nutritionaldissorders-140211001156-phpapp01 (1).pdf

Guided by: Latha mam
02/11/14 1
NUTRITIONAL DISORDERS

What is calorie?
CALORIE - is the amount of energy
needed to raise the temperature of
one gram of water by one degree
Celsius
CALORIE = is represented by
the letter C.
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Essential nutrients
Proteins
Fats
Carbohydrates
Vitamins
Minerals
 water
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Main nutritional disorders
Obesity
Starvation
Kwashiorkor
 Marasmus
Anorexia nervosa
Bulimia nervosa
Vitamin deficiency
Trace element deficiency
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Obesity
Obesity is defined as an excess of adipose tissue that
imparts health risk.
Etiology
 genetic predisposition
 diets largely derived from carbohydrates and fats
than protein rich food.
hypothyroidism, cushings syndrome, insulinoma, and
hypothalamic disorders
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Pathophysiology
Obesity is associated with increased
adipose stores in the subcutaneous
tissue, skeletal muscles, internal organs
such as the kidneys, heart, liver and fatty
liver is also more common in obese
individuals. There is increase in both
sizes number of adipocytes and there is
hypertrophy as well as hyperplasia.
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Obesity
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Metabolic changes
Hyper insulinaemia
Non- Insulin dependant diabetes
Hypertension
Hyper lipoproteinaemia:
Atherosclerosis
Coronary artery disease
Cholelithiasis
Cancer
Osteoarthritis:
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Serious health hazards of obesity
Stroke
Coronary artery diseases
Hypertension
Fatty liver
Diabetes
Atherosclerosis
Hyperlipidaemia
Osteoarthritis
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Management of obesity
Nutritional therapy
Behavior modification
Support groups
MEDICAL MANAGEMENT
Drug therapy
{appetite suppressing drugs}
Phentermine, diethylpropion etc.
SURGICAL MANAGEMENT
Vertical banded gastroplasty
Adjustable gastric banding
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Starvation
Starvation is a state of overall deprivation of
nutrients.
Etiology
 deliberate fasting
 famine conditions in a country or community.
 secondary under nutrition such as chronic
wasting diseases, cancers etc.
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Signs and symptoms
Dry and scaly skin
 muscular weakness
Anemia
Increased susceptibility to infections
Loss of appetite
Wound healing may be delayed
Brittle nails
Loss of hair
Depression
Decreased B P ,pulse, slight cyanosis.
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Starvation
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Nursing management
Health promotion
Acute intervention
Health education
Try to maintain an optimal body weight
TYPES OF SPECIALISED NUTRITIONAL
THERAPY
Oral feeding
Tube feeding
nasogastric and nasointestinal feeding
gastrostomy and jejenostomy
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Protein deficiency
malnutrition
Kwashiorkor- Which is related to protein
deficiency through calorie intake may be
sufficient.
Marasmus- is starvation in infants occurring due
to overall lack of calories.
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KWASHIORKOR
Clinical features
Occurs in children
between 6 months 3
years of age
Growth failure
Wasting muscles but
preserved adipose tissue
Edema , localized or
generalized, present
Enlarged fatty liver
Serum proteins low
Anemia present
Alternate bands of light
and dark hair
MARASMUS
Clinical features
Growth failure
Wasting of all tissues
including muscles and
adipose tissue
Edema present
No hepatic enlargement
Serum proteins low
Anemia present
Monkey-like face,
protuberant abdomen,
thin limbs
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Morphology
KWASHIORKOR
Morphology
Enlarged fatty liver
Atrophy of different
tissues and organs but
subcutaneous fat
preserved
MARASMUS
Morphology
No fatty liver
Atrophy of different
tissues and organs
including
subcutaneous fat
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marasmus
Diagnostic Evaluation
Severe hypo chromic anemia is
generally diagnosed. The plasma
proteins level is usually lowered unless
hemo concentration is present.
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Pathophysiology marasmus
When adequate calories are not ingested to fulfill the
metabolic needs of the body, reserve food elements such as
protein and fat in the tissues are used to sustain life. This
process may be caused by
An inadequate diet or faulty eating habits
Congenital anomalies that present the infant taking an
adequate diet
Disease condition that interfere with the assimilation of food
 Infections that produce anorexia and decrease the infants
ability to digest food
Loss of food intake through vomiting and diarrhea
Food allergy that is not managed appropriate
Emotional problems such as disturbed mother child
relations.
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Nursing Management of
marasmus
 Management consists of providing a
nutritional intake that is rich in the essential
nutrients to correct the dietary insufficiency
and to promote normal growth and
development. Parenteral fluid therapy may
initially be necessary to correct the
electrolyte imbalance and dehydration and
to restore kidney if oral feedings are not
tolerated, hyper alimentation is used.
Additional vitamins and minerals and blood
transfusion may be necessary.
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In addition to assisting with administering parenteral
fluids and giving oral feedings, the nurse is also
responsible for maintaining the infant’s body
temperature within a normal range, providing for
periods of rest and appropriate activity and
stimulation, recording intake and output, daily
weighing turning and preventing infection. The
nurse carefully observes affected infants for infection
of mouth, skin and respiratory and genitourinary
tracts. These infections are appropriately treated
when they occur. The infant is protected from other
patient and care givers who have infections because
infants who have marasmus may also have emotional
deprivation, their care is like that for those who have
failure to thrive.

