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Vitamin k and e
1. 1. VITAMIN E
2. VITAMIN K
3. HYPOPHOSPHATASIA
4. PSEUDO HYPOPHOSPHATASIA
Overview
2. VITAMINS
Vitamins or “vital
amines” are essential
food factors required
in the diet in small
amounts to do
specific biological
functions to maintain
normal growth and
health of an
organism.
4. VITAMIN E
Tocopherol aka “the alcohol which brings forth offspring”
Vitamin E consists of 8 naturally occurring tocopherols of
which α-tocopherol is the most active.
FUNCTIONS:
1. Prevent peroxidation of polyunsaturated fatty
acids .
2. Anti-oxidant.
3. Aids in the formation of RBC’s.
4. Anti-cancer. (γ- tocopherol )
5.
6. Daily Requirements
Infant 3mg
Adult 10mg
Deficiency is very rare as our daily intake is approx. 15 mg per day.
Deficiency
Increased fragility of RBCs
Degeneration of neurons – chronic cholestatic liver disease
muscle weakness, degeneration of retina- abetalipoproteinemia
In animals
decreased male sterility
vit-E deficient rats -loss of pigmentation and atrophic, degenerative changes
in enamel organ is seen.
9. Vitamin
Also called as “Koagulation vitamin”.
Two natural forms of vitamin K
K1- phylloquinone - derived from vegetables and animal
source
K2- menaquinone – synthesized by bacterial flora and
found in hepatic tissue.
One synthetic form K3 – menadione which is water
soluble.
10.
11. Vitamin K is necessary for the post transitional carboxylation
of glutamic acid necessary for calcium binding to gamma
carboxylated proteins such as prothrombin, factors VII, IX, X,
protein C, protein S and proteins found in bone.
14. The ability to bind calcium ions is acquired by the activation of
vitamin K dependent clotting factors or proteins in clotting
cascade.
15. Other functions of vitamin K
Protects bones from weakening
or fracture
Prevents calcification of blood
vessels or heart vessels
16. Daily requirements
Deficiency
1. In new-borns : bleeding into skin
blood in stool can be seen.
2. In adults : Secondary hypovitaminosis K- due to
impaired fat absorption or
ulcerative colitis or
obstructive jaundice.
1-2 mcg per kg
But our dietary intake is approx. 300-500 mcg ,
which is more than enough to meet daily
requirements
18. Diagnosis : elevated prothrombin time
reduced clotting factors.
Treatment
new-borns are given vitamin K injection.
Dierary supplements.
19. Hypophosphatasia
It is a rare metabolic bone disorder characterised by a
deficiency of tissue non specific alkaline phosphatase.
The main features include the following:
1. Reduced levels of bone, liver and kidney isoenzyme of alkaline
phosphatase.
2. Increased levels of blood and urinary
phosphoethanolamine.(inhibit mitochondrial function)
3. Bone abnormalities that resemble rickets.
20. I. Perinatal hypophosphatasia
Most severe
Infant rarely survives- death is due to respiratory failures.
Hypo calcification of skeletal structures.
21. II. Infantile hypophosphatasia
Appear normal up to 6 months of age- then show a failure to grow.
Vomiting and hypotonia.
Skeletal malformations – shortened and bowed limbs.
Deformities of ribs- rachitic rosary- which predisposes patients to
pneumonia.
Nephrocalcinosis and nephrolithiasis
H/P: abundant production of poorly mineralised osteoid
22. III. Childhood hypophosphatasia
Premature loss of primary teeth without evidence of a
significant inflammatory response.
Enlarged pulp chambers and alveolar bone loss
Open fontanelles with premature fusion of cranial
sutures- increased intracranial pressure and
subsequent brain damage.
Short stature, bowed legs and waddling gait.
H/P: woven bone (less mature form of osseous tissue)
maybe seen, absence of cementum that
covers the root surface.
24. IV. Adult hypophosphotasia
Many patients are edentulous- loss of permanent and deciduous teeth
Stress fractures that involve metatarsal bone of the feet
H/P: woven bone maybe seen
25. Treatment and prognosis
Symptomatic treatment
Orthopaedic surgery for fractures, prosthetic appliances for missing teeth
Genetic counselling
Perinatal and infantile- poor prognosis
Childhood and adult- better prognosis
Diagnosis
Clinical manifestations
Decreased levels of serum alkaline phosphatase
Increased amounts of phosphoethynylamine in urine and
blood
