1
Q
what is Estimated Average Requirement (EAR)?
A
intake that meets estimated nutrient needs of 50% of individuals in a group
2
Q
What is RDA?
A
intake that meets nutrient needs of almost all (97-98%) individuals in a group
3
Q
What is Adequate Intake (AI)?
A
the average observed or experimentally derived intake by a defined population or subgroup that seems to sustain a defined nutrition-related state
4
Q
What is UL?
A
maximum intake that is unlikely to pose risks of adverse health effects in almost all individuals
5
Q
What is the folate trap?
A
conversion of homocysteine to methionine involves demethylation of 5-methyltetrahydrofolate into its active form, tetrahydrofolate (THF)
*when B12 is lacking, folate becomes “trapped” in its methyl (ie inactive form) thus B12 deficiency often presents as folate deficiency and is commonly misdiagnosed
6
Q
Functions of vitamin A
A
-vision (formation of rhodopsin)
-epilethial (skin cells)
-wound healing
7
Q
Food sources of vitamin A
A
-liver
-fortified milk
-eggs
-dark green veg
-yellow/orange veg
8
Q
What is required to transport liver retinol to target tissues?
A
RBP bound to prealbumin
9
Q
Where is vitamin A primarily stored?
A
liver
10
Q
Biologically active form of vitamin D
A
calcitriol
11
Q
Role of vitamin D
A
Calcium homeostasis
*maintains serum Ca and P concentrations to support neuromuscular function, bone calcification, cellular processes
12
Q
Food sources of vitamin D
A
sunlight, fish liver oils, fatty fish, fortified milk, breakfast cereals
13
Q
Where is vitamin D primarily stored?
A
liver
14
Q
Active form of vitamin E vs predominant form in diet
A
alpha-tocopherol
(predominant form in diet: gamma-tocopherol)
15
Q
Food sources of vitamin E
A
vegetable oils, wheat germ, asparagus, peanuts
16
Q
Functions of vitamin E
A
action as antioxidant
17
Q
which fat soluble vitamin has the least storage capability?
A
no mechanism for vitamin K storage in the body
18
Q
How is vitamin E excreted?
A
urine, bile, (and feces due to body’s limited absorption of vitamin E)
19
Q
Functions of vitamin K
A
-blood clotting
-bone health (osteocalcin is vitamin K-dependent protein secreted by osteoblasts during bone formation)
20
Q
Food sources of vitamin K
A
liver, green leafy veg, broccolis, peas, green beans
also ILE and propofol contain some vitamin K
21
Q
How is vitamin K stored?
A
not stored, no mechanism for vitamin K in the body
22
Q
Vitamin A deficiency signs
A
-follicular hyperkeratosis
-hair casts
-roughened conjunctiva
-Bitot’s spots
-xeropthalmia
-night blindness
-Impaired wound healing
23
Q
Vitamin A toxicity signs
A
-Pruritus
-Alopecia
-Vision disorders
-Conjunctivitis
-Cheilitis
-Ataxia
-Bone loss, bone pain, hip fractures
-Hyperlipidemia
-Renal osteodystrophy
-Muscle pain
-Hepatotoxicity
-Birth defects
24
Q
nutrient-nutrient interactions of vitamin A
A
malnutrition and/or zinc deficiency may decrease circulating vitamin A concentrations (b/c retinol circulates attached to RBP)
25
Cholestyramine (bile acid sequestrant) may decrease absorption of which micronutrients?
-Fat soluble vitamins
-Folate
-Iron
26
Lomitapide (lipid lowering agent) may decrease absorption of which micronutrients?
Fat soluble vitamins
27
Octreotide (somatostatin analog) may decrease absorption of which micronutrients?
-Fat soluble vitamins
-B12 (may decrease serum levels)
28
Mineral oil (laxative) may decrease absorption of which micronutrients?
Fat soluble vitamins
29
Phenobarbital (anticonvulsant) may impact which micronutrients?
-Vitamin D and Vitamin K (increases metabolism)
-Folate
30
Phenytoin (anticonvulsant) may impact which micronutrients?
-Vitamin D and Vitamin K (increases metabolism)
-Folate
31
Valproic acid may increase metabolism of which vitamin?
