Mar 07

Now, biotin deficiency is one of the rarer types. Again, there is the overlap between this and the other vitamin B2, B6 deficiencies. Just be aware that they share some similar features.
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What about toxicity states? Can you get vitamin poisoning? Would you be able to recognize vitamin poisoning if you saw it? There are only three water soluble vitamins which cause toxicity when given in excess; niacin, vitamin B6 and vitamin C. Know that. How would you know niacin toxicity? These are its characteristics. It became apparent, one of the ways that they treat some adults who have problems with cholesterol and they try to increase, those who are able, their HDL production is by giving those individuals large amounts of niacin. One of the characteristics that these people talk to you about is the skin flushing. They get very very red and they get tingling. It’s not a very pleasant experience, and sometimes they stop the niacin because the toxic effects are really too much for them to tolerate.
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Vitamin B6 toxicity. These are basically all neurological manifestations that are seen with it. Again, it would be an unusual phenomenon to see but it does occur. Probably vitamin C toxicity would be the commonest vitamin toxicity we might see, of the water soluble vitamins, in children because a lot of parents believe that vitamin C taken in high doses will prevent viral infections, will stimulate the immunity. Maybe it does, I don’t know, but there are considerable side effects from it; nausea, diarrhea, cramps, kidney stones. What kind of dosage will produce this? If you give vitamin C at a dosage that is greater than 10 times what the RDA’s are, this is when you start to see this phenomenon begin to become manifest.
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There are four fat soluble vitamins, A,D,E and K. What are the signs of deficiency? The characteristics that you see with vitamin A deficiency, clinical presentation, night blindness. And the other thing is xerophthalmia where they get problems like scaly-ness of the eyelids is one of the characteristics of it because it affects the skin and affects the cornea of the patient. So the cornea tends to become irregular. They also have a general problem with their skin as a result of it. Photophobia, conjunctivitis, so-called Bitot’s spots, keratomalacia, again because in vitamin A deficiency you have failure to regenerate the epithelium of the eye as well as the conjunctiva. They also get hyperkeratosis in the sun, on the skin. Poor growth, impaired resistance to infection. Vitamin D deficiency, the clinical presentation is most likely going to be rickets and it is very common – and I’ve seen this so repeatedly – that they will show you an x-ray and have you try to make a diagnosis of rickets. Here you see some of the classical features. You see splaying of the ends of the long bones in this patient. That’s the other thing that you see, this is before and this is after. This is the normal, this is the abnormal. And they will ask you, “What is this characteristic of?” and they will show you some vitamins, but they usually show this. Again, this is a patient who turned out to have vitamin C deficiency and one of the things that this patient has is very osteopenic bone. But they are probably not going to ask you that.