Prevention of marasmus
The prevention of marasums consists of
Parent education
Prompt treatment congenital defects
Prevention of emotional disturbance
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KWASHIORKOR

Pathophysiology
Kwashiorkor
While growth is occurring, sufficient nitrogenous
food must be consumed to maintain a positive
nitrogen balance. When inadequate amounts of the
essential aminoacids are not provided, not
absorbed or abnormally lost, protein under
nutrition results. The impaired absorption or loss of
protein may occur in infants and children who have
chronic diarrhea, nephrosis, hemorrhage, burns or
infection. Nutritional edema, results when the
body, lacking sufficient intake or sustaining a loss
of high quality protein, burns its own tissues and
destroys the plasma protein so that the level of
plasma albumin becomes low.
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kwashiorkor
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PROTEIN CONTENT FOODS
Eggs
Cow’s milk
Cheese
Meat cooked
Fish cooked
Rice cooked
Soy beans
White potato
wheat germ
Nuts

Nursing Management
The management of infants and children who
have kwashiorkor includes replacement of the
missing nutrients and treatment for any acute
problems such as diarrhea, renal failure and
shock. The dietary intake of protein and calorie in
increased gradually, skin milk, synthetic amino
acid mixtures or case in hydrolysates may be
given to supplement the usual diet. Vitamins and
minerals, especially vitamin 4, magnesium and
potassium are added to the intake to correct any
deficiencies.
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The accompanying anemia can be corrected
by administering iron and folic acid. In spite of
this management the infant or child may
initially loss weight because of the loss of
edema fluid. However improvement can
gradually be seen. Infections or infestations are
treated appropriately. The long term
management consists of feeding the child a
diet with adequate calories, especially one
high in protein of good biologic quality.

