TABLE 20-4 Vitamin and Mineral Requirements and Imbalances

VITAMIN, RDA
RE!IREMENT"
#!N$TI%N $LINI$AL
MANI#E"TATI%N" %#
IMBALAN$E
DIA&N%"TI$
EVAL!ATI%N
MANA&EMENT
Vitamins
Vitamin A 'Retin(l)
RDA: 700-900 mcg
Fat soluble
Tissue maintenance
via antioxidant
ability
Skeletal and soft
tissue go!t" and
develo#ment
$isual ada#tation to
lig"t and dak
Su##ots
e#oductive
function
Deficiency: %ig"t
blindness& xeo#"t"almia&
keatini'ation& geneali'ed
mucosa dyness(damage&
vomiting& dia"ea& !eig"t
loss& uinay and vaginal
infections& toot" decay&
follicula "y#ekeatosis)
Toxicity: *ai loss& +oint
#ain& dy skin& mout"
soeness& anoexia&
vomiting& ci"osis)
Deficiency:
*istoy and
#"ysical findings
ae "el#ful in
diagnosis of most
vitamin
imbalances)
Seum level less
t"an ,- mg(d.
suggests vitamin
deficiency)
Deficiency:
Re#lacement t"ea#y
of ,0&000 /0 to teat
nig"t blindness)
1ood dietay souces
of vitamin A ae geen
and yello! fuits and
vegetables and live)
/n #atients !it"
malabso#tion of fat-
soluble vitamins and
#atients !it" lo!
dietay intake of
vitamin A& /)$)
su##lements ae
e2uied)
Vitamin B*
'T+iamine)
RDA: 3)3 mg
4ate soluble
5abo"ydate
metabolism
%ecessay fo
neuologic& gastic&
cadiac& and
musculoskeletal
function
Deficiency: A##etite loss&
consti#ation& dys#nea&
fatigue& iitability&
nevousness& memoy loss&
#aest"esias& muscle #ain&
beibei)
Toxicity: .age doses may
be given geneally !it"out
difficulty& alt"oug"
ana#"ylaxis "as been
e#oted)
Deficiency:
6yt"ocyte
tansketolase
activity less t"an
3-7-807)
Deficiency:
Teat undelying
cause)
*ig"-#otein diet !it"
su##lemental 9
com#lex vitamins)
Food souces ic" in
t"iamine ae be!e:s
yeast& meat& !"eat
gem& enic"ed gains
and beans)
;aenteal t"ea#y
!it" -0-300 mg(day
follo!ed by --30
mg(day ;<)
B2 'Rib(,la-in)
RDA: 3)3 mg
4ate soluble
5abo"ydate
metabolism
;omotes go!t"&
ed blood cell
fomation& and
"ealt"y eyes and
skin
Deficiency: Soe t"oat&
c"eilosis& dematitis&
buning and itc"ing of eyes&
teaing and vasculai'ation
of coneas= late-stage
sym#toms include
neuo#at"y and go!t"
etadation)
Toxicity: %one kno!n)
Deficiency:
6yt"ocyte
glutat"ione activity
geate t"an 3)8-
3),)
Deceased uinay
iboflavin levels)
Deficiency:
1ood dietay souces
of 98 ae daiy
#oducts& vegetables&
enic"ed gains& eggs&
nuts& live)
<al su##lements of
--3- mg(day)
B. '/0rid(1ine)
RDA: 3)8-3)- mg
4ate soluble
Re2uied fo #otein
metabolism
>aintains
neuologic function
and R95 #oduction
Deficiency: Anemia&
!eakness& glossitis&
c"eilosis& iitability&
sei'ues)
Toxicity: %euomuscula
damage& #ei#"eal
neuo#at"y)
Deficiency:
;yidoxal
#"os#"ate levels
less t"an -0
ng(m.)
