USMLE Vitamins

The B Vitamins-all water soluble except folate and B12

B1: Thiamine: A cofactor for dehydrogenase enzymes. Mainly pyruvate dehydrogenase, alpha keto
glutamate dehydrogenase,transketolase
-If there is a defiency of thiamine then there is a defiency of a lot of enzymes
-Common in alcoholics
-Dry Berri Berri: PNS Periheral neuropathies, difficulty walking, confused, myalgia, nystagmus
-Wet Berri Berri: Cardiac findings: peripheral edema, tachycardia, dyspnea on exertion
-Wernickes encephalopathies can develop if too long. Can progress into Korsckoffs Snyndrome
-Wenickes Encepahloophies can cause receptive aphasia: Cannot proess anything coming to you. Cannot
understanding anything written or spoken language. Different than Brocas. This occurs suddenly.
Findings: Nystagmus, ataxia, short term memory loss, confusions
-Can progress into Korscoff syndrome damage to medical thalamus and mammillary bodies, also general
atrophy of the cerebral cortex.
-6 main findings in Korscoff Syndrome (HAVE TO KNOW THESE 6 MAIN FINDINGS) 1. Anterograde
amnesia (trouble forming new memories) 2. Retrograde amnesia (have trouble recalling prior memories)
3. Meagerconve conteat. 4. Confabulation: fill in gaps with made up stories often make no sense 5.
Apathy: lose interest 6.lack of insight: everthing is superficial
-All due with emotion /memory because limbic system is affected
Vitamin B2 Riboflavin: Cofactor for FAD. Component of complex 2 in the electron transport chain, also
TCA succinate dehydrogenase. SuccinateFumerate enzyme. Impt in metabolism of ketones, fats,
proteins, and carbs. Constantly excreted in the urine. Poor diets can be deficient. Also in chronic
alcoholics this is low.
-Angular Chelitis: Lesions on the corner of the mouth, inflammation of other mucous membranes-lips,
mouth, and the tongue.
-Dry Skin
-Photosensitivity
VITAMIN B3: Niacin (think management of dyslipidemia)
-Part of NAD, NADH, NADP, NADPH
-Also required in dehydrogenase rxn pyruvate, alpha keto gluterate, and BCAA dehydrogenase
-Can manage a patient with dyslipedmia.
-Can improve HDL by 25-30% better than any other modality out there
-Can increase hepatic triglycerides.
-Can lower VLDL
- SIDE EFFECTS are common including flushing of the skingive aspirin 30 mins before the dose of
niacin.
-Use a time released drug
-High doses of niacin are hepato-toxic do not use on patient with liver disease
-Can also exacerbate diabetes sx in diabetics
-Minor deficiencies are seen as decreased ability to concentrate, patients will be fatigued, restless,
anxious, irritable, apathy, and may be depressed.
-Severe deficiency is pellagra: 4Ds Diarrhea, dementia, dermatitis, and death. (hyperpigmentation,
necklace lesions-around the neck, oral inflammation, amnesia, deliriumdeath)
-Hartnups disease: body cannot breakdown tryptophan. Try is a precursor to niacin. Main finding amino
acid uria restrict to the neutral amino acids.
-Give patient a high protein diet, and supplement with nicotinic acid

Vitmain B4: Lipoic Acid (alpha-lipoic acid)

-Pyruvate dehydroenade , ADH complex, Alpha Keto gluteratepresent in may different complexes.
-Certain benefits with lipoic acids including benefits to patients with cardiovascular disease, accelerate
wound healing, organ dysfunctions, reduces endothelial dysfunctions, treatment for patients with
metabolic syndrome, slows the progression of Alzeheimers disease, can help with erectile dysfunction,
also may help with MS, useful with patients with P.V.D, can overall reduce inflammation.
Vitamin B5: Panthonic Acid
-Active CoA
-KrebsCoA
-Very rare to see the def.
-Unless in very malnurioused patient
-Paresthesia and dysesthesia = Burning feel syndrome
-Also GI distress
Vitamin B6: Pyrdoxine
-Required for every transaminase AsT/Alt/Ggt
-Gets depleted by Isoniazid or INH. Deficiencies complain about neuropathies (peripheral)
-Makes serotonin, dopamine, ne, e
-genetic condition called Pyridoxine dependent epilepsy caused by a mutation in the ALDPPH leds to
epilepsy
-B9: Folate or Folic Acid
-First vitamin to become deficient when cells are rapidly dividing such as in cancer, pregnancy
-Many cancers block folate production, same with sulfa drugs (folate antagonists)
-Folate will convert into one carbon donors to produce DNA, RNA, etc
-Folic Acid One carbon donor
-Folic Acid DHF THF (donates one carbon molecules)
-Enzyme: DHF reductase
B12
-neurological findings not like folate
-megloblastic anemia
-subacute combined degeneration
-schilling test
The Fat Soluble Vitamins Video