Dr. Ebraheim’s educational animated video describes different vitamins.
Vitamin D and PTH (parathyroid hormone) are important for calcium hemostasis. Vitamin D is important for proper maturation and development of the bone. Vitamin D is naturally found in Tuna, Salmon and Cod liver oil. Vitamin D and K are not present in sufficient quantity in breast milk. Production in the body:
Precursor for vitamin D is found in the skin. Cholesterol derived precursor (pro-vitamin D3) is formed in the liver and stored in the skin. UV light converts it to pre-vitamin D3. The liver will then convert it to 25 hydroxyvitamin D3. Then the kidney will convert it to 1,25-dihydroxyvitamin D3, which is the active form of vitamin D3. PTH regulates the active form of vitamin D3. Active vitamin D3 stimulates the absorption of calcium and phosphate from the intestine.
Low vitamin D levels lead to rickets. Low vitamin D rickets is the most common form of rickets worldwide. In adults, it leads to osteomalacia. Looser zones are stress fractures in patients with osteomalacia. Darker skin individuals should have more sun exposure.
Vitamin D resistant rickets: the most common form of rickets in the United States. Also known as familial hypophosphatemic rickets. It is an X-linked inherited disease (dominant). The defective mineralization of bone in osteomalacia leads to a qualitative defect of bone with a high amount of unmineralized osteoid matrix.
Osteoporosis, on the other hand, is a quantitative defect of bone.
Vitamin D deficiency is considered when blood levels of 25 hydroxyvitamin D3 fall below 20 ng/ml. vitamin D levels are usually found to be low in patients with low energy fractures. Vitamin D deficiency is found in the majority of patients with endocrine or metabolic problems presenting with fracture non-unions. Dilantin (phenytoin) inhibits vitamin D formation in the liver. Decreased exposure to sun light and decreased intake of vitamin D are risk factors for developing Multiple Sclerosis. Recent research has also demonstrated a link between low vitamin D and vitamin B12 levels and the development of Alzheimer’s disease. Daily requirements of vitamin D are 400-800 international units. Vitamin D and calcium are given for female athletic triad.
Vitamin E affects peripheral nerves and is a major antioxidant as it stabilizes free radicals and reduces the potential for oxidative damage. Vitamin E prevents peroxidation of fatty acids in cell membranes, helping to maintain their normal fluidity. Vitamin E also has some enzymatic activity.
Deficiency of Vitamin E can lead to hemolysis, neurological problems, and retinitis pigmentosa. Vitamin E is found in milk, nuts, corn oil, sunflower oil, avocados, asparagus, and broccoli.
Vitamin K is needed to introduce calcium binding sites on Vitamin K dependent clotting factors in order to activate them. Without Vitamin K the blood will not clot. This process is called gamma-carboxylation of glutamic acid. Vitamin K dependent factors are 1972 (factors: 10, 9, 7, 2,).
Vitamin K is found in green leafy vegetables. Causes of Vitamin K deficiency include fat malabsorption, prolonged use of broad-spectrum antibiotics, breast-fed newborns, and infants of mothers taking Phenytoin (Dilantin).
How to differentiate between Vitamin K and Vitamin C deficiencies?
Vitamin K deficiency: easy bruising and bleeding, normal bleeding time and increased prothrombin time, no connective tissue problems.
Vitamin C deficiency: easy bruising and bleeding, prolonged bleeding time and normal prothrombin time. Vitamin C deficiency patients have skeletal deformities, gum hyperplasia and bleeding, and poor wound healing.
Coumadin is a vitamin K antagonist. Coumadin affects vitamin K metabolism in the liver, leading to the inhibition of vitamin K dependent clotting factors (1972). The therapeutic target level for Coumadin is an INR of 2-3. It takes 3 days to reach that therapeutic level and takes another 3 days to reverse it by vitamin K. fresh frozen plasma would act immediately. Protamine sulfate and fresh frozen plasma would work immediately in the case of heparin.
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