Deficiency:
<al
su##lementation:30-
80 mg)
1ood dietay souces
of 9? ae bananas&
be!e:s yeast& fis"&
meat& !"ole gains&
live)
/ndividuals taking oal
contace#tives o
isonia'id may need to
su##lement t"ei diets
!it" #yidoxine)
;egnancy also
inceases need)
B*2 '$(balamin)
RDA: 8)@ mcg
4ate soluble
>aintains
neuologic function
and R95
develo#ment via
"emoglobin
synt"esis
Deficiency: >egaloblastic
anemia& memoy
im#aiment& confusion&
de#ession& fatigue&
nevousness& deceased
eflex es#onse& balance
im#aiment& s#eec"
difficulties& demyelination
of t"e lage fibes of t"e
s#inal cod& anoexia&
vomiting& !eig"t loss&
yello!ing of skin&
abdominal #ain& dys#nea&
dia"ea& glossitis)
Toxicity: %one)
Deficiency:
Seum levels of
less t"an 300
#g(m.)
Deceased
"ematocit !it"
elevation of >5$)
Sc"illing test also
measues
abso#tion of
adioactive 938)
Deficiency:
938 800 mcg(day /)>)
fo 3 !eek& t"en evey
mont" fo life if
deficiency is due to
#enicious anemia)
<al vitamin 938 may
be necessay fo stict
vegetaians)
1ood dietay souces
of 938 ae eggs& fis"&
ogan meats& lean
meat& daiy #oducts)
Bi(tin
RDA: 8--,0 mcg
4ate soluble
>etabolism of
#oteins& fats& and
cabo"ydates
Deficiency: Dy skin&
fatigue& gayis" skin
discoloation& muscle #ain&
de#ession& insomnia&
anoexia)
Toxicity: %one)
ABC Deficiency:
1ood souces of biotin
ae egg yolks&
vegetables& yeast&
milk& gains)
#(late '#(lic Acid)
RDA: @00 mcg
4ate soluble
R95 fomation
D%A and R%A
synt"esis and
su##ot of cell
go!t" and
e#oduction
;evention of bit"
defects
Deficiency: 1lossitis&
dia"ea& megaloblastic
anemia& digestive #oblems)
Toxicity: /nactivation of
anticonvulsants& masking of
vitamin 938 deficiency)
Deficiency:
Seum level less
t"an , ng(m.)
Deficiency:
%utitional
su##lementation:3
mg(day ;<)
Avoid alco"ol)
1ood souces of folate
ae citus fuits& eggs&
milk& geen leafy
vegetables& daiy
#oducts& ogan meats&
seafood& !"ole gains&
yeast)
Niacin
RDA: 3@-3? mg
4ate soluble
>etabolism of
cabo"ydates& fats&
and #oteins
4oks !it" t"iamine
and iboflavin fo
t"e #oduction of
cellula enegy
;omotes skin&
neuologic& and 1/
function
Deficiency: A#at"y& fatigue&
a##etite loss& "eadac"es&
indigestion& muscle
!eakness& nausea&
insomnia& dematitis&
dia"ea& confusion&
disoientation& memoy
im#aiment& glossitis&
stomatitis& #ellaga)
Toxicity: .ive damage&
flus"ing)
Deficiency:
Seum levels less
t"an ,0 mcg(300
m.)
Diminis"ed o
absent metabolites
in uine)
Deficiency:
1ood souces of
niacin ae eggs& lean
meats& ogan meats&
#oulty& seafood& fis"&
daiy #oducts& nuts&
!"ole and enic"ed
gains& be!e:s yeast)
%utitional
su##lementation: 30-
3-0 mg)
Su##lemental niacin
may also be necessay
!"en taking oal
contace#tives)
/ant(t+enic Acid
RDA: - mg
4ate soluble
$ital fo oveall
metabolism
Aids in fomation of
cabo"ydates&
#oteins& and fats
Aids in cotisone
#oduction& AT;
#oduction& stess
toleance& vitamin
utili'ation&
"emoglobin
synt"esis
Deficiency: Dia"ea& "ai
loss& es#iatoy infections&
nevousness& muscle
cam#s& #ematue aging&
intestinal disodes&
ec'ema& kidney disodes)
Toxicity: %one)
ABC Deficiency:
T"is vitamin is !idely
available in foods&
es#ecially ogan
meats& legumes&
vegetables& fuits)
Vitamin $
RDA: ?--90 mg
4ate soluble
Antioxidant action
deceases cellula
Deficiency: 9leeding gums&
toot" decay& nosebleeds&
lo! infection esistance&
Deficiency:
Seum levels less
Deficiency:
%utitional
dysfunction
;omotes !ound
"ealing
Aids in connective
tissue& bone& toot"&
and catilage
fomation
;omotes ca#illay
integity
;omotes non"eme
ion abso#tion
buising& anemia& delayed
!ound "ealing& anoexia&
+oint #ain& let"agy&
#eifollicula "emo"age)
Toxicity: 1/ distess)
t"an 0)3 mg(300
d.)