Vitamin D
32
Rifampin (antibiotic) may impact which micronutrients?
Vitamin D (increase metabolism), B12 (confound measurement), folate (confound measurement)
33
Corticosteroids may impact which micronutrients?
Vitamin D (decrease serum concentration), Vitamin C (increase urinary excretion), Vitamin B6 (decrease concentrations/activity), Zinc (increase urinary wasting), Chromium (increase urinary wasting)
34
Carbamazepine (anticonvulsant) may impact which micronutrients?
Vitamin D (decrease serum concentrations), Folate (decrease serum levels), Iron (decrease serum levels with long-term use)
35
Isoniazid (antibiotic) may impact which micronutrients?
Vitamin D (decrease serum concentrations), Niacin/B3 (decrease concentrations by inhibiting niacin production from tryptophan), Vitamin B6 (decrease concentration/activity)
36
Tetracycline (antibiotic) may impact which micronutrients?
Vitamin C (increases urinary excretion)
Riboflavin (decrease absorption)
Vitamin B12 (decrease serum), Pantothenic Acid (decrease serum)
Iron (decrease absorption), Zinc (decrease absorption), Manganese (decrease absorption)
37
Aspirin may impact which micronutrient?
may increase urinary vitamin C excretion
38
Diuretic therapy (especially loop diuretics such as lasix) may impact which micronutrient?
Thiamine, increased urinary excretion
39
Tricyclic antidepressants (amitriptyline, desipramine, nortriptyline) may impact which micronutrient?
Riboflavin (B2), may decrease absorption
40
Mercaptopurine (for IBD) may impact which micronutrient?
Niacin, interferes with conversion of niacin>NAD
41
Penicillamine (chelating agent) may impact which micronutrient?
Vitamin B6 (decrease concentrations/activity)
42
Metformin may impact which micronutrients?
B12, folate
(decrease absorption)
43
PPIs may impact which micronutrients?
Vitamin B12, Iron, Copper
(decrease absorption)
44
Hormonal oral contraceptives may impact which micronutrients?
DECREASE: B6, B12, folate, iron
INCREASE: copper
45
Methyldopa (antihypertensive) may impact which micronutrients?
Iron increases absorption of methyldopa, methyldopa increases B12 need
46
Pancrealipse may impact which micronutrients?
May decrease folate absorption
47
Phosphorus binders may impact which micronutrients?
Iron (decrease absorption), Zinc (decrease absorption)
48
Levothyroxine may impact which micronutrients?
Iron (decrease absorption)
49
Vitamin A treatment (deficiency vs wounds)
DEFICIENCY: 606-60,600 RAE (2000-200,000 IU)
WOUNDS: 3000-4500 RAE
50
Who is at risk for vitamin A deficiency?
-fat malabsorptive disorders
-liver disease
-pregnant with low vitamin A intake
51
Who is at risk for vitamin D deficiency?
-inadequate sun exposure
-older adults
-dark skin
-breastfed infants
-extensive skin damage (burns)
-fat malabsorptive disorders
-liver or renal disease
-long term PN
52
How is severe deficiency, deficiency, insufficiency, and sufficient vitamin D defined?
25(OH)D (calcidiol)
severe deficiency: <12 ng/mL
deficiency: <20 ng/mL
insufficiency: 20-30 ng/mL
sufficient: >30 ng/mL
53
Vitamin D deficiency symptoms
osteomalacia (bone softening), bone pain, tetany, hypocalcemia
54
Vitamin D toxicity symptoms
soft tissue calcification (CV, lungs), confusion, psychosis, tremor, hypercalcemia, hypercalciuria
55
How is excess vitamin D related to vitamin K?
excess vitamin D stimulates hepatic oxidation and excretion of vitamin K
56
Vitamin D deficiency treatment
50,000 IU 1x/week x 8 weeks then 1000 IU/day for several months
57
Who is at risk for vitamin E deficiency?
-fat malabsorption disorders
-long term PN without vitamin E supplementation
*deficiency is rare
58
Levels of vitamin E status: deficient, normal, vs toxic
plasma or serum vitamin E (alpha-tocopherol)
DEFICIENT: <0.5 mg/dL
NORMAL: 0.5-2.0 mg/dL
TOXIC: >2 mg/dL
59
What ratio of plasma alpha-tocopherol: cholesterol indicates deficiency risk?
