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Summary of Vitamins: Vitamin A Vitamin D Vitamin E Vitamin K
Summary of Vitamins: Vitamin A Vitamin D Vitamin E Vitamin K
Summary of Vitamins: Vitamin A Vitamin D Vitamin E Vitamin K
• stored in the body for only a brief period of time and are
then excreted by the kidneys. The one exception to this is
vitamin B12, which is stored in the liver. Water-soluble
vitamins need to be taken daily.
Vitamins
•contain no useful energy for the body
•link and regulate the sequence of metabolic reactions that
release energy within the food that are consumed.
•Vitamins cannot be made in the body and must be obtained
in our diet
•A well balanced diet provides an adequate quantity of all
vitamins regardless of age and level of physical activity.
Vitamin A (fat-soluble)
Uses: maintains the health of the epithelium and acts on the
retina's dark adaptation mechanism.
Deficiency leads to: Keratinization of the nasal and respiratory
passage epithelium, night blindness
•Sources: Dairy products, eggs, liver. Can be converted by the
body from the beta-carotene found in green vegetables,
carrots and liver.
Signs of Vitamin A Toxicity
• Gingivitis Serum vitamin A of
• Cheilosis
75 to 2000 RAE/100
ml
• Anorexia
Bone pain and
• Irritability fragility
• Fatigue Hydrocephalus and
• Hepatomegaly and vomiting (infants
abnormal liver and children)
function Dry, fissured skin
• Ascites and portal Brittle nails
hypertension
Hair loss (alopecia)
Vitamin D3 (fat-soluble) cholecalceferol
•Sources: Fish liver oils, dairy produce. Vitamin D is formed in
the skin when it is exposed to sunlight
•Uses: Has a role in the absorption of calcium, which is
essential for the maintenance of healthy bones
•Deficiency leads to: Rickets
Signs of Vitamin D Toxicity
• Excessive calcification of bones
• Kidney stones
• Metastatic calcification of soft tissue
(kidney, heart, lung, and tympanic membrane)
• Hypercalcemia
• Headache
• Weakness
• Nausea and vomiting
• Constipation
• Polyuria
• Polydipsia
Vitamin E (fat-soluble)
• Sources: Pure vegetable oils; wheatgerm,
wholewheat bread and cereals, egg yolk, nuts,
sunflower seeds
• Uses: Protects tissues against damage;
promotes normal growth and development;
helps in normal red blood cell formation
• Deficiency leads to: May cause muscular
dystrophy
Vitamin K (fat-soluble)
• Sources: Green vegetables
• Uses: Used by the liver for the formation of
prothrombin
• Deficiency leads to: Bleeding due to delayed
clotting times caused by lack of clotting
factors. Patients may show signs of bruising
easily and have nosebleeds.
Water-soluble Vitamins
Vitamin B1 (thiamin))
•Sources: Yeast, egg yolk, liver, wheatgerm, nuts, red
meat and cereals
•Uses: Carbohydrate metabolism
•Deficiency leads to: Fatigue, irritability, loss of
appetite; severe deficiency can lead to beriberi
Vitamin B2 (riboflavin) (water-soluble)
•Sources: Dairy products, liver, vegetables, eggs, cereals, fruit, yeast
•Uses: Intracellular metabolism
•Deficiency leads to: Painful tongue and fissures to the corners of the
mouth, chapped lips , CHEILITIS
•Vitamin B6 (Pyridoxine)
•PYRIDOXINE
•PYRODOXAL
•PYRODEXAMINE
Folate Deficiency
•Impaired biosynthesis of DNA and RNA
•Megaloblastic, macrocytic anemia
•Folate-responsive homocystinemia
•Neural tube defects
Carnitine
•Functions in the transport of long-chain fatty acids into mitochondria for oxidation as sources of
energy
•Meats and dairy products are good sources.
•Muscle weakness and hypoglycemia are symptoms of deficiency.
myo-Inositol
•Provides structural support in membranes
•Source of arachidonic acid and important intracellular signals and
secondary cell messengers
•Synthesized from glucose and also obtained from fruits, grains,
vegetables, nuts, legumes, and organ meats
Ubiquinones
•Referred to as coenzyme Q10 (CoQ10)
•Function as essential components of the mitochondrial electron transport
chain
•Function as a fat-soluble antioxidant
•Found in fish oils, nuts, fish, and meats
Bioflavonoids
•Have been shown to reduce capillary fragility and to potentiate the antiscorbutic
activity of ascorbic acid
•Studies show association of diets high in bioflavonoids with reduced risks for
cardiovascular disease and several cancers.