su##lementation: 300-
3&000 mg(day of
vitamin 5)
1ood souces of
vitamin 5 ae citus
fuits& geen leafy
vegetables& boccoli&
tomatoes& #e##es&
#otatoes& sta!beies)
Avoid smoking)
Vitamin D
RDA: --3- mcg
Fat soluble
Regulates calcium
and #"os#"ate
abso#tion and
metabolism and
bone fomation
Aids in enal
#"os#"ate cleaance&
myocadial function&
nevous system
maintenance& and
nomal blood
clotting
Deficiency: Rickets&
osteomalacia)
Toxicity: *y#ecalcemia&
bone #ain& !eakness)
5alcifications in soft tissue
can be fatal)
Deficiency:
.o! levels of
vitamin D and
calcium Dcalcium
less t"an E)-
mg(300 m.F)
Radioga#"ic bone
defomities)
Abnomal bone
densitomety)
Deficiency:
%utitional
su##lementation:
6gocalcifeol& 8-
mcg(day ;<)
1ood souces of
vitamin D ae egg
yolks& yeast& enic"ed
milk& fis" live oils)
6x#osue to sunlig"t)
Vitamin E
'T(c(2+er(l)
RDA: 3- mg
Fat soluble
Antioxidant action
deceases cellula
dysfunction
Aids in R95
fomation
Deficiency: %euomuscula
distubances& including
deceased eflexes&
vibatoy and #osition
sense& and ataxia)
Toxicity: /ntefeence !it"
Deficiency:
Seum levels less
t"an 0)- mg(d.)
Deficiency:
%utitional
su##lementation: 300-
@00 /0(day ;<)
;aenteal t"ea#y
may be necessay to
vitamin G) teat neuologic
sym#toms)
1ood souces of
vitamin 6 ae
vegetable oils& milk&
eggs& meat& fis"& geen
leafy vegetables)
Vitamin 3
RDA: 7--380 mcg
Fat soluble
;omotes
coagulation t"oug"
t"e fomation of
#ot"ombin and
ot"e clotting factos
Deficiency: Abnomal
bleeding times&
"emo"age& e#istaxis&
"ematemesis& and bleeding
at any oifice o #unctue
site ae #ossible)
Toxicity: %o toleable u##e
limit "as been establis"ed)
Deficiency:
;ot"ombin time
extended longe
t"an ;TT)
Deficiency:
Administation of
vitamin G 3- mg
subcutaneously)
1ood souces of
vitamin G ae geen
leafy vegetables& live&
!"eat gem& c"eese&
egg yolk& soybean oil)
Minerals
$alcium
A/: 3&000-3&,00 mg
Aids in bone and
toot" fomation&
muscle contaction&
blood coagulation&
neve im#ulse
tansmission& cadiac
function& cell
membane
#emeability&
en'yme activation
Deficiency: Toot" decay&
muscle cam#s& tetany&
nevousness and delusion&
cadiac #al#itations& "eat
failue& and #aest"esia)
Toxicity: 5onsti#ation&
enal calculi)
Deficiency:
Seum level less
t"an E)- mg(d.)
Toxicity:
Seum level
geate t"an 30)-
mg(d.)
Deficiency:
<al su##lements of
3-8 g(day of elemental
calcium)
/n sevee
"y#ocalcemia& 30 m.
of 307 calcium
gluconate /)$)
administeed no faste
t"an 8 m.(minute)
1ood souces of
calcium ae milk
#oducts& geen leafy
vegetables& legumes&
tofu #ocessed !it"
calcium)
Toxicity:
Foce fluids& diuetics&
and limit dietay
intake) Administation
of #"os#"ate salts and
glucocoticoids may
also be necessay)
$+r(mium
A/: 80-,- mcg
>aintains seum
glucose levels
>aintains fat
metabolism
Deficiency: 1lucose
intoleance& vetigo&
abdominal #ain& s"ock&
convulsions& anuia&
dematitis)
Toxicity: 0nkno!n)
Deficiency:
Seum levels less
t"an 0), mg(m.)
