Water-soluble Vitamins and their Deficiencies

Water-soluble vitamins are soluble in the blood and minimally stored in the body, unlike fat-
soluble vitamins. The most clinically important water-soluble vitamins include vitamin
B1 (thiamin), vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B5 (pantothenic acid), vitamin
B6 (pyridoxine), vitamin B7 (biotin), vitamin B9 (folate), vitamin B12 (cobalamin) (the last 2
being some of the most clinically important vitamins and discussed separately), and vitamin C
(ascorbic acid). Many of these vitamins are critical components of different metabolic pathways
and play important roles in normal cell function. Most are found in our daily diet, but some
people with restrictive diets, malabsorptive conditions, or alcohol use disorder may present
clinically with vitamin deficiencies and their consequences. Since they are water-soluble and
excreted by the kidneys, most of these vitamins do not reach toxic levels.

Definition
Vitamins are important organic substances that are required for normal metabolic functions
These substances cannot be synthesized by the body; they must be ingested in the diet. The
vitamins are divided into water-soluble and fat-soluble vitamins.

• The most clinically important water-soluble vitamins are the B vitamins and vitamin C.

• Deficiencies of these vitamins can lead to clinical manifestations.

• In some cases, overuse can result in toxicity, but for most of the water-soluble vitamins,
excess is simply excreted by the kidneys.

• Intake recommendations are listed as a U.S. Recommended Dietary Allowance (RDA),

which is the average daily level of intake sufficient to meet the nutrient requirements of
nearly all (97%–98%) healthy individuals.
Vitamins Deficiency
Thiamine (B1) can result in adenosme triphosphate (ATP)
depletion and often affects highly aerobic
tissues such as the brain, nerves,and heart first

Thiamine deficiency often is part of the

presentation in patients with alcohol use
disorder secondary to malnutrition and
malabsorption, in addition to patients suffermg
from malnutrition.
Riboflavin (B2 leads to cheilosis (mflammation of lips and
fissures of the mouth) and corneal
vascularization
Niacin (B3) Deficiency is rare but can occur in alcoholics
and those with malnutrition
Pantothenic acid (B5) Deficiency 15 characterized by dermatitis,
enteritis, alopecia, and adrenal insufficiency
Pyridoxme (B6) It is critical for the formation of red blood
cells, and deficiency can result in sideroblastic
anemia, hyperuritability convulsions,
peripheral neuropathy, and mental confusion
Biotin (B7) Deficiency can lead to muscle pain heart
problems, anemia, and depression
Pantothenic acid (B5) Deficiency characterized by 15 dermatitis,
enteritis, alopecia, and adrenal insufficiency
Pyridoxme (B6) It is critical for the formaton of red blood cells,
and deficiency can result in sideroblastic
anemia, hyperirritability, convulsions,
peripheral neuropathy, and mental confusion.
Biotin (B7) Deficiency can lead to muscle pam heart
problems, anemia, and depression
Folate (B9) Deficiency can result in neural tube defects,
prompting folate supplementation during
pregnancy, and macrocytic megaloblastic
anemia Folate deficiency may also be a feature
of alcohol use disorder
Cobalamin (B12) Deficiency may lead to pernicious anemia and
subacute combined degeneration of the spinal
cord B12 deficiency will present with
neurologic symptoms
When deficiency occurs, it can result m scurvy
which can present with swollen and bleeding
gums, loss of teeth, poor wound healing, and
Vitamin C (ascorbic acid,
ascorbate) poor tissue growth