IMPORTANT POINTS

1. VITAMINS AND
DEFICIENCY
DISEASES
AISWARYA THOMAS
2nd year Pharm D
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2. INTRODUCTION
 Vitamins are organic compounds required in
the diet in small quantities to perform
biological functions.
 We obtain them from :
foods we eat or via vitamin supplements.
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3. HISTORY OF VITAMINS
 In 1749 the prevention of scurvy by citrus
foods was first discovered by Scottish
surgeon James Lind.
 In Orient: Beriberi was common due to
polished white rice.
 In 1913 Funk coined the term “VITAMINE”.
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4. VITAMINS
 According to solubility vitamins are of:
Fat-soluble &
Water-soluble
 Thirteen vitamins are known of which:
Four are fat-soluble : Vitamins A , D , E ,K
Nine are water- soluble.
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5. Distinction between fat-soluble and
water-soluble vitamins.
 Fat soluble vitamins are readily stored in
the body.
 Not readily excreted in urine.
 Excess consumption can lead to their
accumulation and toxic effects.
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6. VITAMIN SUPPLEMENTS
 Synthetic or natural substances which can be
purchased as pills, capsules, powders or
liquids.
 Best when accompanied by a well balanced
diet.
 Do not replace a healthy diet.
 Do not provide calories or energy.
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7. RECOMMENDED DIETARY
ALLOWANCES (RDA)
 These are suggested levels of essential
nutrients considered adequate to meet
nutritional needs of healthy individuals.
 Requirements are influenced by physical
characteristics , dietary habits, sex,
pregnancy, lactation and age.
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8. MULTIVITAMIN SUPPLEMENT
 A multivitamin should contain fat-soluble
vitamins A,D,E ; water-soluble vitamins
B1,B2,B6,B12 , niacin, biotin , folic acid ,
pantothenic acid and vitamin C.
Contains minerals :zinc, magnesium,
copper, and calcium.
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9. VITAMINS
Fat-soluble Water-soluble
Vitamin A Non B- Complex B-Complex
Vitamin D Vitamin C Thiamine (B1)
Vitamin E Riboflavin(B2)
Vitamin K Niacin (B3)
Pantothenic acid(B5)
Pyridoxine(B6)
Biotin(B7)
Folic acid (B9)
Vitamin B12
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10. FAT-SOLUBLE
VITAMINS
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11. VITAMIN- A
 It is the name given to a group of related
compounds :
Retinol (vitamin A alcohol)
Retinal ( vitamin A aldehyde)
Retinoic acid ( vitamin A acid)
 Its provitamin carotenes are found in
plants.
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12. SOURCES:
 Fish oil , liver, egg yolk, milk, cheese , butter.
 Vegetable sources contains provitamin A
carotenes.
 Yellow and dark vegetables and fruits are
sources of carotenes.
Carrots
mango
papaya
spinach.
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13. FUNCTIONS OF VITAMIN A
 Maintenance of normal vision.
 Maintenance of normal cartilaginous and
bone growth.
 Increased immunity against infections in
children.
 Anti-proliferative effect.
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14. VITAMIN- A DEFICIENCY
 May be due to :
inadequate dietary intake
impaired intestinal absorption
Chronic alcoholism.
 Impaired vision – Night blindness.
 Extremely dry skin ,hair or nails.
 Epithelial metaplasia and keratinization.
 Xerophthalmia ( dry eye ).
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15. WHO IS AT RISK ?
 Young children's.
 Children with inadequate health care.
 Adults with diseases of :
pancreas
liver
intestine
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16. Too Much Can Be Toxic !!
 Hypervitaminous A leads to toxic
symptoms:
Dry , itchy skin
Hair loss
Liver damage
Skin coloration
Loss of appetite
Head ache and fatigue
Blurred vision.
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17. SIDE EFFECTS OF VITAMIN A
 Severe birth defects.
women of child bearing age should
not consume more than 8000 IU per day.
 Skin can take on yellow or orange glow.
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18. VITAMIN D
SUNSHINE VITAMIN.
 CALCITRIOL.
 Exists in two activated sterol forms:
Vitamin D2 - CALCIFEROL
Vitamin D3 - CHOLECALIFEROL.
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19. SOURCES:
 Sunlight.
 Milk.
 Fish.
 Orange juice .
 Fortified cereals.
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20. FUNCTIONS OF VITAMIN D
 Maintenance of adequate plasma levels of
calcium and phosphorous.
 Metabolic functions.
 Bone mineralization.
 Neuromuscular transmission.
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21. VITAMIN -D DEFICIENCY
 May be due to:
Limited exposure to sunlight
Diet deficiency.