Prevention
Prevention consists of providing a diet
containing an adequate quality of protein of high
biologic quality for all infants and children. In
those areas where kwashiorkor is endemic parents
should be taught the nutritional needs of all family
members and adequate amounts of food should be
provided to fulfill these needs.
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Anorexia nervosa
An eating disorder in which the person
experiences hunger but refuses to eat
because of a distorted body image,
leading to a self perception of fatness.
Anorexia nervosa is a condition of self-
generated weight loss usually seen in
adolescent girls and young women, but
also in middle-aged women or men
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Etiology of eating disorders
Although the cause of eating disorders is not
certain, several factors are likely to contribute
to development of the disorders. Socio cultural
and environmental factors including media and
peer influences, family factors including
parental discord, and biologic factors
including genetics, neurotransmitter
regulation, and hormonal functioning have
been implicated. Negative affect, low self-
esteem, and dieting behavior commonly
predate the onset of an eating disorder.
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Clinical manifestations of
anorexia nervosa
Clients with anorexia nervosa are usually first
introduced to the health care system when the
disordered eating behavior results in obvious
weight loss. Clients may limit themselves to 200 to
500 kcal/day-only 60% to 70% of the amount
needed for ideal body weight. Physical
manifestations include dry skin, pallor,
bradycardia, hypotension, intolerance to cold,
constipation, and amenorrhea
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Pathophysiology
 The pathophysiologic changes associated with
anorexia nervosa are similar to those seen in
starvation. When caloric intake is severely limited, the
body adapts by using the body's fat stores and sparing
nitrogen stores. With prolonged starvation, significant
shifts in fluid and electrolyte balance can occur and can
be life-threatening.
The hypothalamus responds to the lack of nutrient
intake with changes in pituitary function, resulting in
amenorrhea and infertility. The extent of malnutrition
will determine the pathophysiologic changes
observed.
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Bulimia nervosa
 An eating disorder characterized by
uncontrollable binge eating alternating with
vomiting or dieting.
Bulimia nervosa is a less serious and
entirely separate illness. Clients with bulimia
nervosa tend to maintain a relatively normal
weight, but go through periods of eating
excessively (binging) and vomiting (purging)
gastric contents to prevent weight gain. It has been
suggested that bulimia nervosa is a form of
depressive illness.
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Clinical manifestations of
bulimia nervosa
 Clinical manifestations of bulimia nervosa include
episodes of binge eating followed by self-induced
vomiting. The eating and vomiting episodes occur most
often in the late afternoon and evening and are done in
secret. Some clients may abuse laxatives and diuretics
as well. Personality characteristics typical of clients
with bulimia are related to depression. Physical
manifestations may not be as obvious, because the
client with bulimia may be of normal weight without
any depletion of fat stores. Less obvious clinical
manifestations are erosion of tooth enamel from
frequent vomiting and esophageal and throat irritation.
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Nursing management of
eating disorders
 Outcomes
 The client will be able to resume normal earning behaviors. In clients
with severe nutritional depletion, the client will be able to regain weight
at a safe rare (1 to 2 pounds/week).
 Interventions: When caring for a client with anorexia nervosa,
help the client select foods from the Food Guide Pyramid for a
nutritionally balanced diet. The client is usually allowed to refuse
a specific number of foods (such as two or three) so that some
sense of control is felt. Observe the client during mealtimes. Be
supportive during mealtimes and, if needed, stay with the client
after he or she eats to prevent him or her from purging. Education
related to nutrition must include the client's family, care-givers, or
co-residents. An accurate calorie count and regular monitoring of
weight are other important interven-tions. Parenteral or enteral
nutrition may be needed forrrefractory clients with extreme
malnutrition.
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Management cond………
Outcomes
 The client will lose 1 to 2 pounds per week until
ideal body weight is achieved and maintain ideal body
weight thereafter
Interventions
 Teach the client how to use the Food Guide Pyramid
to select a healthy diet with portions of appropri-ate size.
Encourage the client to eat slowly and develop a regular
exercise pattern. Encourage the client to approach food,
eating, and self-image in a new way. Provide emotional
support and supervision for the client to overcome
stressful periods and break the binge-and-purge cycle.
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Management cond………
Outcomes
 The client will develop a more normal image of self, as
evidenced by statements concerning increased self-esteem by
the client's ability to overcome the eating disorder.
Interventions
 Recognize that clients suffering from eating
disorders typically have low self-esteem. These clients
see the regulation of food and exercise of self-control
in eating patterns and amounts as ways to prove
themselves successful. It is important that the client's
significant others help the client find other areas of
self-regard. It is expected that the client will overcome
the eating disorder with consistent and continued
treatment and that weight will return to normal.
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Vitamins
Fat soluble vitamins
a) vit A
b) vit D
c) vit E
d) vit K
 water soluble vitamins
a) vit C
b) vit B complex
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Vitamin A [retinol]
Physiologic functions of retinol
Maintenance of normal vision in reduced light.
This involves synthesis of rhodopsin, a light
sensitive pigment in the rods and cones of retina,
by oxidation of retinol. This pigment then
transforms the radiant energy in to nerve impulses.
Maintenance of structure and function of
specialized epithelium
Maintenance of normal cartilaginous and bone
growth.
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Deficiencies of vit A
Night blindness
Ocular lesions
Cutaneous lesions
Bitot spot
Xerophthalmia
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Bitot’s spot
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Pathological changes: - Consequent to vitamin A
deficiency following pathologic changes are seen.
Ocular lesions: - Lesions in the eyes are most
obvious. Night blindness is usually the first sign of
vitamin A deficiency. As a result of replacement
metaplasia of mucus secreting cells by squamous
cells, there is dry and scaly sclera conjunctiva
(xerophthalmia). The lacrimal duct also shows
hyperkeratosis corneal ulcer may occur. Bitot's
spots may appear which are focal triangular areas
of opacities due to accumulation of keratinized
epithelium.