Deficiency:
%utitional
su##lementation: -0-
800 mg(day)
1ood souces of
c"omium ae
be!e:s yeast& !"ole
gains& ceeals)
$(22er
RDA: E90-900 mcg
*emoglobin
synt"esis
>aintenance of
"emostasis
6negy #oduction
Deficiency: *y#oc"omic
anemia& bone disease&
!eakness& skin lesions&
alteed es#iatoy status)
Toxicity: %ausea& vomiting&
dia"ea& abdominal #ain&
malaise)
Deficiency:
/n addition to
diminis"ed seum
levels& 8@-"ou
uine sam#les
s"o!ing levels of
uinay excetion
of co##e belo!
3--?0 mcg(8@
"ous)
Deficiency:
%utitional
su##lementation: 0)3
mg(kg(day ;<)
/)$)
su##lementation:3-8
mg(day)
1ood souces of
co##e ae nuts& seeds&
ogan meats& seafood)
I(dine
RDA: 3-0 mcg
T"yoid "omone
synt"esis
Deficiency:
*y#ot"yoidism o goite&
nevousness& iitability&
Deficiency:
.o! T, and T@
Deficiency:
%utitional
su##lementation: -0-
obesity& cold "ands and
feet& c"ills& bittle "ai&
fatigue& badycadia&
deceased cadiac out#ut&
t"ick tongue& "oaseness&
#oo memoy& "eaing loss&
anoexia)
Toxicity: 1oite)
levels)
T"yoid scan)
300 mg daily ;<)
1ood souces of
iodine ae iodi'ed salt&
seafood)
Ir(n
RDA: E-3E mg
*emoglobin
synt"esis
5ellula oxidation
Tans#otation of
oxygen
Deficiency: /on deficiency
anemia& fatigue&
tac"ycadia& #al#itations&
dys#nea& susce#tibility to
infection& bittle nails)
Toxicity: /on #oisoning)
Deficiency:
Deceased
"emoglobin&
"ematocit& ion&
and feitin levels
and inceased total
ion-binding
ca#acity)
Deficiency:
%utitional
su##lementation:
feous sulfate ,8- mg
;< T/D= /mfeon 8-0
mg( day /)>) fo eac"
gam of "emoglobin
belo! nomal)
/)$) su##lementation:
3)--8 g ove @-? "ous)
1ood souces of ion
ae egg yolks& fis"&
ogan meats& !"eat
gem& beans& lentils&
beef& #otatoes& #eas)
Ma4nesium
RDA: ,30-@80 mg
;aat"yoid "omone
egulation
Acid-base balance
6n'yme activation
Smoot" muscle
egulation
Deficiency: Tetany&
temos& confusion&
de#ession& tac"ycadia&
dys"yt"mias& sei'ues)
Toxicity: %ausea& vomiting&
do!siness& muscle
!eakness& deceased dee#
tendon eflexes&
"y#otension& es#iatoy
Deficiency:
Seum levels less
t"an 3), m62(.)
Toxicity:
Seum levels
geate t"an 8)3
m62(.)
Deficiency:
%utitional
su##lementation: 3-8
g /)$) duing 3-
minutes)
1ood souces of
magnesium ae nuts&
meat& !"ole gains&
geen vegetables&
>etabolism of
cabo"ydates and
#otein
5ell go!t" and
e#oduction
de#ession) seafood& daiy
#oducts)
Toxicity:
Su##otive measues)
/+(s2+(rus
RDA: 700-3&8-0 mg
%eve and muscle
activity
$itamin utili'ation
Gidney function
>etabolism of
cabo"ydates&
#oteins& and fats
5ell go!t" and
e#ai
>yocadial
contaction
6negy #oduction
9one and toot"
fomation
Acid-base balance
Red blood cell
function
Deficiency: Anoexia&
!eakness& temo&
#aest"esias& anemia&
mental status c"ange&
"y#oxia& osteomalacia)
Toxicity: Tetany& soft tissue
calcification& sei'ues& enal
damage)
Deficiency:
Seum levels less
t"an 8)- mg(d.)