Renal disorders.
 Rickets.
 Osteomalacia ( in adults).
 Hypocalcaemictetanydue to neuromuscular
dysfunction.
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22. 22

23. CAUSES
 Increased risk of:
Cancers
Autoimmune diseases
Hypertension
WHO IS AT RISK ?
Covered and protected skin
Elderly
breast – fed infants
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24. Too Much Vitamin D !!!
 High dose can cause accumulation in the
liver.
 Produces symptoms of poisoning.
 Signs of toxicity include:
excess calcium in the blood.
nausea
vomiting
decreased appetite.
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25. VITAMIN E
 Vitamin E describes a family of eight
antioxidants:
four tocopherols
four tocotrienols.
 It is an antioxidant in cells.
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26. SOURCES
 Vegetables:
spinach
carrot
 Egg
Bread
Almonds
Peanuts.
 vegetable oils
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27. FUNCTIONS OF VITAMIN- E
 Antioxidant.
 Inhibits platelets aggregation.
 Enhances vasodilation.
 Scavenger of free radicals.
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28. VITAMIN -E DEFICIENCY
 Increased risk of cardiovascular diseases.
 Hemolytic anaemia in children.
 Neurological symptoms (impaired
coordination and muscle relaxation).
 RISK FACTOR : fat malabsorption
syndrome.
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29. THERAPEUTIC USES
 DIABETES MELLITUS.
 CANCER PREVENTION.
 PREVENTION OF CARDIOVASCULAR
DISEASES.
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30. TOXICITY
 Excess vitamin E causes :
Impaired blood clotting leading to risk
of bleeding in some persons.
 Recommended that vitamin E supplements
to be stopped one month before surgery.
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31. VITAMIN K
 K derived from the German word
KOAGULATION
 Two naturally occuring forms :
Plants synthesize phylloquinone –Vitamin K1
Bacteria synthesize menaquinone-3 –Vitamin K2
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32. SOURCES
 Vegetable oils
 Almonds
 Peanuts
 Spinach
 Body can produce its own(from bacteria in
intestine).
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33. FUNCTIONS OF VITAMIN -K
 Helps in clotting .
 Assist in bone mineralization.
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34. VITAMIN K DEFICIENCY
 It is common in adults.
 Biliary obstruction .
 Due to antibiotic therapy.
 Due to malabsorption syndrome.
 Hemmorhage.
 Deficiency may appear in infants or in
people.
 Who take anticoagulants such as Warfarin.
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35. WATER-SOLUBLE
VITAMINS
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36. VITAMIN C
 Exist as L- ascorbic acid.
 Smokers and lactating mother needs higher
range.
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37. SOURCES
 Fruits
 Vegetables
 Tomato juice
 Sweet potato
 Citrus fruit
 Orange juice.
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38. FUNCTIONS OF VITAMIN C
 Collagen synthesis.
 Body to fight against infections.
 Keep gum’s healthy.
 Aids in the prevention of heart disease and
cancer.
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39. VITAMIN C DEFICIENCY
 Leads to scurvy.
 Weight loss.
 Slow healing of wound and fractured bone.
 Fatigue and joint pain.
 Skin rash .
 Anaemia.
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40. THERAPEUTIC USES
 Cardiovascular diseases.
 Cataracts.
 Diabetes mellitus.
 Cancer prevention.
 Common cold.
 Lead toxicity.
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41. VITAMIN B
 Group of seven water-soluble vitamins :
Thiamine
Riboflavin
Niacin
Pyridoxine
Cobalamin
Biotin
Pantothenic acid
Folic acid
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42.  Biotin and pantothenic acid deficiencies are
rare.
 As it is found in numerous foods.
 Biotin deficiency may occur with prolonged
antibiotic therapy.
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43. VITAMIN B1-THIAMINE
SOURCES
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 Yeasts
 Cereals
 liver

44. FUNCTIONS OF THIAMINE
 ATP production.
 Stabilizing the appetite.
 Proper nerve function.
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45. VITAMIN -B1 DEFICIENCY
 BERI-BERI.
 WERNICKE –KORSAKOFF SYNDROME.
RISK OFTHIAMIN DEFICIENCY
 Excessive loss: hemodialysis and diuretics.
 Low intake and alcoholism.
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46. THERAPEUTIC USE
 CONGESTIVE HEART FAILURE.
 CANCER PREVENTION.
 ALZHEIMER’S DISEASE.
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47. VITAMIN B2-RIBOFLAVIN
 Also calledYELLOW RESPIRATORY
ENZYME.