<2.2
60
Vitamin E deficiency symptoms
-vision changes
-ophthalmoplegia
-ptosis
-vision loss
-dysarthria
-ataxia
-neuronal degeneration
-hemolytic anemia
-increased platelet aggregation
61
Vitamin E toxicity symptoms
-bruising from decreased vitamin K absorption
-Thrombocytopenia
-Cerebral hemorrhage
-Impaired coagulation
62
How does vitamin E intake impact vitamin K absorption?
vitamin E intakes >1200 mg/d interferes with vitamin K absorption/metabolism (and may be problematic for pts on warfarin therapy)
63
Who is at risk for vitamin K deficiency?
-fat malabsorption
-IBD
-antibiotic therapy
-long term PN without ILE
64
What is the most common lab value for assessing vitamin K status?
INR (but more sensitive marker is phylloquinone)
65
Vitamin K deficiency symptoms
bruising, prolonged bleeding, decreased bone density
66
How can vitamin A and vitamin E intake impact vitamin K?
excess intake can decrease vitamin K absorption
67
does warfarin increase or decrease INR?
increase
68
does vitamin K increase or decrease INR?
decrease
69
Vitamin C functions
-synthesis of collagen, carnitine, NTs
-enhances intestinal absorption of non-heme Fe
-immune mediated and antibacterial functions of WBCs
70
Prolonged vitamin C intake <____ mg/day can result in classic deficiency symptoms
10 mg/day
71
How does hyperglycemia impact vitamin C?
prevents vitamin C transport
72
Does renal clearance increase or decrease once serum ascorbic acid concentrations reach elevated level?
increase
73
Functions of thiamine (vitamin B1)
energy transportation and major role in CHO metabolism
74
Food sources of thiamine
enriched/fortified whole grains, pork products, sunflower seeds, wheat germ
75
Functions of riboflavin (vitamin B2)
macronutrient metabolism, antioxidant
76
food sources of riboflavin (vitamin B2)
organ meat, milk, bread products, fortified cereals
77
Functions of niacin (vitamin B3)
-metabolism of AAs, FAs, CHOs
-required for activation of folate
78
Food sources of niacin
meat/fish/poultry, fortified breads, fortified cereals
79
Which B vitamin is more rapidly excreted, thiamine (B1) or niacin (B3)?
Unused thiamine excreted rapidly in urine; minimal niacin excreted because reabsorbed from glomerular filtrate
80
Functions of vitamin B6
coenzyme in many enzymatic reactions (including AA, lipid metabolism, gluconeogenesis, heme biosynthesis, normal immune function)
facilitates conversion of homocysteine to cysteine
81
Food sources of vitamin B6
fortified cereals, organ meats, whole grains
82
Functions of vitamin B12
required for conversion of homocysteine to methionine
83
Food sources of vitamin B12
fortified cereals, meat/fish/poultry, eggs
84
Absorption of vitamin B12
1. B12 released from ingested proteins via HCl and pepsin in gastric secretions
2. encounters intrinsic factor in duodenum (produced by gastric parietal cells)
3. B12 secreted into bile so most is reabsorbed via enterohepatic circulation
85
Which B vitamin can be stored?
B12, can be stored in the liver
86
Functions of folate
coenzyme for AA metabolism and nucleic acid synthesis
87
Food sources of folate
enriched grains, dark leafy green veggies, fortified cereals
88
Functions of biotin (B7)
genetic expression of enzymes; cofactor for FA synthesis, gluconeogenesis, BCAAs
89
Food sources of biotin (vitamin B7)
ubiquitous in diet
90
Functions of pantothenic acid (vitamin B5)
involved in energy released from fat, CHO, and ketogenic AAs
required for synthesis of bile salts, cholesterol, steroid hormones, and FAs
91
Food sources of pantothenic acid (vitamin B5)
sunflower seeds, beef liver, mushrooms, peanuts, eggs, broccoli, milk
92
Functions of choline
needed for NT synthesis, lipid transport/lipid cholesterol transport
by-product (betaine) is a methyl group donor and may act as a B12 substitute in the regeneration of methionine from homocysteine
93
Food sources of choline
milk, liver, eggs, peanuts
94
Vitamin C deficiency symptoms
-Delayed wound healing
-Petechiae
-Perifollicular hemorrhage
-Hyperkeratotic papules
-Corkscrew hairs
-Bleeding gums
-Joint effusions
-Increased infection susceptibility
95
Vitamin A toxicity symptoms
*toxicity rare
-N/V/D
-Kidney stones
96
How does vitamin C assist in iron absorption?
