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VITAMIN DEFICIENCY DISORDERS Similima

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					 VITAMIN
DEFICIENCY
DISORDERS

   www.similima.com   1
Vitamins are divided into two groups.

     Fat soluble vitamins- A, D, E & K

     Water soluble vitamins – B & C




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         Vitamin A ( Retinol )

 pre vitamins – Retinol, Retinal

provitamins - Beta-carotene and other
                           carotenoids.



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               FUNCTIONS
 Indispensable for normal vision.

 Regulation of gene expression

 Regulation of gene expression

 Growth and devolepment

 Red Blood Cell Production
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                 SOURCES

a) Animal foods: Liver, eggs, butter,
    cheese, whole milk, fish and meat.
.
b) Plant foods: Green vegetables
     ( spinach & maranth)
     Yellow and orange vegetables.

c) Fortified foods : Foods fortified with vit A.
                 ( Vanaspati, margarine, milk)
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Life Stage    Age                    Males:       Females:
                                    mcg/day      mcg/day (IU/
                                    (IU/day)        day) 
Infants       0-12             500 (1667 IU)    500 (1667IU)
                months 
Children      1-13 years       600 (1000 IU)   600 (1000 IU)
Adolescents 14-18             900 (3000 IU)    700 (2333 IU)
              years 
Adults        19 years        900 (3000 IU)    700 (2333 IU)
                and
                older 
Pregnancy     19-years                   -     770 (2567 IU)
                and older
Breastfeedi   18 years                   -     1,200 (4000 IU)
  ng            and
                younger 
Breastfeedi   19-years                   -     1,300 (4333 IU)
  ng            and
                older     www.similima.com                6
                Deficiency Disorders
1) Ocular manifestations
   Night blindness
  Conjunctival xerosis
  Bitot’s spots
  Corneal xerosis
  Keratomalacia
2) Extra ocular manifestations
•   - follicular hyperkeratosis
•   - anorexia
•   - growth retardation
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                  MANAGEMENT
• 110 mg retinol palmitate orally on two
                                  successive days

   HOMOEOPATHIC MANAGEMENT
 Kent’s 3 mark medicines are: CHIN., LYC.
 Kent’s 2 mark medicines are: Hyos., Nitr. ac.,
                               Ran. Bulb.
 Rare medicines : Cadm. s., Meph., Petros,
                 Physost
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            VITAMIN B COMPLEX
THIAMIN
      Thiamin monophosphate (TMP),
      Thiamin triphosphate (TTP)
      Thiamin pyrophosphate (TPP).
FUNCTIONS
• As Coenzymes
SOURCES
        Whole grain cereals, legumes (e.g.,
  beans and lentils), nuts, lean pork, and
  yeast are rich sources of thiamin.
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Life Stage     Age                       Males      Females
                                        (mg/day)    (mg/day)

Infants        0-12 months              0.3 (AI)    0.3 (AI)


Children       1-13 years                     0.9     0.9


Adolescents    14-18 years                    1.2     1.0


Adults         19 years and                   1.2     1.1
                 older

Pregnancy       all ages                       -      1.4


Breastfeedin   all ages                        -      1.4
  g

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      DEFICIENCY DISORDER

   Dry Beriberi- Peripheral neuropathy
• Wet Beriberi - Cardiovascular manifestations
• Cerebral Beriberi -Wernicke's encephalopathy
                      and Korsakoff's psychosis.
      MANAGEMENT
 1.2 mg of thiamin/day for men and 1.1 mg/day
  for women as a prophylatic.

  HOMOEOPATHIC MANAGEMENT
 Important medicines are: Elaterium
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 officianalum, Lathyrus,Rhust., Ars.alb.
          RIBOFLAVIN (VITAMIN B2)
       In plant and animal derived foods.
Riboflavin is easily destroyed by exposure to
  light.

DEFICIENCY DISEASES
sore throat, redness and swelling of the lining of
 the mouth and throat
 Cheliosis
 Angular stomatitis
 Magenta tongue
 Seborrheic dermatitis
 Vascularization of the cornea
 Normochromic normocytic anemia
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     Recommended Dietary Allowance (RDA) for
                   Riboflavin
Life Stage      Age             Males (mg/    Females
                                    day)      (mg/day) 

Infants         0-12              0.4 (AI)    0.4 (AI) 
                  months 
Children        1-13 years           0.9        0.9 

Adolescents 14-18                    1.3        1.0 
              years 
Adults          19 years             1.3        1.1 
                  and older 
Pregnancy       all ages               -        1.4 

Breastfeedi all ages  www.similima.com -        1.6    14

  ng 
HOMOEOPATHIC MANAGEMENT
            Kent’s 3 mark- Astacus
 fluviatillis., Kali.iod., Nux.vom.,
 Sulph.
            Kent’s 2 mark- Alum.,
 Ars., Arundo., Caps., Kali.bich.,
 Myrica cerifera


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           NIACIN (VITAMIN B3)

      Niacin refers to nicotinic acid and
 nicotinamide, which are both used by the body
 to form the coenzymes.

