Always consider that more than one nutritional disorder is likely to be present
Scurvy - lack of Vitamin C
Look for environmental signs (poor, pregnant, odd diet). Signs - 1. listlessness, anorexia, cachexia, 2. gingivitis, loose teeth, halitosis (foul breath), 3. bleeding from gums, nose, hair follicles, into joints, bladder and gut, 4. muscle pain/weakness. Diagnosis - No test completely satisfactory. WBC ascorbic acid Management - dietary education, ascorbic acid
Beriberi - lack of Thiamine
Wet beriberi - heart failure with general oedema Dry beriberi - neuropathy see Wernicke’s encephalopathy
Pellagra - lack of Nicotinic Acid
Classic triad - diarrhoea, dementia, dermatitis Other symptoms include neuropathy, depression insomnia, tremor, ataxia, fits Management - education, electrolyte replacement, nicotinamide
Xeropthalmia - lack of Vitamin A
Causes blindness, very common in tropics. Conjunctivae become dry and develop oval/triangular spots. Cornea become cloudy and soft Management - give vitamin A, education, monitor diet. Get special help if pregnant (vitamin A embryopathy)
| Molecule | Site of absorption | Deficiency syndrome |
|---|---|---|
| Vit A* | Small intestine | Xerophthalmia |
| Vit (thiamine) | Small intestine | Beriberi, Wernicke’s encephalopathy |
| Vit (riboflavin) | Proximal small intestine | Angular stomatis; cheilitis |
| Vit (pyridoxine) | Small intestine | Polyneuropathy |
| Vit | Terminal ileum | Macrocytic anaemia |
| Vit C | Proximal ileum | Scurvy |
| Vit D* | Jejunum as free vit | Rickets |
| Vit E* | Small intestine | Haemolysis, neurological deficit |
| Vit K* | Small intestine | Bleeding disorders |
| Folic acid | Jejunum | Anaemia |
| Nicotinamide | Jejunum | Pellagra |
| Calcium | Duodenum + jejunum | See hypo/hypercalcemia |
| Copper | Stomach + jejunum | Menkes’ kinky hair syndrome |
| Fluoride | Stomach | Dental caries |
| Iodide | Small intestine | Goitre; cretinism |
| Iron | Duodenum + jejunum | Anaemia |
| Magnesium | Small intestine | See hypo/Hypermagnesemia |
| Phosphate | Small intestine | osteoporosis |
| Selenium | Small intestine | Cardiomyopathy |
| Zinc | Jejunum | Acrodermatitis enteropathica, poor wound healing |
* Fat soluble