Fe3+ > Fe2+
97
Treatment of vitamin C deficiency vs wounds
Deficiency: 100 mg 3x/day
Wounds: 100-200 mg/day
98
Who is at risk for vitamin C deficiency?
-malabsorptive disorders
-insufficient diet
-alcohol disorders
-elderly
-smokers
-T2DM and certain cancers
99
Who is at risk for thiamine deficiency?
-alcohol disorder (most common cause)
-recurrent vomiting
-gastric/bariatric surgery
-long term PN
-dialysis
-refeeding syndrome
-malabsorption
-hyperemesis gravidarum
100
Which two biochemical markers may be used to assess thiamine status?
erythrocyte transketolase activity and whole blood thiamine
101
Dry vs wet beriberi symptoms
DRY: paresthesia, muscle weakness
WET: high output cardiac failure, dyspnea, hepatomegaly, tachycardia, oliguria, Na/H2O retention, elevated lactic acid
102
What are the typical causes of beriberi vs Wernicke encephalopathy?
beriberi: usually caused by inadequate thiamine intake with adequate CHO intake
Wernicke encephalopathy: usually caused by alcohol
103
Wernicke Encephalopathy symptoms
symptom triad: ocular abnormalities, gait ataxia, mental status changes
likely develops into Wernicke-Korsakoff which results in psychosis and memory disturbances
104
How are magnesium and thiamine related?
magnesium is required for conversion of thiamin to its active form, thus mag deficiency makes thiamin unusable
105
Thiamine dosing for refeeding risk
100 mg/day x 5-7 days
106
Who is at risk for riboflavin (B2) deficiency?
-alcohol disorder
-thyroid disorder
-T2DM, trauma, or extreme stress may excrete more
-Malabsorption
107
What biochemical marker may be used to assess riboflavin deficiency?
erythrocyte glutathione reductase activity coefficient assay
108
Symptoms of riboflavin deficiency
-seborrheic dermatitis (face, scrotum)
-visual impairmenet
-glossitis
-cheilosis
-angular stomatitis
-peripheral nerve dysfunction
-normochromic normocytic anemia
-edema
-photophobia
-corneal vascularization
109
Which nutrients may prevent absorption of riboflavin?
Cu, Zn, Fe, Mn (these chelate with riboflavin and may prevent absorption)
110
Alcohol disorders may cause deficiency of which micronutrients?
B vitamins, vitamin C
111
Dialysis may impact which micronutrients?
-thiamine
-copper (HD)
-vitamin B6
112
Symptoms of niacin deficiency
pellagra (deficiency rare)
3 Ds: dermatitis, diarrhea, dementia
-sun sensitivity causing symmetrical pigmented rash
-glossitis
-apathy
-fatigue
-memory loss
-peripheral neuritis
-diarrhea/vomiting
-extremity paralysis
113
Symptoms of vitamin B6 deficiency
-seborrheic dermatitis
-angular stomatitis
-cheilosis
-glossitis
-confusion
-depression
-microcytic anemia
114
Symptoms of vitamin B6 toxicity
-sensory neuropathy
-ataxia
-areflexia
115
elevated values of both homocysteine and MMA may indicate what micronutrient deficiency?
vitamin B12
116
homocysteine levels may be elevated in which micronutrient deficiencies?