contd
If these occur on cornea, they impede transmission
of light. Ultimately, infection, scarring and
opacities lead to blindness.
Cutaneous lesion:- The skin develops popular
lesions giving toad like appearance (xeroderma).
This is due to follicular hyper kurtosis and keratin
plugging in the sebaceous gland.

Sources
The major sources of retinol are liver, dairy
products, eggs and carotenes are found in varying
amounts in vegetables and fruits, especially in
most of the dark green leafy and bright orange
ones. Carotenes may also be present in the foods
listed above that naturally contain retinol.
Recommended intake
The 1980 RDA for Vitamin A is (5000 IU) for
men and (4000 IU) for woman.
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Management
Mild to moderate cases of deficiency can be
treated by daily oral dose of 10,000 IU of fat
soluble vitamin A for 10 days. In severe cases
larger dose (50,000 IU) is recommended for one
week. A single massive dose of 50,000 IU of
vitamin A every six months is prophylactic for
children below six years of age.
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Vitamin D[Calciferol]
Functions
Vitamin D is of almost importance in the
regulation of calcium and phosphorous
metabolism in the body. It serves to maintain
proper blood levels of calcium and phosphorous
by promoting their intestinal absorption and by
mobilizing these minerals from the skeleton when
needed. Mineralization of the skeleton and teeth
requires an adequate supply of vitamin D.
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Sources
Exposure to straight, fortified foods, fish lives oil
are good sources of vitamin D natural foods are
poor sources at vitamin D although small amounts
are present in egg yolk, liver, and fish such as
herring, sardines, tuna and salmon.
Recommended dietary allowances
Vitamin D is now considered more as a pro
hormone than a vitamin. Exposure to sunlight even
for 5 minutes per day. A specific recommendation
of a daily supplement of 400 IU is made.
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Vitamin D deficiencies
Tetani
Rickets
Osteomalacia
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Tetani
This is characterized by low serum
calcium (less than 7.5 mg per 100ml)
muscle twitching, cramps, and
convulsions. It results from insufficient
absorption of calcium or vitamin D, or
from a disturbance of the parathyroid
gland.
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Osteomalacia
 Osteomalacia frequently called
as adult rickets, occurs when there is
lack of vitamin D and calcium. It may
also occur when there is an
interference with fat absorption and
hence also vitamin D absorption.
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Osteomalacia

