Fat soluble vitamins

2. HISTORY
The term vitamin
was coined by
Kazimierz funk in 1913.
The word vitamin is
derived from Greek
word meaning vital for
life.

3. DEFINITION
Vitamins are regarded as
organic compounds required in diet
in small amounts to perform specific
biological functions for normal
maintenance of optimum growth &
health.

4. CLASSIFICATION
FAT SOLUBLE
 Vitamin A
 Vitamin D
 Vitamin E
 Vitamin K
WATER SOLUBLE
 B Complex vitamins
 Vitamin C

5. RETINOL

6. DAILY REQUIREMENTS
INFANT : 300-400µg
CHILDREN : 400-600µg
ADOLESCENTS : 750µg
ADULT : 750µg

7. > Six parts of carotene is
equivalent to one part of vitamin A.
> Vitamin a is stable below
100 ̊̊c .
> Vitamin a is stored in liver
as retinyl esters & these stores
can last upto 6-9 months.

10. CAUSES OF DEFICIENCY
PRIMARY CAUSES SECONDARY CAUSES
 Prolonged dietary
deficiency
 Chronic alcoholics
 Toddlers
 Pre school children
 Refugees
 Duodenal bypass
 Chronic diarrhoea
 Bile duct
obstruction
 Cirrhosis of liver

11. EFFECTS OF DEFICIENCY
 Fatigue
 Dryness of skin
 Night blindness
 Bitot spot
 Xeropthalmia
 Keratomalacia
 Iris prolapse

14. INVESTIGATIONS:
 Serum retinol level [low]
 Serum retinyl esters [low]
 Ophthalmoscopy
xerophthalmia

15. MANAGEMENT
 Infants <6 months : 50,000IU / orally
 Infants 6-12 months : 1,00,000IU / orally
[Once in 4-6 months]
 Children>12 months :2,00,000 IU / orally
[once in 4-6 months]
 Mothers : 2,00,000 IU orally
[within 8 weeks of delivery]

16. HYPERVITAMINOSIS OF VITAMIN A
CAUSES
 Self medication
 Long term consumption of fish liver
ACUTE TOXICITY
 Abdominal pain
 Nausea & vomiting
 Head ache
 Desquamation of skin

17.  Hypercarotenemia
occurs due to intake of carotene
rich substance such as
carrot.
 Hypercarotenemia
doesn’t lead to hypervitaminosis A.

18. CHRONIC TOXICITY
Seen in people who take 40,000 units
of vitamin a daily for a prolonged period.
The symptoms include ,
 Body ache
 Arthralgia
 Hair loss
 Anorexia
 Hepatomegaly

19. CHOLECALCIFEROL

20. DAILY REQUIREMENTS:
 Infants & children : 400 IU
 Age 19-50 years : 200 IU
 Age 51-70 years : 400 IU
 Above 71 years : 600 IU

22. Exposure to sun light for 20-30
minutes daily ensures adequate supply of
vitamin d [exposure to sun light doesn’t
cause hypervitaminosis]
Burns, scars, clothes, pigmentation &
sunscreen hinder vitamin d synthesis.
Dark skin produces vitamin d less
efficiently than fair skin.

28. G
E
N
U
V
A
R
U
M

30. INVESTIGATIONS:
 Serum calcium levels [low]
 Serum phosphate level [low]
 Serum alkaline phosphatase [high]
 X – ray of wrist / knee joints

31. Oral bolus dose of vitamin d [stoss
therapy]
 60,000 IU weekly once for 4-6 weeks.
 1000-2000 IU of vitamin D along with
500-1000 mg of calcium to correct
rickets & osteomalacia.
 40,000 IU / IM injection once in 2
weeks [4 injections required]
MANAGEMENT

32. CAUSES
• Self medication
• Prolonged administration
of large dose of vitaminD.
HYPERVITAMINOSIS OF
VITAMIN D

33. SYMPTOMS
 Nausea
 Vomiting
 Drowsiness
 Constipation
 Signs of renal impairment

34. TOCOPHEROL

35. Daily requirements:
 Infants : 0.4 mg / kg body weight
 Pre mature infants : 15-20µg
 Adults men : 10mg
Women : 5mg

39. EFFECTS OF DEFICIENCY
 Muscle weakness
 Ptosis
 Dysarthria
 Visual scotoma
 Opthalmoplegia
 Loss of deep tendon reflex
 Hemolytic anemia