B12, folate
117
First clinical manifestations of B12 deficiency are typically ....
neurological (then hematologic and GI)
118
Vitamin B12 deficiency treatment
IM injections 100 mcg or 1000 mcg 1x/month until corrected
119
Folate deficiency symptoms
-cheilosis
-dementia
-megaloblastic or macrocytic anemia
-diarrhea
-weight loss
-CV disease
120
How are zinc and folate deficiency related?
zinc deficiency can impair absorption of folate
121
why is biotin (vitamin B7) deficiency rare?
because synthesized by colonic microflora
122
Symptoms of biotin (vitamin B7) deficiency
-pallor
-alopecia
-vision problems
-glossitis
-cheilosis
-dementia
-depression
-hypotonia
-anorexia
-N/V
-lethargy
-muscle pain
-ketolactic acidosis
-elevated cholesterol
123
Symptoms of pantothenic acid (vitamin B5) deficiency
-poor wound healing
-numbness
-staggering gait
-depression
-malaise
-muscle cramps
-N/V/D
-hypoglycemia
124
Who is at risk for choline deficiency?
-demand increases during pregnancy
-lactation
-hypermetabolic states
-post-menopausal (d/t decreased de novo synthesis with decreased estrogen)
-long term PN without choline
125
Symptoms of choline deficiency
-impairment of verbal and visual memory
-hypotension
-anorexia
-fishy body odor
-hepatotoxicity
126
Symptoms of choline toxicity
sweating and excessive salivation
127
RDA for iron
men: 8 mg
women (pre-meno): 18 mg
women (post-meno): 8 mg
pregnant: 27 mg
128
Functions of iron
oxygen transport, energy metabolism, immune function
primary function is making hemoglobin which delivers oxygen from lungs to tissues
129
How is iron regulated in the body?
regulated at level of absorption, not excretion (unlike most nutrients); iron is difficult to eliminate once in body
130
Food sources of manganese
nuts, oats, whole grains
131
Functions of selenium
required cofactor for glutathione, iodine, and thyroid metabolism
132
Which micronutrients and their food sources are impacted by soil content?
selenium and iodine
133
Functions of iodine
integral component of thyroid hormones T3 and T4
134
Ferritin level that indicates deficiency
<10 ng/mL in women and <20 ng/mL in men
135
Symptoms of iron deficiency
-pallor
-koilonychia
-conjunctival pallor
-glossitis
-impaired behavioral/intellectual performance
-tachycardia
-fatigue
-sleepiness
-headache
-nausea
-decreased infection resistance
-impaired ability to maintain body temp in cold environments
136
Symptoms of iron toxicity
-skin pigmentation
-organ damage (liver cirrhosis, cardiomegaly, pancreatic damage)
137
Which nutrients decrease nonheme iron absorption?
-phytic acid in grains
-oxalic acid in spinach, chart, tea, chocolate
-polyphenols in coffee, tee, cocoa
-Ca, Zn, Mn
-Chromium toxicity due receptor site competition
138
Treatment of iron deficiency
150-200 mg/day (elemental)
139
Which form of iron is preferred for treating deficiency?
ferrous sulfate and ferrous gluconate
140
Biochemical assessment of zinc status - low, marginal, sufficient
lab: plasma zinc
LOW: <70 mcg/dL
MARGINAL: 70-85 mcg/dL
SUFFICIENT: >85 mcg/dL
*interpret cautiously with hypoalbuminemia
141
How do plasma zinc levels change during fasting?
increase during fasting
142
Symptoms of zinc deficiency
clinical manifestations noted at serum/plasma zinc <33 mcg/dL
-rash (periorificial, perianal, buttocks)
-impaired wound healing and epithelization
-alopecia
-impaired night vision
143
Symptoms of zinc toxicity
-GI distress
-nausea
-dizziness
-decreased immune functoin
-decreased HDL
144
How can zinc deficiency impact vitamin A status?
can cause secondary vitamin A deficiency: zinc deficiency impacts vitamin A metabolism (dec retinol mobilization from liver and dec zinc-dependent enzyme conversion of retinol to retinal which is critical to vision cycle)
145
Zinc deficiency treatment
standard PO adult replacement: 220 mg 2x/day (ie 50 mg elemental 2x/day)
146
Biochemical assessment of copper status
lab: serum Cu (reflects change in both depleted and repleted patients)
EARLY DEF: <0.7 mcg/dL
ceruloplasmin is useful data but may not reflect hepatic Cu stores
147
Symptoms of copper deficiency
-hypopigmentation (skin and hair)
-sensory ataxia
-paresthesia in extremities
-hypochromic microcytic anemia
-leukopenia, neutropenia
-abnormal ECG
148
Symptoms of copper toxicity
toxicity uncommon because body regulates Cu storage via biliary excretion
-Kayser Fleischer rings
-Metallic taste
-Hematuria
-Liver damage
149
How can copper deficiency impact iron?