Rickets
Etiology
Poor exposure to sunlight may also be related
to the inactivity of the malnourished children.
Disturbed metabolism and poor synthesis of vit
D from the skin ,malabsorption state , diarrheal
diseases and excessive phylate with low
calcium and low phosphate content of the food
may well be some causes of rickets in
malnourished children.
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Rickets
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Rickets clinical features
Head-Increased size and delayed
closure of fontanels , craniotabes
 Teeth-delayed dentition
Thorax- rachitic rosary, pigeon chest
Spine-scoliosis , kyphosis
Limbs-widening of wrists, ankles and
other epiphysis , genu valgum
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rickets
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Management
In case of rickets recommended
dose of vit D is 10000 to 50000units
per day
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Rickets heals promptly with 4,000 IU of oral
vitamin D per day administered for
approximately one month.. The bone
abnormalities (visible by x ray) generally
disappear gradually over a period of 3-9
months. Parents are instructed to take their
infants outdoors for approximately 20 minutes
per day with their faces exposed. Children
should also be encouraged to play outside.
Foods that are good sources of vitamin D
include cod liver oil, egg yolks, butter, and oily
fish. Some foods, including milk and breakfast
cereals, are also fortified with synthetic vitamin
D.

Rickets
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Vitamin E[Tocopherol]
Functions
Vitamin E is needed for normal stability of red
blood cells. In animals it has been shown to be
essential for normal reproduction and for integrity
and muscle and for nerves. There is no sound
scientific basis for claims in the lay literature that
vitamin E promotes fertility and sexual
performance..
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Source
The richest source of vitamin E are the
vegetable oils that are risk in poly unsaturated
wheat germ, nuts, whole grains, legumes and
certain vegetables.
Another sources
Soybean oil, sunflower oil, mayonnaise
walnut, lima beans, sweat potatoes, spinach, fish,
liver, shell fish, eggs.
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Recommended intake
Although the 1980 RDA has been set at 10 mg
tocopherol for men and 8 mg for woman this
should be considered to be a recommendation for
people consuming customary American diets.
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Vitamin E deficiency
 Vitamin E deficiency is extremely rare in
humans. It is limited to those individuals with
fat malabsorption, or patients on total
parenteral nutrition, or in formula fed
premature infants. Changes occurring in
severe deficiency include, increased
hemolysis of red blood cells, creatinuria
deposition of brandish ceroid pigments in
smooth muscles and , in some cases,
development of a form of muscular dystrophy
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Management of Vitamin E disorders
 Vitamin E has been used in daily doses of 400 to
800 mg for the treatment of diverse conditions such as
habitual abortion, sterility muscular dystrophy
diabetes ischemic heart disease, skin disorders and
anemia in infants. Benefit has been reported in some of
these cases but none has been established in clinical
trails.
Administration of 3 to 4 g of tocopherol daily over long
periods has not produced any toxic effects in human
beings. However several reports of adverse effects
such as elevation of serum lipids, impaired blood
coagulation and reduction of serum thyroid hormones
suggest that indiscriminate ingestion of excessive
amounts over long periods should be avoided.
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Vitamin K
Vitamin K is concerned with
synthesis of coagulation factors
2,7,9,and 10 in the liver. Green leafy
vegetables, soybeans and fish are
it’s natural sources. Enough of these
vitamin is produced by intestinal
flora
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Function
Vitamin K is essential for the hepatic synthesis of
prothrombin and certain others factors involved in
blood clotting. For this reason it is sometimes called
the antihemorrhagic it also appears to have a role in
some metabolism.
Sources
Green leafy vegetables, cauliflower, broccoli and
liver all the richest dietary sources of vitamin K.
However, bacterial synthesis of vitamin K in the gut
accounts for a large proportion of a persons daily
supply initially a new born infant has a sterile gastro
intestinal tract and thus cannot synthesize significant
amounts of vitamin K for a few days since milk is low in
vitamin K the vitamin is routinely administered to new
borne.
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DEFICIENCY DISORDERS
Hemorrhagic disease of new born:- The new
born infants are deficient in vitamin K because of
minimal stores of vitamin K of birth, lack of
established intestinal flora for endogenous
synthesis and limited dietary intake since breast
milk is a poor source of vitamin K.
Biliary obstruction:- Bile is prevented from
entering the bowel due to biliary obstruction so
that this fat soluble vitamin cannot be absorbed.
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Malabsorption syndrome:- Patients suffering
from malabsorption of fat develops vitamin K
deficiency e.g. coelic disease, sprue, pancreatic
disease, hyper motility of bowel etc.
Diffuse liver disease:- Patients with diffuse liver
disease (e.g. cirrhosis, omyloidosis of liver
hepatocellular carcinoma, hepatoblastoma) have
hypoprothrombinaemia due to impaired synthesis
of prothrombin administration of vitamin K to such
patients is of no avail since liver, where
prothrombin synthesis utilizing vitamin K takes
place, is diseased.
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Deficiency of vitamin K
Deficiency of vitamin K causes defective blood
coagulation
Because of variation is the intestinal synthesis of
vitamin K no special recommendation for
allowance has been made. The food and nutrition
board has established 1-2mg of vitamin K per kg
body weight to be safe and adequate intake.
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Thiamine
Thiamine (vitamin B1), a water-soluble
vitamin, is an essential coenzyme for
metabolism of carbohydrates
02/11/14 83

