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
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
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
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
