacia "soft bone"

Hyperparathyroidism

*toxicity:

-hypercalcaemia -myocardial infarction

-Mental retardation - deposition of Ca in soft tissue

-Increase digitalis toxicity - constipation

- stop the growth

*uses: Treatment of hyperparathyroidism & rickets

*daily req: 400 IU &for rickets 4000-40000

N.B: + Vit D is completely absorbed from GIT & depend on hepatic & biliary function, so drug
that increase hepatic microsomal enz (e.g. anticoagulants, barbiturates, rifampicin &
antidepressants ) cause vit D deficiency

+ lasix (furosemide) is contra indicated in vit D deficiency because it cause hypocalcaemia

(decrease Ca++)

3-VIT E : alpha -tocopherol

*present naturally in green vegetables, eggs & meat

* uses:

-increase absorption of vit A

- Anti oxidant for oily solution

- Carried in plasma by B- lipoprotein

*deficiency:

a- anemia b- muscular dystrophy

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 c- Male sterility d- habitual abortion in females

*toxicity:

Safe in very high doses

*daily req: 5-10 IU/day

NB: contraindicated with minerals as Ca++ & iron

4-VIT K : K1 phyto quinone plant origin

K2 mena quinone bacteria origin in GIT

K3 mena dione synthetic origin (H2O sol)

*Uses:

Essential for production of prothrombin in the liver

* Deficiency:

- In infant: hemorrhagic anemia & kernicterus (increase bilirubin)

- In adult: decrease liver function jaundice

N.B: .Antidote of vit K is coumarine (dicoumarol)

. xss Ab use decrease normal flora decrease vit K synthesis

deficiency of vit k

II-water soluble vitamins

1-vit B1 (thiamine)
Co enz in CHO metabolism, present naturally in yeast & liver. It is thermo labile

* Deficiency:

Cause Beri –Beri disease (peripheral neuritis) its symptoms:

- Mental disorder - fatigue

- Tachycardia -heart edema

-Low conc of HCL

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*toxicity: not marked (safe)

*daily Req : adult >0.6mg 4,5mg

Child 0.4mg

*uses:

1-Beri Beri treatment 2-diabetes mellitus (peripheral neuritis)

3-Neuralgia 4 -Mental disorder

2-vit B2 (Riboflavin )
An H+ carrier which play imp role in energy metabolism in respiratory chain.

Absorbed from upper GIT & never given alone but in combination with other Vit B cplx

* Deficiency:

1-chelosis (cracks in the corner of the mouth)

2-Glossitis (tongue inflammation)

3-photophobia (due to corneal vascularization)

4-Keratitis

5-embryo toxicity in pregnant female

*Daily Req. child > 0.6 adult >1mg oraly ,IM ,SC

3- vit B3 (Nicotinic acid or Niacin)

Nicotinic acid

Occur in 2 forms Nicotinamide

It is H+ carrier coenz for protein metabolism &production of energy ATP (in resp . chain)

*side effect of Vit B3 :

-Flushing -vasodilatation -hyperuricemia

-Hyperglycemia -hypocholesterolemia

* Deficiency:

Mainly cause pellagra characterized by:-

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 1-dermatitis 2-weakness 3-Neuritis

4-CNS confusion 5-photosensitivity 6-GIT irritation

7-schizophrenia sub clinical pellagra

*Daily Req.: child > 4mg adult > 6mg 45mg

4-Vit B6 (pyridoxine)
1-for amino acid metabolism: tryptophan vit B6 Nicotinic acid

2-Co enz essential for GABA production in the brain which is the main neurotransmitter
inhibitor to prevent convulsion

* Deficiency:

+epileptic convulsion +peripheral neuritis +Dermatitis

+ iron deficiency anemia

*Drug interaction with Vit B6

-oral contraceptive: deplete B6 should be supplied

-pregnancy : deplete B6

-Hydralazine, INH, penecillamine: decrease tryptophan metabolism

-L-Dopa: increase metabolism of vit B6 by increase synth of decarboxylase enz

(convert L-Dopa dopamine)

5-VIT B12 (cyanocobolamin)

- Maintenance of myelin sheath in the nervous tissue (its deficiency neurological signs)

-imp for synthesis of epithelial cells & normal growth

-It needs an intrinsic factor for its absorption from GIT, it is a glycoprotein in nature

(Its deficiency is called pernicious anemia)

- How to differentiate if pernicious anemia is due to either

a) Deficiency of intrinsic factor

Or b) deficiency of B12 by

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 Schilling test: take vit B12 + Co57 or Co58

1-if Co57 appear in feaces: (not absorbed)

So pernicious anemia due to lack of intrinsic factor

Vit B12

2- If Co57 appear in urine (absorbed)

So anemia due to lack of vit B12 alone

Pernicious anemia (addison's pernicious anemia)

-due to decrease in intrinsic factor in GIT

- lead to peripheral gastric mucosal atrophy, glotitis, achlorohydria (decrease HCL

secretion) &lead to megaloplastic anemia

- III by vit B12 IM or SC inj (depovit B12)

NB: * oral preparation are of no value

6-Folic acid :
- Essential for synthesis of pyrine &pyrimidine bases

- used in megaloplastic anemia beside B12

*not use folic acid because it mask signs of vit B12 deficiency

*folic acid anti metabolite (methotrexate) used as anticancer

7-Biotine:-

*synthesized by bacterial flora or taken with food

*involved in some fatty acid synthesis & many carboxylation reactions

*consumption of egg white only deficiency

8-Choline:-

*synthesized in the body from Methionine amino acid

* Essential for phosphatidyl Choline synthesis which is involved in lipid transport

&Ach synthesis

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9-Pantothenic acid:- (panthenol)

Converted to co A enz which is essential for A Ch . synthesis

Used locally to heal wounds F.A. metabolism

10-Vit C: Ascorbic acid

Present in green veg. & citrus fruits

Level in female > male & smoking decrease vit C in blood

Importance: 1-essential for collagen synthesis in the connective tissue

2-imp in oxidation – reduction reaction (redox) & cellular respiration

3-as a reducing agent: - used in III of Meth Heamoglobinemia

4-antidote for alcohol over dose bec – it activate alc. Dehydrogenase

enz. Which is essential for alc metabolism

NB: vit C give false +ve result with clinitest depends on cuso4 reduction by glucose in urine

Defficiency:

Scurvy disease:- Gum bleeding- lesion in teeth, bones & blood vessels

Toxicity:

1-stones in urinary tract

2-diarhea

3-ingesion of 10 gm daily then withdrawal frank symptom or scurvy

NB: scurvy appears in new bornes whom mothers ingest high amount of vit C

Dose: child >20mg/day

Adult >150mg/ day

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