sources
 It is freely distributed in animal and vegetable
products such as liver, egg, yolk, pork, legumes,
yeast, pericarp and germ of cereals, autolysis
yeast (marmite), and milk. Polishing the rice
considerably destroys its thiamine content
02/11/14 85

Clinical Features
Thiamine deficiency leads to the disease, beriberi.
It occurs usually in infants (wet beriberi) though
older infants and children may also suffer from its
chronic form (dry beriberi).
The earliest symptoms, occurring in early
infancy (especially if the mother is providing
thiamine-deficient breast milk), include
restlessness, bouts of excessive crying (as if the
infant is having an abdominal colic), vomiting,
abdominal distention, flatulence, constipation/ and
insomnia.
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Treatment/management
 As soon as the diagnosis is convincingly made,
the child must receive 10 mg of thiamine intravenously.
In the subsequent three days, he should be given 10
mg of the vitamin intramuscularly twice daily. Over the
next six weeks, 10 mg daily should be administered
orally.
The breastfeeding mother should receive thiamine
therapy simultaneously.
Prognosis is excellent provided reasonable intake of
thiamine is ensured.
Prevention
Ensuring that at least 0.4 mg of thiamine is provided in
the daily diet (thrice the quantity in case of pregnant
and lactating women) prevents beriberi.
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Riboflavin
 Riboflavin (vitamin B2), another water-soluble
vitamin, is a constituent of flavoprotein enzymes
vitally concerned with the intermediary
metabolism of carbohydrates. It is found in both
animal and vegetable foods such as liver, fish, egg,
kidney, meat, beans, yeast, green leafy vege-
tables, cereals, legumes, groundnut and milk (5
times more in cow milk than in human milk).
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Riboflavin deficiency
Clinical Features
Manifestations include angular stomatitis,
cheilosis (fissuring of lips), nasolabial
seborrhea and, occasionally magenta
(purplish-red, smooth) tongue. There may
occur corneal injection (vascularization) at the
limbus, leading; to excessive lacrimation,
photophobia, eye pain and later interstitial
keratitis.
02/11/14 91

Therapy consists in administering riboflavin, 3 to 10
mg orally or 2 mg intramuscularly daily for a few days.
This / should be followed by 10 mg orally daily for
about three weeks.
With this regimen, response is good. Complete
recovery occurs provided that adequate intake of
vitamin B2is ensured in the weeks and months ahead.
Prevention
In order to prevent riboflavin deficiency, it should be
ensured that the daily diet provides at least 0.6 mg
riboflavin per 1,000 kcal. It is advisable to administer
supplements of riboflavin (the whole B-complex may .
be still better) to the infants and children belonging to
vulnerable categories.
02/11/14 92

Nicotinic acid
Nicotinic acid (niacin) is also involved in the
carbohydrate metabolism and plays vital role
in the functioning of the skin, gastrointestinal
tract, central nervous system and hemopoietic
system.
This vitamin may be obtained either from the
natural food sources or from the tryptophan
endogenously. The natural food sources
include milk, liver, pork, cheese, yeast,
cereals, etc.
02/11/14 93

Clinical Features
The disease caused by nicotinic acid deficiency is
called pellagra. It usually occurs in children of school-
going age.
The characteristic lesions are seen over the exposed
areas of the skin, such as limbs, neck, ("Casal
necklace") and cheeks. It is worth noting that the
lesions are symmetrical, of desquamating pigmentary
dermatitis type and are aggravated by sunlight.
There is a widespread gastrointestinal inflammation,
leading to red and sore tongue, dysphagia, nausea,
vomiting and diarrhea.