SOURCES
 yeast, meat, poultry, fish (e.g., tuna, salmon
 cereals (especially fortified cereals),
 legumes, and seeds.
 Milk, green leafy vegetables.
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 coffee, and tea.
                           R DA
Life Stage    Age              Males (mg Females (mg
                                NE*/day    NE/day)
                                    ) 
 Infants      0-                   4(AI)     4 (AI) 
                12month
                s 
Children      1-13 years              12      12 
Adolescent 14-18                      16      14 
 s           years 
Adults        19 years                16      14 
                and
                older 
Pregnancy  all ages                     -     18 
Breastfeedi all ages                    -      17
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  ng 
         DEFICIENCY DISORDER

               PELLAGRA
 The four D's: dermatitis, diarrhea, dementia,
   and death.
 In the skin, a thick, scaly, darkly pigmented rash
   develops symmetrically in areas exposed to
   sunlight.
Symptoms of GIT include a bright red tongue,
   vomiting, and diarrhea.
Neurologic symptoms include headache, apathy,
   fatigue, depression, disorientation, and memory
   loss.
If untreated ultimately fatal.
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         HOMOEOPATHIC MANEGEMENT

Medicines in Boricke’s rep.
              Italics- Ars.alb., Bov., Sedinha
Ars.sulph.rub., Cinch., Gels., Pedic., Plumb.iod.,
Psor., Sulph.

Pellagra with skin affections – Hep., Graph.,
 Ignatia, Phos., Puls., Sepia


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               VITAMIN B12
largest and most complex of all the
   vitamins.
It contains a metal ion, cobalt. Cobalamin is
   the term used to refer to compounds
   having B12 activity.
  SOURCES
 Only bacteria can synthesize vitamin B12.
 Meat, poultry, fish (including shellfish), and
                    to a lesser extent milk
 Not generally present in plant products or
 yeast .           www.similima.com        22
                              RDA

Life Stage     Age                      Males        Females
                                       (mcg/day      (mcg/day
                                          )             ) 
Infants        0-12months              0.5 (AI)      0.5 (AI) 

Children       1-13 years                     1.8      1.8 

Adolescents    14-18 years                    2.4      2.4 

Adults         19-50 years                    2.4      2.4 

Adults         51 years and               2.4*        2.4* 
                 older 
Pregnancy      all ages                        -       2.6 

Breastfeedin   all ages    www.similima.com    -       2.8    23

  g 
      DEFICIENCY DISORDERS
1) an autoimmune condition known as pernicious
  anemia
 2) food-bound vitamin B12 malabsorption.
• Neurological symptoms:
         Numbness and tingling of the arms and
  more commonly the legs, difficulty walking,
  memory loss, disorientation, and dementia, with
  or without mood changes.
• Gastrointestinal symptoms:
   A sore tongue, appetite loss, and constipation

                     Ars.alb,
 Medicines include :www.similima.com T.N.T.   24
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                  FOLIC ACID
                 folate and folic acid.
    SOURCES
Green leafy vegetables
Citrus fruit juices, legumes
fortified cereals

    DEFICIENCY DISORDER
Blood cell division becomes abnormal
resulting in fewer but larger red blood cells.
megaloblastic or macrocytic anemia.
Fatigue, weakness, and shortness of breath.26
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                              RDA
Life Stage     Age                       Males      Females
                                        (mcg/day    (mcg/day
                                           )           ) 
Infants        0-6 months                65 (AI)    65 (AI)
Infants        7-12 months               80 (AI)    80 (AI)
Children       1-3 years                      150    150
Children       4-13 years                     300    300
Adolescents    14-18 years                    400    400
Adults         19-years and                   400    400
                 older
Pregnancy      all ages                        -     600
Breastfeedin   all ages    www.similima.com    -     500   27

  g
                    VITAMIN C
           Ascorbic acid.
FUNCTIONS
synthesis of collagen, (an important structural
 component of blood vessels, tendons,
 ligaments, and bone).
synthesis of the neurotransmitter,
 norepinephrine.
Vitamin C is an antioxidant.

SOURCES
    Rich in lemon, orange, grapes and
 strawberries.      www.similima.com              28
Life Stage     Age                 Males       Females
                                  (mg/day      (mg/day)
Infants        0-12months          50 (AI)     50 (AI)
Children       1-13 years              15-45   15-45
Adolescent     14-18 years              75       65
 s
Adults         19 years and             90       75
                 older
Smokers        19 years and            125      110
                 older
Pregnancy   19-years and                 -       85
              older
Breastfeedi 18 years and                 -      115
  ng          younger
Breastfeedi 19 years &                   -      120
  ng          older www.similima.com                  29
          DEFICIENCY DISORDER

SCURVY
  Bleeding and bruising easily,
  Hair and tooth loss,
  Joint pain and swelling.
  Early symptoms of scurvy such as fatigue.