Toxicity:
Seum levels
geate t"an @)-
mg(d.)
Deficiency:
%utitional
su##lementation: ;<
o /)$) #"os#"ate)
1ood souces of
#"os#"ate ae daiy
#oducts& eggs& fis"&
gains& meat& #oulty&
c"eeses& beans& cocoa&
c"ocolate& live& milk&
#eas& nuts)
Toxicity:
Administation of
#"os#"ate-binding
agents DAm#"o+elF)
*emodialysis o
#eitoneal dialysis)
/(tassium
A/: @&700 mg
>uscle contaction
5adiac function
Deficiency: >uscle
!eakness& fatigue& malaise&
flaccidity& mental
Deficiency:
Seum levels less
Deficiency:
%utitional
su##lementation: ;<
;otein synt"esis
%eve im#ulse
tansmission
5abo"ydate
metabolism
Acid-base balance
>a+o intacellula
cation
confusion& iitability&
de#ession& dys"yt"mias&
"y#otension& nausea&
vomiting& anoexia&
deceased 1/ motility&
muscle cam#s&
#aest"esias&
"y#eglycemia& #olyuia&
metabolic alkalosis)
Toxicity: >uscle !eakness&
#aalysis& #aest"esias&
nausea& vomiting& dia"ea&
metabolic acidosis&
#olonged cadiac
conduction& venticula
dys"yt"mias)
t"an ,)- m62(.)
Toxicity:
Seum levels
geate t"an -
m62(.)
o /)$)& /)$)
e#lacement geneally
at a ate of 30
m62("ou !it" caeful
cadiac monitoing
and fe2uent
measuements of
seum #otassium
levels)
1ood souces of
#otassium ae
bananas& oanges&
beef& #unes& beans&
seafood& aisins)
Toxicity:
/nfuse calcium
gluconate 307 D30
m.F)
Sodium bicabonate
infusion)
/nsulin and glucose
infusion)
<al o ectal
exc"ange esins)
*emodialysis o
#eitoneal dialysis)
"(dium
A/: 3&800 -3&-00 mg
>aintains fluid
balance
5ell membane
Deficiency: >uscle
!eakness& iitability&
"eadac"e& sei'ues& nausea&
vomiting& malaise&
Deficiency:
Seum levels less
t"an 3,- m62(.)
Deficiency:
Restict fee !ate
intake)
/nfuse 0)97 saline
#emeability and
abso#tion of
glucose
9ioelectic #otential
of tissues
5adiac function
Acid-base balance
Regulation of
neuomuscula
function
abdominal cam#ing&
"y#otension& tac"ycadia)
Toxicity: Flus"ed skin&
oliguia& agitation& t"ist&
dy mucous membanes&
sei'ues)
Toxicity:
Seum levels
geate t"an 3@-
m62(.)
solution if #atient is
"y#ovolemic)
/nfuse ,7 saline and
administe diuetic if
sodium levels
significantly lo!)
Demeclocycline may
be used to block AD*
in t"e enal tubules to
#omote !ate
excetion)
Toxicity:
Administe salt-fee
solutions suc" as D-4
follo!ed by 0)@-7
saline solution)
.o! sodium diet)
Administe
vaso#essin if
diminis"ed AD* is
t"e cause)
5inc
RDA: E-33 mg
5ellula metabolism
>aintenance of taste
and smell
9un and !ound
"ealing
1onadal function
Deficiency: Fatigue& "ai
loss& #oo !ound "ealing&
im#aied go!t"& bone
defomities& loss of taste&
anoexia& ion deficiency
anemia& "y#ogonadism&
"y#e#igmentation)
Toxicity: Diminis"ed dee#
tendon eflexes& malaise&
Deficiency:
Seum levels less
t"an 7- mcg(d.)
Deficiency:
%utitional
su##lementation: 'inc
sulfate 800 mg T/D
;<)
1ood souces of 'inc
ae live& seafood&
beans& lentils& oatmeal&
!"eat ban& egg yolks&
>aintenance of
seum vitamin A
concentation
Acid-base balance
;otein digestion
;omotion of go!t"
deceased level of
consciousness& dia"ea&
leuko#enia)
#eas& c"icken& and
milk)
Toxicity:
Su##otive measues)