Vitami

n
A

B1

Alt. Name

Function

Deficiency

Excess

Other

Retinol

Antioxidant;
constituent of
visual
pigments;
essential for
normal
differentiation
of epithelial
cells into
specialized
tissue
(pancreatic
cells, mucussecreting cells);
prevents
squamous
metaplasia.
Used to treat
measles and
AML subtype
M3.
In TPP, which is
a cofactor for
dehydrogenase
enzyme rxn:
-Pyruvate deh.
(links glycolysis
to TCA cycle)

Night blindness
(nyctalopia); dry,
scaly skin (xerosis
cutis); corneal
degeneration
(keratomalacia);
bitot spots on
conjunctiva;
immunosuppressio
n (esp. measles).

Acute Toxicity- n/v,

vertigo, blurred vision
Chronic Toxicityalopecia, dry skin
(scaliness), hepatic
toxicity and
enlargement,
arthralgias, and
pseudotumor cerebri.
Teratogenic (cleft
palate, cardiac
abnormalities),
therefore a neg.
pregnancy test and
reliable contraception
are required before
isoretinoin (vit A
derivative) is
prescribed for severe
acne.

Retinol = vit A, so
think retin-A
(used topically for
wrinkles and
acne).

Thiamine

Impaired glucose
breakdown ATP
depletion
worsened by
glucose infusion;
highly aerobic
tissues affected

Sources: liver,
leafy veggies

-a-ketoglutarate
deh. (TCA
cycle)
-Transketolase
(HMP shunt)
-branched
chain ketoacid
deh.

first.
Wernicke: triad of
confusion,
opthalmoplegia,
ataxia
WernickeKorsakoff: triad +
confabulation,
personality
change, memory
loss (permanent);
damage to medial
dorsal nucleus of
thalamus,
mammillary
bodies
Dry Beri Beri:
symmetrical
peripheral
neuropathy,
sensory and motor
impairments esp
distal extremities;
polyneuritis,
symmetrical
muscle wasting
Wet Beri Beri: high
output cardiac
failure (dilated
cardiomyopathy),

edema
Infantile beri beri:
onset btwn 2-3
months; fulminant
cardiac syndrome
w/ cardiomegaly,
tachycardia,
cyanosis, dyspnea,
vomiting

B2

Riboflavin

Component of
flavins FAD and
FMN, used as
cofactors in
redox rxns, e.g.
succinate
dehydrogenase
rxn in TCA cycle

B3

Niacin

Constituent of
NAD+, NADP+
(used in redox
rxns); derived

Dx: made by
increase in RBC
transketolase
activity following
vit B1
administration
Cheilosis
(inflammation of
lips, scaling,
fissures at corners
of mouth), corneal
vascularization;
stomatitis,
glossitis,
dermatitis,
ariboflavinosis
Glossitis. Severe
deficiency
pellagra which can
be caused by:

Side Effects: flushing,

warmth, itching

from Trp;
Synthesis
requires B2 and
B6; Used to tx
dyslipidemia;
lowers VLDL
and raises HDL

B5

Panthothenic
Acid

B6

Pyridoxine

Essential
component of
coenzyme A
and fatty acid
synthase.
Converted to
pyridoxal
phosphase
(PLP), a
cofactor used in
transamination,
decarboxylation

1) Hartnup ds
(decreased Trp
absorption); 2)
malignant
carcinoid
syndrome
(increased Trp
metabolism); 3)
Isoniazid
(decreases vit B6)
Sx: Diarrhea,
Dementia,
Dermatitis (broad
collar rash),
hyperpigmentatio
n of sun-exposed
limbs
Dermatitis,
enteritis, alopecia,
adrenal
insufficiency.
Convulsions,
hyperirritability,
peripheral
neuropathy
(deficiency
inducible by
isoniazid and oral

B7

Biotin

rxns, glycogen
phosphorylase.
Synthesis of
cystathionine,
heme, niacin,
histamine, and
nerotransmitter
s, inc.
serotonin,
epinephrine,
norepi,
dopamine, and
GABA.
Cofactor for
carboxylation
enzymes
(which add a 1C group):
-pyruvate
carboxylase:
pyruvate (3C)
oxaloacetate
(4C)
-acetyl-CoA
carboxylase:
acetyl-CoA (2C)
malonyl-CoA
(3C)
-Propionyl CoA
Carboxylase:

contraceptives),
sideroblastic
anemias due to
impaired Hgb
synthesis and iron
excess.
Cheilosis, glossitis,
dermatitis

Relatively rare.
Dermatitis,
alopecia, enteritis.
Caused by Ab use
or excessive
ingestion of raw
egg white. (Avidin
in egg whites
binds avidly to
biotin)

B9

Folate

B12

Cobalamin

Propionyl CoA
(3C)
methylmalonyl
CoA (4C)
Converted to
THF, a
coenzyme for
1-C
transfer/methyl
ation reactions.
Important for
the synthesis of
N bases in DNA
and RNA.