can lead to impaired Fe absorption (Fe must be in Fe3+ state to leave enterocyte and bind to transferrin)
150
How can excess molybdenum impact copper?
can increase urinary Cu wasting
151
Symptoms of manganese deficiency
rare unless totally absent from diet
-abnormal bone and cartilage formation
-ataxia
-congenital abnormalities in offspring
-growth retardation
-defects in lipid/CHO metabolism
152
Symptoms of manganese toxicity
-hallucinations
-libido disturbances
-ataxia
-parkinson like motor dysfunction
-immune dysfunction
-reproductive dysfunction
-nephritis
-pancreatitis
-hepatic damage
153
Symptoms of selenium deficiency
-whitening of nailbed
-N/V
-gait ataxia
154
Symptoms of selenium toxicity
-skin lesions
-hair/nail loss
-tooth decay
-peripheral neuropathy
-fatigue
-irritability
155
Symptoms of iodine deficiency
-elevated TSH
-nodular goiter
-weight loss
-tachycardia
-muscle weakness
-skin warmth
156
Symptoms of chromium deficiency
-peripheral neuropathy
-weight loss
-hyperglycemia refractory to insulin
-glycosuria
-elevated plasma FFAs
157
Burn patients may be at risk for which micronutrient deficiencies?
zinc, selenium, vitamin D
158
Patients with impaired biliary excretion or cholestasis are at risk for which micronutrient toxicities?
copper, manganese
159
PN dosing requirement for vitamin A
1 mg
160
PN dosing requirement for vitamin D
5 mcg
161
PN dosing requirement for vitamin E
10 mg
162
PN dosing requirement for vitamin K
150 mcg
163
PN dosing requirement for thiamine
6 mg
164
PN dosing requirement for riboflavin
3.6 mg
165
PN dosing requirement for pyridoxine (B6)
6 mg
166
PN dosing requirement for vitamin B12
5 mcg
167
PN dosing requirement for niacin
40 mg
168
PN dosing requirement for folic acid
600 mcg
169
PN dosing requirement for pantothenic acid
5 mg
170
PN dosing requirement for biotin
60 mcg
171
PN dosing requirement for vitamin C
200 mg
172
PN dosing requirement for zinc
2.5-5 mg
173
PN dosing requirement for copper
0.3-0.5 mg
174
PN dosing requirement for chromium
10-15 mcg
175
PN dosing requirement for manganese
60-100 mcg
176
PN dosing requirement for selenium
20-60 mcg
177
Petechiae may indicate which micronutrient abnormality?
vitamin C deficiency
178
Alopecia may indicate which micronutrient abnormalities?
deficiency: biotin (B7), zinc, EFAs
toxicity: vitamin A, selenium
179
Corkscrew hairs may indicate which micronutrient abnormality?
vitamin C deficiency
180
Hypopigmentation may indicate which micronutrient abnormality?
copper deficiency
181
Hair casts may indicate which micronutrient abnormality?
vitamin A deficiency
182
Bitot's spots may indicate which micronutrient abnormality?
vitamin A deficiency
183
Kayser-Fleischer rings may indicate which micronutrient abnormality?
copper toxicity
184
xeropthalmia (eye dryness) may indicate which micronutrient abnormality?
vitamin A deficiency
185
photophobia (light sensitivity) may indicate which micronutrient abnormality?
riboflavin deficiency
186
night blindness may indicate which micronutrient abnormalities?
vitamin A and zinc deficiency
187
conjunctivitis may indicate which micronutrient abnormality?
vitamin A toxicity
188
pale conjunctiva may indicate which micronutrient abnormalities?