Clinical Features
Just like diarrhea, dementia is encountered
much less childhood than in adults. Most
children with pellagra are, no doubt, quite
apathetic.
Anemia as also other signs of malnutrition are
usually present.

Pellagra

Treatment/management
 Nicotinamide, 50 to 300 mg daily in
divided doses orally, given for two
weeks followed by adequate supply of B-
complex vitamins in diet brings about
complete recovery.
Prevention
 The disease may be prevented by
providing a balanced diet containing 5 to
10 mg daily supply of nicotinamide.
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Pyridoxin
 Pyridoxine (vitamin B6) plays a vital role in the
metabolism of proteins and fatty acids. It is
claimed to have a role in blood formation, in
proper functioning of the nervous system and in
conversion of tryptophan into nicotinic acid.
 Its natural sources include liver, egg yolk,
meat, wheat] germ, soybeans, yeast, peas, pulses
and cereals. It ii found in only small quantity in
most vegetables am milk.
02/11/14 101

Clinical Features of deficiency of pyridoxin
 The manifestations include
convulsions and microcytic, hypo
chromic anemia refractory to iron
therapy. Growth retardation and
gastrointestinal symptoms like diarrhea
may occur. Seborrheic dermatitis around
nose and eyes, and sensory neuropathy
occur only uncommonly in children.
Cheilosis and glossitis are infrequent in
childhood.
02/11/14 103

Growth retardation
02/11/14 104

Administration of 5 mg of pyridoxine
intramuscularly followed by 0.5 mg daily orally for
two weeks causes complete recovery.
02/11/14 105

Vitamin C[ascorbic acid]
 Ascorbic acid, which structurally resembles a
monosaccharide sugar, is known to play important role
in oxidation of tyrosine and phenylalanine, in formation
of hydroxyproline, in preventing de polymerization of
collagen and in hemopoiesis.
 Deficiency of vitamin C, though quite common in
its subclinical form, has virtually disappeared in its
overt form from the affluent countries. But, its frank
cases still continue to be seen from time to time in
some parts of the developing regions.
02/11/14 106

sources
Fruits and vegetables are the only
significant sources of vitamin C.
Recommended intake
 For adults 60 mg daily. This level of
intake is expected to maintain a body
pool of 1500mg ascorbic acid.

Scurvy occurs usually in infants between the age of 6
months to 2 years. No age is a bar, however.
Infantile scurvy is characterized by gross irritability,
excessive crying and tenderness to touch, more so in
the lower limbs. The infant adopts the so-called "frog-
position”. The posture of the lower limbs gives an
impression as though these are paralyzed
 The palpable sub periosteal hemorrhage into the
lower third of the femur may contribute to pain, thus
preventing movements of the leg further and
strengthening the impression that the limb may be
paralyzed.

Hemorrhages may occur into the skin and mucous
membranes. Hemorrhages into the gums may
result in spongy, swollen, bluish purple gums,
especially about the erupted teeth. Hemorrhages
in the internal organs may cause hematuria,
melena, proptosis and subdural swellings. Mild to
moderate anemia is usual.
 Scorbutic rosarymay result from posterior
displacement of the sternum. Unlike rachitic
rosary, it is tender,-sharp and angular and has a
"step-shaped" configuration the sternum, being
depressed.

scurvy
02/11/14 111

 It consists in giving a dose of 500 mg of
vitamin C followed by a daily dose of 100 to 300
mg for several weeks. Oral administration is good
enough.