Cofactor for
homocystein

Macrocytic,
megaloblastic
anemia;
hypersemented
PMNs; glossitis; no
neuro sx (vs. B12).
Labs: increased
homocysteine,
normal
methylmalonic
acid levels.
Most common vit
deficiency in USA.
Seen in alcoholism
and pregnancy.
Caused by drugs:
phenytoin,
sulfonamides,
methotrexate.
Supplement
maternal folic acid
early to prevent
neural tube
defects.
Classic Pernicious
Anemia: older,

Found in leafy
green veggies.
Absorbed in
jejunum. Small
reserve in liver.

Found in animal
products.

methyltransfera
se (transfers
CH3 groups as
methylcobalami
n) and
methylmalonylCoA mutase.

mentally slow
woman, N.
European descent,
lemon colored
(anemic and
icteric), smooth
shiny tongue
(atrophic glossitis),
broad based
shuffling gait
Macrocytic,
megaloblastic
anemia;
hypersegmented
PMNs;
paresthesias and
subacute
combined
degeneration
(dorsal columns,
lateral
corticospinal
tracts, and
spinocerebellar
tracts) due to
abnormal myelin.
Associated w/
increased serum
homocysteine and

Synthesized only
by
microorganisms.
Very large,
prolonged reserve
in liver.

Ascorbic Acid

Antioxidant;
facilitates Fe
absorption by
reducing it to
Fe2+ state.
Necessary for
hydroxylation
of Pro and Lys
in collagen

methylmalonic
acid levels.
Prolonged
deficiency
irreversible nerve
damage.
Caused by
insuffieicnt intake
(vegan),
malabsorption
(sprue, enterieis
etc.), lack of
intrinsic factor
(pernicious
anemia, gastric
bypass), or
absence of
terminal ileum
(Crohns).
Dx: anti-intrinsic
factor Abs
Scurvy swollen
gums, bruising,
petechiae,
hemarthrosis,
anemia, poor
wound healing,
perifollicular and
subperiosteal
hemorrhages,

N/V, diarrhea, fatigue,

Ca oxalate
nephrolithiasis.
Can increase risk of Fe
toxicity in predisposed
individuals (e.g. those
with transfusions,
hereditary
hemochromatosis).

Found in fruits
and vegetables.
Ancillary tx for
methemoglobine
mia by reducing
Fe3+ to Fe2+.

synthesis.
Necessary for
dopamine betahydroxylase,
which converts
dopamine to
NE.
Increase
intestinal
absorption of
Ca and
Phosphate;
increase bone
mineralization

Tocopherol,
Tocotrienol

Antioxidant
protects RBCs
and
membranes
from free
radical damage

corkscrew hair
Weakened
immune response
to local infxn.

Rickets in kids
(bone pain and
deformity),
osteomalacia in
adults (bone pain
and muscle
weakness),
hypocalcemic
tetany.
Breastfed infants
should receive oral
vit D.
Deficiency
exacerbated by
low sun exposure,
pigemneted skin,
prematurity.
Hemolytic anemia,
acanthocytosis,
muscle weakness,
post. column and
spinocerebellar
tract

HYpercalcemia,
hypercalciuria, loss of
appetite, tupor.
Seen in
granulomatous
disease (increased
activation of vti D by
epithelioid macs)

D2=ergocalciferol
(plants)
D3=cholecalcifero
l (milk, sun
exposed skin
stratum basale)
25-OH D3=
storage form
1,25-(OH)2 D3=
calcitriol, active
form

Can enhance
anticoagulant
effects.

demyelination.

Phytomenadio
ne,
Phylloquinone,
Phytonadione

Neuro
presentation may
seem similar to
B12 def but w/o
megaloblastic
anemia,
hypersegmented
neutrophils, or
increased serum
methylmalonic
acid levels.
Cofactor for
Necessary for
gammamaturation of
carboxylation of clotting factors 2,
glutamic acid
7, 9, 10, C, and S.
residues on
Neonatal
various proteins hemorrhage w/
required for
increase PT and
clotting.
aPTT but normal
Synthesized by bleeding time.
intestinal flora. Neonates cannot
synthesize vit K
b/c sterile
intestines.
Can also occur
after prolonged
use of broad
spectrum Abx.

Warfarin is a vit K
antagonist.
Not in breast
milk..
Give neonates vit
K injection at
birth to prevent
hemorrhagic
disease of
newborn.

Zinc

Essential for
activity of 100+
enzymes.
Important in
formation of
zinc fingers
(transcription
factor motif).

Delayed wound
healing,
hypogonadism,
decreased adult
hair (axillary,
facial, pubic),
dysgeusia,
anosmia,
acrodermatitis
enteropathica.
May predispose to
alcoholic cirrhosis.