•Found in colorful foods of plant origin
Notes :
•Fat-soluble vitamins should not be consumed in excess as they are stored in the body
and excess can result in side effects
•An excess of water-soluble vitamins should not result in any side effects, as they will disperse in the body
fluids and voided in the urine
Key Vitamin & Mineral Requirements for Hospitalized
Patient
• Vitamin A – wound healing & tissue repair
• Vitamin C – Collagen synthesis & wound repair
• Vitamin B1 – Metabolism & CHO utilization
• Pyridoxine ( B6) – Protein Synthesis
• Zinc – Wound repair, immune function & CHON synthesis
• Folic acid, Fe, B12- Synthesis & turnover of erythrocytes
• Vitamin E –antioxidant
6. FLUORIDE
1. IRON
2. ZINC 7. MOLYBDENUM
3. COPPER 8. COBALT
4. IODINE
9. SELENIUM
5. MANGANESE
10. CHROMIUM
MINERALS
Large class of ESSENTIAL MICRONUTRIENTS
TOXICITY
Liver disease
Arrhythmias
ZINC
•Important in function of many enzymes
•Wound healing
DEFICIENCY
Infertility
Failureof wounds and ulcers to heal
Poor growth
Alopecia (hair loss)
Diarrhea
Excessive body odor
TOXICITY
Nausea and vomiting
Abdominal pain
COPPER
Enzyme cofactor in iron metabolism, melanin synthesis, electron transport
DEFICIENCY
White hair, Gray hair, Brittle hair, Varicose veins
Ptosis, Reduced glucose tolerance
Menke’s Kinky hair syndrome
DEFICIENCY= GOITER
GRAVE’S DISEASE
Symptoms:
◦ Insomnia
◦ Heat intolerance
◦ Excessive sweating
◦ Exopthalmos
◦ Rapid pulse
◦ Irritability
MANGANESE
•it activates numerous enzyme systems including
those involved with glucose metabolism, energy
production
•Responsible for the development of fragile ear bones
and joint cartilage
DEFICIENCY
Muscular weakness
mental apathy
Cardiac failure
CHROMIUM SELENIUM
•Works with insulin for •Involved in fat metabolism
proper glucose metabolism •Cooperates with vitamin E
•Acts as an antioxidant
DEFICIENCY
Low blood sugar
DEFICIENCY
Age spots
Diabetes
Muscular weakness
Hyperinsulemnia
Infertility
Hyperactivity
Cancer
Infertility and
Irregular heart beat
decreased sperm count
MACROMINERALS
1.CALCIUM
2.PHOSPHORUS
3.MAGNESIUM
4. SULFUR
CALCIUM
•Helps build strong bones and teeth
•Involved in muscle contractions and nerve function
•CALCIUM DEFICIENCY>>OSTEOMALACIA
DEFICIENCY>>
CALCIUM TOXICITY
Muscle and abdominal pain
Calcium kidney stones
• PHOSPHORUS
• Works with calcium to build and maintain bones and teeth
• Helps convert food to energy
• Regulates blood pH
Phosphorus Deficiency
Aggravates osteoporosis, arthritis, high blood
pressure, loose teeth, etc.
loss of appetite
Weakness
Pain
Phosphorus Toxicity
Lowers blood calcium which may lead to tetany and
convulsions
MAGNESIUM
•production and transfer of energy for protein synthesis
• for contractility of muscle and excitability of nerves
• cofactor in myriads of enzyme systems
DEFICIENCY
-Asthma, Anorexia, Menstrual migraines, Growth
failure
- ECG changes, Neuromuscular problems,
Tetany (Convulsions)
TOXICITY
Inhibited bone calcification
Low blood pressure
Drowsiness
Nausea
Slurred speech
Unsteadiness
SULFUR
•Attached to proteins to maintain:
1. Hemoglobin
2. Hormones (Insulin, adrenal cortical hormones)
3. Enzymes
4. Antibodies
DEFICIENCY
degenerative types of arthritis involving degeneration of cartilage,
ligaments, tendons
Systemic Lupus Erythematosis
Cations
Potassium (K+)
Sodium (Na+
Calcium (Ca+)
Magnesium (Mg+)
Anions
Chloride (Cl )
Bicarbonate (HCO3 )
Phosphate (PO4 )
Sulfate (SO4 )
3 Types of FLUID CONCENTRATION
1.Iso-osmolar – same proportion of particles
2.Hypo- osmolar – fewer particles than water
3.Hyperosmolar – more particles than water
TONICITY
Measurement of the concentration of intravenous (IV)
solutions
Tonicity: range 240 to 340 mOsm/L
FLUID REPLACEMENT
Intravenous Solutions
Indication: Body Fluid loss
spaces
Isotonic solutions – management for fluid volume loss.