40. PTOSIS
VISUAL
SCOTOMA

41. INVESTIGATIONS
 Blood routine : HB, TC ,DC , ESR,
peripheral smear
 Serum tocopherol : cholesterol ratio
 Serum electrolytes
MANAGEMENT
15-20 mg / kg / day orally

42. SYMPTOMS [Seen in persons
ingesting 800-1200mg / day]
 Muscle weakness
 Fatigue
 Nausea
 Diarrhoea
HYPERVITAMINOSIS OF
VITAMIN E

43. PHYLLOQUINONE

44. DAILY
REQUIREMENTS:
 Infants : 3-5 µg
 >2 years : 10 µg
 Adolescent : 10-30 µg
 Adult : 80 µg

50. CAUSES FOR DEFICIENCY
Chronic antibiotics
Malabsorption syndrome
Biliary obstruction
Cystic fibrosis
Celiac disease

51. EFFECTS OF DEFICIENCY
 Easy bruising of skin
 Nose bleed
 Bleeding gums
 Hematuria
 Heavy menstrual flow

52. NOSE BLEED
SKIN BRUISE
GUM BLEED

53. INVESTIGATIONS
Prothrombin time
Partial thromboplastin time
Platelet counts
Management
10 mg intramuscular for 3-5
days

54. SYMPTOMS
 Nausea
 Diarrhoea
 Dizziness
 Stomach cramp
 Fatigue
 Head ache
HYPERVITAMINOSIS OF VITAMIN K

55. PROPERTIES FAT SOLUBLE
VITAMINS
WATER SOLUBLE
VITAMINS
SOLUBILITY FAT SOLUBLE WATER SOLUBLE
ABSORPTION ALONG WITH LIPIDS SMALL INTESTINE
STORAGE LIVER NO STORAGE
EXCRETION NO EXCRETION EXCRETED
EXCESS INTAKE TOXIC NON TOXIC
DEFICIENCY SLOW
MANIFESTATION
RAPID
MANIFESTATION
TREATMENT SINGLE LARGE DOSE DIETRY
SUPPLEMENT
DIFFERENCE B/W FAT & WATER SOLUBLE VITAMINS

56. VITAMINS DAILY
REQUIREMENT
SOURCES EFFECTS OF
DEFICIENCY
HYPER
VITAMINOSIS
INVESTIGATION MANAGEMENT
A
RETINOL
750µg/day CARROT
PAPAYA
FISH
BROCOLI
NIGHT
BLINDNESS
XEROSIS
BITOT
SPOT
ABDOMINAL
PAIN
NAUSEA
VOMITING
ARTHRALGIA
HAIRLOSS
SERUM
RETINOL
LEVEL
OPTHALMO
-SCOPY
200000IU
ORALLY
D
CHOLE
CALCIFEROL
200 IU/day
SUN LIGHT
BUTTER
MILK
CEREALS
RICKETS
OSTEO
-MALACIA
FATIGUE
NAUSEA
DROWSINESS
CONSTIPATI
ON
SERUM
CALCIUM
LEVEL
X RAY OF
WRIST /
KNEE
500-1000mg
OF
CALCIUM
40,000 IU
ORALLY
SUMMARY

57. VITAMINS DAILY
REQUIREMENT
SOURCES EFFECTS OF
DEFICIENCY
HYPER
VITAMINOSIS
INVESTIGATION MANAGEMENT
E
TOCOPHEROL 10mg/day
Olives
Almonds
Apricot
Pine
nuts
Spinach
Muscle
weakness
Sterility
Ptosis
Dysarthria
Hemolytic
Anemia
Dehydra
Tion
Muscle
Weakness
Fatigue
Nausea
Diarrhoea
Blood
routine
Serum
electro
Lytes
15-20 mg
/ kg / bw/
day
K
PHYLLO
QUINONE
80mg/day
Avacado
Green
Apple
Cabbage
Beans
Easy
bruising
of skin
Nose
bleed
Gum
Bleed
Nausea
Diarrhoea
Dizziness
Cramps
Fatigue
Headache
Prothrombin
Time
Partial
thrombo
Plastin
time
Platelet
counts
10mg im
for
3-5 days
CONTD…

58. References…
1.Text book of medicine by
K.V.Krishnadas 6th edition volume 1 [page.no167]
2. R.Allagappan Manual of clinical 6th edition [page.no 56]
3. Ghai Essential paediatrics 9th edition [page.no. 109]
4.Bio chemistry by U.Chakrapani 4th edition [page.no.116]
5.Davidson’s principles & practice of medicine 23rd edition
[page.no.712]

59. VITAMIN-A