Nutritional Disorders

Nutritional Disorders

Vitamin A (Retinol)


Pathology:                Fat soluble vitamin, found in liver, kidney, eggs and green vegetables. Role in corneal and conjunctival development


Aetiology:                 Rare in the industrialised world but more common in developing countries

Can occur in diseases causing malabsorption including chronic pancreatitis, coeliac disease, Crohn’s disease and cystic fibrosis due to fat malabsorption


Symptoms:               Poor vision at night, dry eyes


Signs:                          Xerophthalmia (due to impaired lacrimal gland function and results in dry eyes, night blindness and can even result in total blindness)


Investigations:      Clinical diagnosis


Treatment:              Medical: Vitamin A supplements, pancreatic enzyme supplements if secondary to

  fat malabsorption due to pancreatic insufficiency


Complications:        Night blindness


Prognosis:             Usually reversible, advanced xerophthalmia can be irreversible



Vitamin B1 (Thiamine)


Pathology:                Water soluble vitamin, found in pork, rice, beans and cereals

Role as enzyme co-factor


Aetiology:                 Alcohol excess


Symptoms:               Confusion, gait abnormalities, memory problems


Signs:                          Beri Beri: Motor and sensory peripheral neuropathy resulting in pain and weakness,

      can also present with CCF, ascites and peripheral oedema

Wernicke’s Encephalopathy: Confusion, nystagmus, ataxia and ophthalmoplegia,

 almost always associated with alcohol excess

Korsakoff’s Syndrome: Chronic state due to Wernicke’s encephalopathy results in

impaired short term memory characterised by confabulation


Investigations:      Clinical diagnosis


Treatment:              Medical: IV thiamine and oral thiamine supplements


Complications:      Korsakoff’s syndrome is irreversible


Prognosis:                Beri Beri and Wernicke’s encephalopathy reverse with supplementation, Korsakoff’s syndrome is irreversible



Vitamin B3 (Nicotinic acid)


Pathology:                Water soluble, found in yeast, meat, beans, role as an enzyme cofactor


Aetiology:                 Alcohol excess, anorexia nervosa, malabsorption


Symptoms:               Rash, memory problems, diarrhoea

Signs:                          Pellagra: symmetrical photosensitive hyperpigmented rash, red tongue


Investigations:      Clinical diagnosis


Treatment:              Medical: Vitamin B3 supplementation such as Niacin


Complications:      Dementia, Diarrhoea, Dermatitis


Prognosis:                Reversible


Vitamin C (Ascorbic acid)


Pathology:                Water soluble vitamin, found in citrus fruits, tomatoes, cabbage and spinach, roles include co-factor and antioxidant.


Aetiology:                 Seen in malnourished individuals


Symptoms:               Bleeding gums, poor wound healing, weakness, malaise, and depression


Signs                            Oedema, neuropathy


Investigations:      Clinical diagnosis


Treatment:              Medical: Vitamin C supplementation


Complications:      Scurvy


Prognosis:                Reversible


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