B12, folic acid, iron deficiency
189
visual impairment (disorders/changes) may indicate which micronutrient abnormalities?
deficiency: vitamin E, riboflavin, biotin, molybdenum
toxicity: vitamin A
190
ophthalmoplegia (paralysis of eye muscles) may indicate which micronutrient abnormality?
vitamin E deficiency
191
nystagmus may indicate which micronutrient abnormality?
thiamine deficiency
192
discoloration of ocular lens may indicate which micronutrient abnormality?
molybdenum deficiency
193
cheilitis/cheilosis may indicate which micronutrient abnormalities?
riboflavin, B6, folate deficiency
194
angular stomatitis may indicate which micronutrient abnormalities?
red/cracked fissures at corners
riboflavin or B6 deficiency
195
glossitis may indicate which micronutrient abnormalities?
beefy red tongue
riboflavin, niacin, B6, B12, iron deficiency
196
sore throat may indicate which micronutrient abnormality?
riboflavin deficiency
197
bleeding gums may indicate which micronutrient abnormality?
vitamin C deficiency
198
excessive salivation may indicate which micronutrient abnormalities?
choline or fluoride toxicity
199
taste alterations may indicate which micronutrient abnormality?
zinc deficiency
200
metallic taste may indicate which micronutrient abnormality?
copper toxicity
201
tooth decay may indicate which micronutrient abnormality?
selenium toxicity
202
mottled teeth may indicate which micronutrient abnormality?
fluoride toxicity
203
dry scaly rash may indicate which micronutrient abnormality?
EFA deficiency
204
dry scaly rash (with red patches) may indicate which micronutrient abnormalities?
zinc deficiency
205
seborrheic dermatitis (red, itchy, greasy rash) may indicate which micronutrient abnormalities?
B6, biotin, riboflavin deficiency
206
follicular hyperkeratosis may indicate which micronutrient abnormalities?
"goose flesh"
vitamin A or C deficiency
207
pruritus may indicate which micronutrient abnormalities?
deficiency: vitamin A
toxicity: niacin (B3)
208
bruising may indicate which micronutrient abnormalities?
deficiency: vitamin K
toxicity: vitamin E (from decreased vitamin K absorption)
209
delayed/poor wound healing may indicate which micronutrient abnormalities?
deficiency: vitamin C, pantothenic acid, zinc, EFA
210
skin sensitivity causing symmetrical pigmented rash may indicate which micronutrient abnormality?
niacin deficiency
211
hypopigmentation may indicate which micronutrient abnormalities?
copper deficiency
212
koilonychia may indicate which micronutrient abnormality?
iron deficiency
213
pale nailbeds may indicate which micronutrient abnormalities?
selenium, B12 deficiency
214
nail loss may indicate which micronutrient abnormalities?
selenium toxicity
215
brittle nails may indicate which micronutrient abnormality?
EFA deficiency
216
ataxia may indicate which micronutrient abnormalities?
lack of voluntary muscle coordination
deficiency: thiamine, copper, manganese, selenium
toxicity: vitamin A, pyridoxine, manganese
217
lower extremity weakness may indicate which micronutrient abnormalities?
thiamine deficiency
218
lower extremity spasticity may indicate which micronutrient abnormality?
copper deficiency
219
paresthesia may indicate which micronutrient abnormalities?
thiamine, B12, biotin, pantothenic acid, copper deficiency
220
tetany may indicate which micronutrient abnormalities?
involuntary painful muscle cramps/spasms
vitamin D deficiency
221
confusion may indicate which micronutrient abnormalities?
deficiency: thiamine, B6, B12, molybdenum
toxicity: vitamin D
222
psychosis may indicate which micronutrient abnormalities?
deficiency: B12
toxicity: vitamin D
223
dementia may indicate which micronutrient abnormalities?
niacin, folate, biotin deficiency
224
fatigue may indicate which micronutrient abnormalities?
niacin, pantothenic acid, iron deficiency
224
hallucinations may indicate which micronutrient abnormalities?
deficiency: biotin
toxicity: manganese
225
apathy may indicate which micronutrient abnormalities?
niacin deficiency
226
depression may indicate which micronutrient abnormalities?