Folic Acid
functions
Folic Acid is needed for energy production,
protein metabolism, the formation of red blood
cells and it is vital for normal growth and
development
Sources
Found in beans, beef, bran, barley, brown rice,
cheese, chicken, dates, green leafy vegetables,
lamb, lentils, liver, milk, oranges, organ meats
(like liver), split peas, pork, root vegetables (like
carrots), salmon, tuna, whole grains, whole wheat
and yeast.

DEFICIENCY SYMPTOMS:
A deficiency of Folic Acid may contribute to
anemia, depression and anxiety,, and birth defects
in pregnant women, sore tongue, and fatigue.

Vitamin B12:Vitamin B12 is a very large
molecule and requires a special mechanism of
absorption. Vitamin B12 functions in all the cells
but especially those of the gastrointestinal tract
and bone marrow and the nervous system.
Sources : Found in beef, blue cheese, cheese,
clams, crab, fish, eggs, herring, kidney, liver,
mackerel, milk and milk products, pork, seafood
and tofu. It is not found in vegetables - only in
animal sources.
BODY PARTS AFFECTED:
liver, nerves, red blood cells, gastrointestinal tract.

DEFICIENCY SYMPTOMS:
Appetite loss, diminished reflex responses,
fatigue, irritability, memory impairment, mental
depression and confusion, nervousness, pernicious
anemia, unpleasant body odor, walking and
speaking difficulties, weakness in arms and legs. A
deficiency can cause problems with digestion,
absorption of food, metabolism of carbohydrates
and fats, nerves, fertility, growth and development.
There can also be hallucinations, memory loss, eye
disorders, and anemia.

About 1 mg of vitaminB12 is required to replace
the daily obligatory losses.
Vitamin B12 administered in doses 250-1000mg
intramuscularly.

TRACE ELEMENTS DEFICIENCIES
Several minerals in trace amounts are
essential for health since they form
components of enzymes and cofactors for
metabolic function besides calcium and
phosphorus required for vitamin D
manufacture, others include iron,
copper, iodine, zinc, selenium,
manganese nickel chromium,
molybdenum, fluorine
02/11/14 120

Iron
Iron is best known for being an active part of
hemoglobin in red blood cells but it is also a
constituent of the muscle protein myoglobin and of a
variety of protein that speed up chemical reactions
within the body.
 Sources
Rating foods as sources of iron requires consideration
of the bioavailability of the iron they contain in general
flesh foods are the best sources because they contain
heam iron. Some plant foods appear to be much better
source of iron than they actually are.

Zinc
Recognition of the importance of zinc as a nutrient
is steadily increasing. growth ,sexual development
, wound healing , ability to fight infections sense of
taste, night vision, healthy epithelial tissue, and
other vital functions depend upon an adequate
supply of zinc.
Sources
 Flesh foods are the most reliable sources of zinc
because they contain reasonably high amount of
zinc. Red meats especially beef are higher in zinc.
among plant foods sun flower seeds are good
sources of zinc. Whole grains ,legumes and
vegetables are richer in zinc.

Iodide
A regular supply of iodide is needed for the
production of the thyroid hormones, thyroxine and
triidothyronine. Lack of iodine results in endemic
goiter
Sources
Iodized salt

Copper
Copper participates in many metabolic reactions
that are necessary for normal development and
maintenance of the skeleton, red blood cell
production, normal skin and hair, and other
functions.
Sources
Oysters are recognized as the leading source

Chromium
 Chromium is essential for normal utilization of
glucose. Chromium is active in the body only in
the form of a complex molecule called glucose
tolerance actor. Meat, cheese, and whole grains
are also reported to be good sources.

Deficiency disorders of
trace elements
Iron:- Microcytic ,hypochronic anemia
Copper:- Muscle weakness, neurologic defect
Iodine:- Goiter and hyperthyroidism
Zinc:- Growth retardation, infertility
Selenium:- Myopathy, cardiomyopathy
02/11/14 126

GOITER
02/11/14 127

Goiter
02/11/14 128

Growth retardation
02/11/14 129

THANK YOU
02/11/14 130

02/11/14 131

02/11/14 132

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