 Cytochrome oxidase enzyme.
 Rapidly absorbed from the bowel and
stored in tissues.
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48. SOURCES
 Eggs.
 Meat.
 Leafy green vegetables.
 Milk
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49. FUNCTIONS OF RIBOFLAVIN
 Energy production.
 Cell respiration.
 Maintenance of good vision ,skin ,nails.
 Carbohydrate ,fat and protein metabolism.
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50. RIBOFLAVIN DEFICIENCY
 Itching and burning eyes.
 Oily skin.
 Dermatitis.
 Digestive disturbances.
 Cracks and sores in mouth and lips.
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51. WHO’S AT RISK ?
 Alcoholics
 People with cataracts.
 People with sickle-cell anemia.
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52. VITAMIN B3 - NIACIN
 Includes biologically active derivative:
NICOTINAMIDE
 Essential for the formation of two oxidative
coenzymes ( dehydrogenases ).
NAD ( Nicotinamide adenine
dinucleotide )
NADP.
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53. SOURCES
 Liver
 Kidney
 Meat
 Green vegetables
 Grain cereals.
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54. FUNCTIONS OF NIACIN
 Energy production.
 Improves circulation.
 Maintenance of skin and tongue.
 Maintenance of nervous system.
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55. VITAMIN B3 DEFICIENCY
 Pellagra – rare in Western societies.
 Nervousness .
 irritability
 Fatigue .
 Head ache.
 Insomnia.
 Mental depression.
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56. VITAMIN B5-PANTOTHENIC ACID
FUNCTIONS
 Produces energy.
SOURCES
Fruits ,meats, poultry ,legumes .
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57. VITAMIN B6-PYRIDOXINE
Related to two naturally occuring
substance:
pyridoxine , pyridoxal , pyridoxamine.
SOURCES
Meat
Eggs
Green vegetables
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58. FUNCTIONS OF VITAMIN B6
 Production of red blood cells.
 Nervous system function.
 Immunity.
 Reducing muscle spasm , cramps and
numbness.
 Maintaining proper balance of sodium and
phosphorous.
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59. DEFICIENCY OF VITAMIN B6
 Nervousness , Insomnia
 Skin lesions
 Loss of muscle control, muscle weakness.
 Arm and leg cramps.
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60. VITAMIN B7 - BIOTIN
SOURCES
 Meat
 Egg yolk
 Soya beans
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61. FUNCTIONS OF VITAMIN B7
 Produce energy.
 Helps produce body chemicals (insulin).
 In gene expression.
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62. VITAMIN-B7 DEFICIENCY
 Nausea.
 Anorexia.
 Mental and neurological symptoms :
Hallucination
Depression
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63. VITAMIN B9-FOLIC ACID
SOURCES
 Yeasts
 leafy vegetables
FUNCTION
Synthesis of nucleic acids
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64. FOLIC ACID DEFICIENCY
 Neural tube defects.
 Anaemia.
THERAPEUTIC USE:
Chronic hemolytic anaemia.
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65. VITAMIN B12- COBALAMIN
FUNCTIONS
 Proper nerve function.
 Production of red blood cells.
 DNA reproduction.
 Prevention of anaemia.
 Metabolizing fats and proteins.
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66. VITAMIN- B12 DEFICIENCY
 Anemia nerve damage hypersensitive skin.
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67. WHO’S AT RISK ?
 Pernicious anemia.
B12 injection often taken regularly.
 HIV
 Chronic fatigue syndrome.
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68. ROLE OF PHARMACIST IN
VITAMIN DEFICIENCY
DISORDES
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69.  Pharmacist by counselling patients provides
safe consumption of vitamins.
 Counselling on vitamin supplements is a
part of their role in pharmaceutical care.
 Provides responses to specific knowledge
questions such as:
Interaction of vitamins with drugs or
the recommended dietary allowance of
vitamins for infants , children , pregnant
women.
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70.  Provides consequences of vitamin
consumption.
 Informs the patients that:
beat ways to meet nutrient needs is by
consuming appropriate foods .
 Vitamins supplementation is only
suggested for:
individuals with chronic diarrhoea.
Pregnant and breast-feeding women.
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71.  Food allergies.
 Food intolerance.
 Surgical removal
 Too much calcium leads to kidney stones.
 Excess vitamin D can damage heart.
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72. REFERENCE
TEXTBOOK OF PATHOPHYSIOLOGY
- HARSH MOHAN.
TEXTBOOK OF BIOCHEMISTRY
- U. SATYANARAYANA.
aggie-horiculture.tamu.edu
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73. THANK YOU
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