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   HOMOEOPATHIC MANAGEMENT

3 mark- CARB.VEG., MERC., MUR.AC.,
  NUX.v., STAPH.
 2 mark- Am.c., Ars., Calc., Carb.an., Dulc.,
  Hep., Iod., Kali.carb, Nat.mur., Sil., Sulph

Rare – Agava americana, Agnus., Aranea
 diad., Elaterium Officianarum., Rat.,
 Saccarum officianale
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                 VITAMIN D
 Calceferol (vit D2) and Cholecalceferol(Vit D3)
 Cholecalceferol is synthesized in human skin
FUNCTIONS
• Intestine- Promotes absorption of Ca & Phos.
• Bone - Normal mineralization, enhances bone
  resorption, helps in collagen maturation.
• Kidney- Tubular resorption of phos & Ca.
• Immunit - The form 125(OH)2D is a potent
  immune system modulator, also inhibit
  autoimmunity.
• Insulin Secretion – Under conditions of insulin
  demand, vit D plays a role in insulin secretion.
• Blood Pressure Regulation– Decreases the
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  risk of hypertension.
 SOURCES
• Sunlight- Synthesized by humans in the skin
  upon exposure to ultraviolet-B (UVB)
  radiation from sunlight.
• Food sources- Butter, Eggs, whole Milk,
  Fish, Fat.




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Life Stage      Age                 Males      Females
                                   mcg/day      mcg/day
                                   (IU/day)    (IU/day)
Infants         0-12            5 mcg (200    5 mcg (200
                  months            IU)           IU) 
Children        1-13 years      5 mcg (200    5 mcg (200
                                    IU)           IU) 
Adolescent      14-18           5 mcg (200    5 mcg (200
 s                years             IU)           IU) 
Adults          19-50           5 mcg (200    5 mcg (200
                  years             IU)           IU) 
Adults          51-70 years        10 mcg    10 mcg (400
                                   (400 IU)      IU) 
Pregnancy       all ages               -      5 mcg (200
                                                  IU) 
Breastfeedi all ages  www.similima.com -      5 mcg (200
                                                      39
       DEFICIENCY DISOEDER
RICKETS
 In infants and children,
 failure of bone to mineralize.
 weight-bearing limbs (arms and legs)
  become bowed.
 In infants- soft spots in the skull
 rib cage may become deformed.
In severe cases,hypocalcemia may
  cause seizures.
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OSTEOMALACIA
  In adults -severe vitamin D
 deficiency,
  bone matrix is preserved but bone
 mineral is lost, resulting in bone
 pain and soft bones.

MUSCLE WEAKNESS AND PAIN

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    Risk factors for vitamin D
              deficiency disorder
• Exclusively breast fed infants:
• Dark skin:
• Aging:
• Covering all exposed skin or using
  sunscreen whenever outside:
• Fat malabsorption syndromes:
• Inflammatory bowel disease: Crohn’s
  disease
• Obesity:        www.similima.com      44
               MANAGEMENT
Supplementation of vitamin D - intakes of 800-
 1,000 IU/day are required by adults

HOMOEOPATHIC MANAGEMENT
 Kent’s 3 mark medicines- ASAFOETIDA,
  CALC.CARB., MERC., PHOS., SIL.
 Kent’s 2 mark medicines- Ars., Bell., Calc. phos.,
  Ferr., Ferr. iod., Guaj., Hep., Ip., Kali. iod., Lyc.,
  Nitric. ac., Ol. J., Phos ac., Psor., Puls., Rhust.,
  Sep., Staph., Sulph.
• Rare - Hecla. hed.www.similima.com                45
• ASAFOETIDA
 Darting pain and caries in bones. Periosteum
  painful,swollen, enlarged. Ulcers affecting
  bones; thin, ichorous pus.

• CALCAREA. CARB
   Rheumatoid pains, as after exposure to wet.
  Sharp sticking, as if parts were wrenched or
  sprained. Cold, damp feet; feel as if damp
  stockings were worn. Cold knees cramps in
  calves. scrofulous and rachitic conditions
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• MERCURIUS
  Weakness of limbs. Bone-pains and in limbs;
  worse, night. Patient very sensitive to cold. Oily
  perspiration.Trembling extremities, especially
  hands, paralysis agitans. Lacerating pain in
  joints. Cold, clammy sweat on legs at night.
  Dropsical swelling of feet and legs.