(240-340 mOsm/kg)
Examples:
• normal saline or 0.9% sodium chloride
(NaCl)
• 5% in water (D5W)
• Lactated Ringer’s (D5LR)
• Ringer’s solutions
• PNSS
Intravenous Solutions
Hypotonic solutions – less than 240 mOsm
Indication: treatment for cellular dehydration
Examples: 0.45% NaCl (half-normal saline),
Solution less than 9%, 45% D5W
Hypertonic
• Treatment of water intoxication
• D5 ½ NS, D10W, 3% NS
• Shifts fluids from ICF & ECF to intravascular
component – expands blood volume
Fluid Replacement
• Intravenous solutions
– Tonicity: range 240 to 340 mOsm/L
– Hypotonic: <240 mOsm/L
– Isotonic: 240 to 340 mOsm/L
– Hypertonic: >340 mOsm/L
4 Classifications of IV Solutions
1.Crystalloids
2.Colloids
3.Blood and blood products
4.Lipids
4 Classifications of IV Solutions
1.Crystalloids – replacement & maintenance fluid
therapy
•Ex : Dextrose, saline, and lactated
Ringer’s solution
•Dextrose5 in water (D5W)
– 250 mOsm/L
– Isotonic (unless used continuously)
•Normal saline solution (0.9% NSS)
– 310 mOsm/L
– Isotonic solution
•D5/0.45% NSS
– 405 mOsm/L
– Hypertonic solution
•D10W
– 500 mOsm/L
– Hypertonic solution
IV SOLUTIONS
•Intravenous Fluid: D5LR Solution
•5% Dextrose in Lactated Ringer's
•Formulation:
•Each 100ml contains 5g of Dextrose Monohydrate,
600mg of Sodium Chloride, 310mg of Sodium Lactate
Anhydrous, 30mg of Potassium Chloride, and 20mg of
Calcium Chloride Dihydrate.
•Electrolytes in 1L:
•Sodium............................130mmol
•Potassium........................4mmol
•Calcium...........................1.4mmol
•Chloride...........................109mmol
•Lactate.............................28mmol
Osmolarity: 525 mOsm/L
pH: 4.0 to 6.5
Type: Hypertonic
Availability: 1000ml and 500ml
Indication: Dehydration, burns, lower GI fluid
loss, acute blood loss, hypovolemia due to
blood loss and replacement of fluid and
electrolytes.
Caution: Contains potassium, do not use with
renal failure patients. Do not use with liver
disease patients, cannot metabolize lactate.
2. Colloids – volume expanders
•Volume expanders
– Dextran solutions
– Amino acids
– Hetastarch
– Plasmanate
•Lipids
– Fat emulsion solution
3. Blood and Blood products
Assessment
• Signs & symptoms of hypokalemia-nausea, vomiting, ileus, cardiac
dysarrythmia & flabby muscles / hyperkalemia – oliguria, abdominal
cramps,weakness & numbness of extremities
• Potassium level = 3.5 -5.3 meq / L
Pharmacodynamics:
•Maintains neuromuscular activity
•Onset of action: within 30 mins (IV)
•Serum K+ is closely monitored
HYPERKALEMIA
Serum K+ level: >5.3 mEq/L
-Due to renal insufficiency or administration of large
doses of K+
Management: Sodium Bicarb, Calcium Gluconate, or
insulin & glucose
(immediately decrease K+)
Management:
Normal saline – has increased Sodium content.
Hypertonic 3% saline
HYPERNATREMIA
Serum Na+: above 145 mEq/L
Nursing Intervention:
SODIUM Restriction is indicated.
CALCIUM
Found equally proportions in the ICF and ECF.
Normal value: 4.5 to 5.5 mEq/dl
Binds with protein