Integument
your 98 year old patient who only consumes early grey tea and plane toast is bleeding from her gums because she is missing:
The incidence of scurvy increased from 8.2 per 100,000 in 2016 to 26.7 per 100,000 in 2020 - studies find rise to be associated with younger patients with ASD, older patients living alone / with concern for elder neglect, patients with severe depression. In kids, first complaint is usually MSK (ie nonverbal child refusing to walk) and in adults more bleeding / injury complaints or incidental finding on hospitalization
Vitamin K
Evidence shows that drops are almost as effective as the Vitamin K shot. However, unlike the Vitamin K shot, there are more chances for missed doses, or the baby spitting up the dose or not absorbing it. In the U.S., there are no FDA-approved oral Vitamin K drops for infants, so parents interested in this option can only access Vitamin K supplements that are unregulated.
Early and classical VKDB are more common, occurring in 1 in 60 to 1 in 250 newborns, although the risk is much higher for early VKDB among those infants whose mothers used certain medications during the pregnancy.
Late VKDB is rarer, occurring in 1 in 14,000 to 1 in 25,000 infants
Infants who do not receive a vitamin K shot at birth are 81 times more likely to develop late VKDB than infants who do receive a vitamin K shot at birth.
Rickets is a skeletal disorder that’s caused by a lack of vitamin D, calcium, OR _________
Phosphate!
- also called "Vitamin D resistant rickets", usually familial
Rickets is rare in the United States, used to be more common, but mostly disappeared in 1940s due to fortified foods, ie cereals with added vitamin D
This supplement is going to mess up your thyroid cascade
Biotin
only deficient in TPN, eggwhite enthusiasts
Deficiency causes dermatitis, but theres no known recommended level - why do people take biotin?
Deficiency causes macrocytic anemia; found in animal products
B12 - cofactor in DNA synthesis. Vegans at risk of deficiency, should get supplementation / fortified foods
Disorder seen in those with CKD involving bone resorption and increasing risk for fracture
Renal Osteodystrophy
Bad kidney > not secreting phos; high phos tells body to put it in bones, which lowers calcium
no calcitriol, active form of vit D
No Calcitriol > now youre bad at absorbing calcium
Lost to bones, lots to absorption, calcium low; body makes BIG PTH to try to raise it - can suck out your bone calcium.
Investigate phos binders and supplement vit D.
Deficiency associated with rash, diarrhea, dementia
B3 / niacin
found in many animal/plant products, can decrease total and low-density lipoprotein cholesterol but often causes nausea / flushing
3 foods that patients on warfarin need to be careful to consume in steady-state
Vit K rich foods
Given to many of our patients with AUD
Thiamine / B1
Does lots of cell metabolism but mostly nerve signaling
Wernicke-Korsakoff syndrome - neurologic complication of thiamine deficiency. Not seprate - just different stages of deficiency. Wernicke encephalopathy (WE) is an acute syndrome requiring emergency treatment. Korsakoff syndrome refers to a chronic neurologic condition that usually occurs as a consequence of WE. Short-term memory and confabulation
Also beriberi- peripheral neuropathy, but can cause cardiomyopathy
Bonus - dosing for patients with concern for wernickes?
Bonus - delay giving what until youve given thiamine?
Iron absorption is IMPROVED by taking with ______ and INHIBITED by taking with __________
Vitamin C and Calcium - calcium disrupts both heme and non heme iron absorption!