Vitamins and Minerals:

Deficiencies and Supplementation

Vitamin and Mineral deficiencies can occur even in
developed countries and can negatively impact a
patients health and recovery. In order to combat
deficiencies and/or to account for increased needs
during illness/injury supplements of some
micronutrients should be considered.

The World Health Organization (WHO) considers

that more than 2 billion people worldwide suffer
from vitamin and mineral deficiencies, primarily
iodine, iron, vitamin A and zinc, with important
health consequences.

Visual Signs of Micronutrient Deficiencies

B12

Swollen, beefy red tongue. Yellow tinged skin.

Brown-gray nails. Pale eyelids, or angular
blepharitis (fissure in the corner of the eye), dry
vertical cracking around lips.
Vitamin C
Swollen, retracted, bleeding discolored gums.
Broken, coiled swan-neck hair.
B-complex
Loss of upper lip.
Fe (Iron)
Iron deficiency is the most common and
widespread nutritional disorder in the world. -WHO
Sores around the mouth. Pale skin. Koilonychia
(spoon nails), and/or pale nail beds.

Vitamin A
Bitots spots in the eyes. Broken, coiled, swan-neck
hair. Follicular Hyperkeratosis (small bumps at hair
follicles). Night blindness, corneal thinning, and
conjunctival metaplasia (dry eye).
Zinc
Flaking skin. Thin, sparse hair.

B6
Seborrheic dermatitis (scaly patches on scalp w/
dandruff and redness). Angular blepharitis (fissure
in the corner of the eye), dry vertical cracking
around lips.
Niacin
Pellegra-like dermatitis, dry vertical cracking
around lips, Swollen, retracted, bleeding discolored
gums.
General Signs of micro-nutrient deficiency
Missing or no teeth, dentures do not fit/pt using
adhesive.

Dx where micronutrient needs may

increase
End Stage Liver Disease
End stage liver disease generally signals a need for
vitamin supplementation. Some water-soluble
vitamin deficiencies associated with liver disease
are thiamin (Wernicke encephalopathy can result),
pyridoxine (B6), cyanocobalamin (B12), folate, and
niacin (B3). If fat soluble vitamins require

supplementation, water soluble forms may be

required (Krause 659).
Non-surgical Wounds (Pressure Ulcers) Protocol
Stage I and II Pressure Ulcers
Supplement with Daily Multi-Vitamin if pt is
consuming <75% of most meals.
Stage III and IV Pressure Ulcers
Daily Multi-Vitamin if pt is consuming <75% of
most meals.
If intake is <50% of most meals supplement with
500 mg Vitamin C daily, and 15-50 mg elemental
Zinc for 2-4 weeks.

Vitamin D Supplementation for Elderly (age >75

yrs) Hip Fracture Patients
As a preventive measure in pts with normal
Vitamin D levels supplement 800-1000 IU/d of
Prophylaxis Vitamin D in combination with 100012000 mg/d calcium.
If Vitamin D deficiency is present supplement; 5000
IU/d Vitamin D for 6 weeks in combination with
1000-1200 mg/d calcium.

References
http://www.publichealthreviews.eu/show/f/28
World Health Organization. World health report, 2000. Geneva: World Health
Organization, 2000.
Mahan, L. Kathleen. (2012) Krause's Food & the Nutrition Care Process. 13th
ed. St. Louis, Mo.: Elsevier/Saunders. 659.
http://www.who.int/nutrition/topics/ida/en/
National Osteoporosis Foundation. 2012 Calcium and Vitamin D: What You
Need TO Know.
Institute of Medicine of the National Academies. 2011 Dietary Supplement
Fact Sheet: Vitamin D
United States Preventive Services Task Force. 2012 Vitamin D and Calcium
Supplementation to Prevent Cancer and Osteoporotic Fractures.
Rejnmark, L., et al. (Aug. 2012). Vitamin D with calcium reduces mortality;
patient level pooled analysis of 70,528 patients from eight major vitamin D
trials. J Clin Endocrinol Metab DOI: 10.1210/jc.2011-3328

Holick, M. F., N. C. Binkly, et all. (2011). Evaluation, treatment, and

prevention of vitamin D deficiency; an Endocrine Society clinical practice
guideline. J Clin Endocrinol Metab 96(7): 1911-30.
IU Health-Goshen Hospital Nutrition Therapy Department Manual

Angular blepharitis

Koilonychia (spoon nails)

Bitots spots

Seborrheic dermatitis

Follicular Hyperkeratosis