B6, B12, biotin, pantothenic acid deficiency
227
excessive bone deposition may indicate which micronutrient abnormalities?
vitamin A deficiency
228
abnormal bone/cartilage formation may indicate which micronutrient abnormalities?
manganese deficiency
229
bone pain may indicate which micronutrient abnormalities?
deficiency: vitamin D
toxicity: vitamin A
230
osteomalacia may indicate which micronutrient abnormalities?
vitamin D deficiency
231
joint effusions may indicate which micronutrient abnormalities?
swollen joint
vitamin C deficiency
232
hypotonia may indicate which micronutrient abnormality?
biotin deficiency
233
myalgia may indicate which micronutrient abnormalities?
muscle pain
biotin deficiency
234
high output cardiac failure may indicate which micronutrient abnormalities?
thiamine deficiency
235
tachycardia may indicate which micronutrient abnormalities?
thiamine, iron, iodine, molybdenum deficiency
236
cardiomegaly may indicate which micronutrient abnormalities?
iron toxicity
237
decreased HDL cholesterol may indicate which micronutrient abnormalities?
zinc toxicity
238
hypercholesterolemia may indicate which micronutrient abnormalities?
copper deficiency
239
dyspnea may indicate which micronutrient abnormalities?
thiamine deficiency
240
hemolytic anemia may indicate which micronutrient abnormalities?
vitamin E deficiency
241
normochromic normocytic anemia may indicate which micronutrient abnormalities?
riboflavin deficiency
242
hypochromic microcytic anemia may indicate which micronutrient abnormalities?
copper deficiency
243
microcytic anemia may indicate which micronutrient abnormalities?
deficiency: iron
toxicity: B6
244
macrocytic anemia may indicate which micronutrient abnormalities?
folate deficiency
245
megaloblastic anemia may indicate which micronutrient abnormalities?
B12, folate deficiency
246
thrombocytopenia may indicate which micronutrient abnormalities?
B12 deficiency
247
impaired coagulation may indicate which micronutrient abnormalities?
vitamin E toxicity
248
prolonged bleeding may indicate which micronutrient abnormalities?
vitamin K deficiency
249
increased prothrombin time (PT) may indicate which micronutrient abnormalities?
vitamin K deficiency
250
kidney stones may indicate which micronutrient abnormality?
vitamin C toxicity
251
nephritis may indicate which micronutrient abnormalities?
manganese toxicity
252
hepatomegaly may indicate which micronutrient abnormalities?
thiamine deficiency
253
liver damage may indicate which micronutrient abnormalities?
copper, manganese, chromium toxicity
254
oliguria may indicate which micronutrient abnormalities?
thiamine deficiency
255
hematuria may indicate which micronutrient abnormalities?
copper toxicity
256
liver cirrhosis may indicate which micronutrient abnormalities?
iron toxicity
257
elevated Na/water retention may indicate which micronutrient abnormality?
thiamine deficiency
258
hyperglycemia may indicate which micronutrient abnormalities?
chromium deficiency
(refractory to insulin)
259
fishy body odor may indicate which micronutrient abnormalities?
choline deficiency
260
impaired ability to maintain body temp may indicate which micronutrient abnormalities?
iron deficiency
261
zinc supplementation with small intestinal fluid loss: additional _____ mg/L fluid loss and ____ mg/kg stool output/ileostomy output
12.2
17.1
262
where is iron primarily absorbed?
duodenum and proximal jejunum
263
long-term valproic acid therapy may cause what micronutrient deficiency?
carnitine
CNSC Exam 2026
flashcards
Decks in class (23)
# Cards
-
Fluids, Electrolytes, Acid-Base207
-
Renal29
-
Pulmonary12
-
Digestion/Absorption, Energy/Macronutrients, GI149
-
Micronutrients264
-
Malnutrition33
-
EN & PN182
-
DNI & Supplements20
-
DM, Obesity, Metabolic Conditions32
-
Neuro17
-
Liver18
-
Pancreatitis9
-
SBS54
-
Transplant14
-
Cancer24
-
Critical Illness/Sepsis, Trauma/Surgery/Burns48
-
Wounds29
-
Surgical Alterations of GI Tract37
-
Older Adults14
-
Pregnancy & Lactation22
-
Home Nutrition Support28
-
Evidence Based Medicine & Healthcare Quality Standards18
-
Numbers113