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• PHOSPHORUS

Ascending sensory and motor paralysis from
 ends of fingers and toes. Stitches in elbow
 and shoulder joints.
Burning of feet. Tibia inflamed and becomes
 necrosed. Arms and hands become numb.
 Can lie only on right side.
Post-diphtheritic paralysis, with formication
 of hands and feet. Joints suddenly give
 way.
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• SILICEA
 Sciatica, pains through hips, legs and feet.
  Cramp in calves and soles.
Loss of power in legs. Tremulous hands when
  using them.
Paralytic weakness of forearm. Icy cold and
  sweaty feet.
The parts lain on go to sleep. Offensive sweat on
  feet, hands, and axillae.
Sensation in tips of fingers, as if suppurating.
  Calves tense and contracted. Pain beneath
  Toes.                www.similima.com          49
              VITAMIN E (Tocoferol)
• Alpha-tocopherol
• vitamin E found in the largest quantities in the
  blood and tissue.

• FUNCTIONS
• Antioxidant
• Alpha-tocopherol inhibit the actvity of protein
  kinase C, an important cell signaling molecule.
• Alpha-tocopherol inhibit platelet aggregation
  and enhances vasodilation.
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• SOURCES
    Vegetable oils
    Cotton seed
    Sun flower seeds
    Egg yolk and Butter.




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Life Stage    Age            Males;      Females;
                             mg/day        mg/day
                             (IU/day)    (IU/day)
Infants       0-12           5 mg (7.5   5mg (6
                months         IU)        IU)
Children      1-13 years 11 mg           11mg
                         (10.5 IU)       (10.5 IU)
Adolescen 14-18              15 mg       15 mg
  ts        years            (22.5 IU)   (22.5 IU)
Adults        19 years       15 mg       15 mg
                and          (22.5 IU)   (22.5 IU)
                older
Pregnancy all ages                 -     15 mg
                                         (22.5 IU)
Breastfeed all ages                 -    19 mg
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  ing                                    (28.5 IU)
  DEFICIENCY DISORDERS
   Neurological symptoms - ataxia.
   Peripheral neuropathy,
   Muscle weakness (myopathy),
   Pigmented retinopathy

• MANAGEMENT
 The average intake of alpha-tocopherol from
  food is approximately 9 mg daily for men and 6
  mg daily for women.
 Vitamin E supplements generally contain from
  100 IU to 1000 IU of alpha-tocopherol. 
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HOMOEOPATHIC MANAGEMENT

3 mark medicines: ALUM.

2 mark medicines: Agar., Arg.nit., calc., Caust.,
  Cocc., Fl.ac., Gels., Graph. Hel., Kali.brom.,
  Lach.,Lil.tig., Nux.vom., Onos., Phos.,
  Sil., Sulph., Zn.


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              VITAMIN K
 Two naturally occurring forms of vitamin K.
 Plants synthesize phylloquinone, (vitamin K1).
 Bacteria synthesize a range of vitamin K
 forms.

FUNCTIONS
• COAGULATION (CLOTTING)
• BONE MINERALIZATION
• CELL GROWTH.
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SOURCES

Green leafy vegetables and some vegetable oils
 (soyabean, cottonseed, canola, and olive) are
 major contributors of dietary vitamin K.

Hydrogenation of vegetable oils may decrease
 the absorption and biological effect of dietary
 vitamin K.

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Life Stage      Age                  Males      Females (mcg/
                                    (mcg/day)        day)

Infants         0-12 months            2.5           2.5


Children        1-13 years             60            60 


Adolescents     14-18 years            75            75 


Adults          19 years and          120            90 
                  older

Pregnancy       19 years and            -            90 
                  older

Breastfeeding 19 Years &                -            90 
                older  www.similima.com                    58
         DEFICIENCY DISORDER
•   Impaired blood clotting.
•   easy bruising and bleeding that may be
    manifested as nosebleeds, bleeding gums,
    blood in the urine, blood in the stool, tarry black
    stools, or extremely heavy menstrual bleeding.
•   In infants, vitamin K deficiency may result in
    life-threatening intracranial hemorrhage.
           MANAGEMENT
•   Vitamin K is usually given to new born babies to
    prevent haemorrhage.
•                        is given.
    Usually 0.3 mg/ kg www.similima.com             59
       HOMOEOPATHIC MANAGEMENT
3 mark medicines: ARN., BELL., BOTH.,
  CALC.CARB., CALC.SULPH., CANTH.,
  CARB.VEG., CHIN., CROT. H., ERIGERONE,
  FERR., HAMM., LACH., MELI., MERC,
   MILL., MUREX, MATR.MUR., NITRIC.AC.,
  PHOS., PULS., SABIN., SEC., SEP.,
  SULPH.AC.
Rare medicines: Adren., Alet.farinosa, Alnus
  rubra., Aur.m., Calc.silicata., Carb.sulph.,
  Casc.sangruda, Dig., Doryphora decemlineata.,
  Sali.ac., Vipera.
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THANK YOU




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