VITAMINS 

MR. ABDOU MARAM PANNEH(RM ,FWACN,NT, RN)

INTRODUCTION Despite their diverse chemical composition,

VITAMINES can be defined as organic substances that must be provided in small quantities from the environment because either they cannot be synthesized in human beings or their rate of synthesis is inadequate for the maintenance of heath.

CLASSIFICATION OF VITAMINS 1. WATER-SOLUBLE VITAMINS:These are the vitamin B Complex

Derivatives:- They Function in intermediary metabolism in many essential reactions.

These includes:-Thiamine (Vitamin B1),Riboflavin (Vitamin B2),Nicotin acid (Vitamin B3), Pyridoxine (Vitamin B6), Pantothenic acid, Biotin, Folic acid, Cyanocobalamin (Vitamin B12), Choline, Inositol Ascorbic acid (Vitamin C) and Paraaminobenzoic acid (is not a true vitamin but is a growth factor

for certain bacteria, where it is a precursor for folic acid synthesis.

1. WATER-SOLUBLE VITAMINS:i. THIAMINE (VITAMIN B1)Was the first member of the vitamin B complex to be

identified.Severe deficiency leads to the condition known as Beriberi.

Deficiency Symptoms related to the nervous system (dry beriberi): Peripheral neuritis with sensory disturbances in the extremities, including localized areas of hyperthesia or anesthesia.

Muscle strength is lost gradually and may result in wrist-drop or complete paralysis of a limb.

Personality disturbances, depression, lack of initiative and poor memory, as may syndromes as extreme as Wernicke’s encephalopathy and Kosarkoff’s psychosis.

1. WATER-SOLUBLE VITAMINS Cont’d..i. THIAMINE (VITAMIN B1) Cont’d..Deficiency Symptoms related to the cardiovascular system

(wet beriberi): Dyspnea on exertion, palpitation, tachycardia and other cardiac abnormalities characterized by an abnormal electrocardiogram and cardiac failure of the high-output type.

Therapeutic uses of Vit B1: Treatment or the prophylaxis of thiamine deficiency.

Varieties of thiamine deficiency includes:Alcoholic neuritisInfantil BeriberiSubacute Necrotizing EncephalomyelophatyCardiovascular DiseaseGastrointestinal DisordersNeuritis of PregnancyMegaloblastic Anemia

Adverse drug reactions: Anaphylactic shock may occasionally follow injection.

1. WATER-SOLUBLE VITAMINS Cont’d..ii. RIBOFLAVIN (VITAMIN B2)Symptoms of deficiency: Sore throat and angular

stomatitis generally appear first. Later, glossitis, cheilosis (red, denuded lips),

seborrheic dermatitis of the face and dermatitis over the trunk and extremities occur,

Followed by anemia and neurophaty. In some subjects corneal vascularization and cataract formation are prominent.

The anemia that develops is normochronic and normocytic and is associated with reticulocytopenia.

Therapeutic uses: Treatment or prevent disease caused by deficiency.

1. WATER-SOLUBLE VITAMINS Cont’d..

iii. NICOTINIC ACIDSymptoms of deficiency: A deficiency of nicotinic

acid leads to the clinical condition known as Pellagra. Pellagra is characterized by signs and symptoms

referable especially to the skin, gastrointestinal tract, and central nervous system, a triad frequently referred to as Dermatitis, Diarrhea and Dementia, or the ¨three D’s¨.

Pellagra occurs most often in the setting of chronic alcoholism, protein-calorie malnutrition, and deficiencies of multiple vitamins

Therapeutic uses: Prophylaxis and treatment of Pellagra prevent desease caused by deficiency.

1. WATER-SOLUBLE VITAMINS Cont.iv. PIRIDOXINE (VITAMIN B6)Deficiency is rare but it may occur during Isonizid

therapy and is characterised by peripheral neuritis.Symptoms of Deficiency:

Skin: seborrhealike skin lesions about the eyes, nose and mouth accompanied by glossitis and stomatitis.

Nervous system: Convulsive seizures.Erythropoiesis: Anemia

Therapeutic uses: Should be a component of therapy for individuals suffering from a deficiency of others members of the B complex. Good in memory activation

v. CYANOCOBALAMIN (VITAMIN B12)Deficiency may occur during total gastrectomy,ileal

resection which may lead to megaloblastic anemia.

1. WATER-SOLUBLE VITAMINS Cont.vi. ASCORBIC ACID (VITAMIN C)Symptoms of Deficiency: A deficiency in the intake of vitamin C

can lead to SCURVY. The manifestation of scurvy is commonly found in the elderly

people living alone, alcoholics, drugs addicts, and others with inadecuate diets, including infants. In spontaneous cases of scurvy, there are usually loosening of the teeth, gingivitis and anemia. 

Therapeutic uses of Vitamin-C: For the treatment of ascorbic acid deficiency, especially frank

scurvy, which occurs rather infrequently in infants and in adults.

The reducing properties of vitamin C have been employed to control Idiopathic methemoglobinemia.

The antioxidant properties improved endothelium-dependent vasodilatation, reduced arterial stiffness and decreased platelet agregation. Also have been associated with protection against age-related cataract formation and degeneration.

2. FAT-SOLUBLE VITAMINSi. VITAMIN A (RETINOL)Deficiency of vitamin A is associated with ocular

defects (particularly xerophthalmia) and an increased susceptibility to infections.

Massive overdose can cause rough skin, dry hair, an enlarged liver and a raised erythrocyte sedimentation rate and raised serum calcium and serum alkaline phosphatase concentrations.

High levels may cause birth defects.

2. FAT-SOLUBLE VITAMINS Cont’d..ii. VITAMIN D (CHOLECALCIFEROL,

ERGOCLCIFEROL)Deficiency of vitamin D results in inadequate absorption

of Ca2+ and phosphate.In children, the result is a failure to mineralize newly

formed bone and cartilage matrix, causing the defect in growth known as rickets (as a consequence of inadequate calcification, bones are soft and the stress of weight bearing gives rise to characteristic deformaties).

In adults results in osteomalacia, a disease characterized by generalized accumulation of undermineralized bone matrix; severe osteomalacia may be associated with extreme bone pain and tenderness.

2. FAT-SOLUBLE VITAMINS Cont’d..iii. VITAMIN E (TOCOPHEROLS)Daily requirement of Vitamin E is not well

defined but is probably about 3 to 15mg daily.It is believed to be useful in malabsorption

secondary to cholestasis in adults and in youg children in congenital cholestasis.

Its deficiency is found to be associated with neuromuscular abnormalities.

However, Vitamin E have been tried for various other conditions but there is liitle scientific evidence of its value.

2. FAT-SOLUBLE VITAMINS Cont’d..iv. VITAMIN KIs necessary for the production of blood clotting

factors and proteins necessary for the normal calcification of bone.

Because is fat soluble, patients with fat malabsorption, especially in biliary obstruction or hepatic disease, may become deficient.

The chief clinical manifestation of vitamin K deficiency is an increased tendency to bleed.

Ecchymoses, epistaxis, hematuria, gastrointestinal bleeding, and postoperative hemorrhage are common;

intracranial hemorrhage may occur while Hemoptysis is uncommon.

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WC1H 9JP, UK, 2008 series. 

QUESTIONS, CONTRIBUTIONS, CLARIFICATIONS & CONSTRUCTIVE CRITICISMS?????