Vitamins

• Alcoholism
  • 80% have thrombocytopenia due to bone marrow suppression
  • Anemia and leukopenia can also occur
• Anti-Vitamin Drugs
• Iron Deficiency
  • Microcytic anemia
  • Treatment
    • Iron Sucrose (Venofer)
      • 90 minute infusions for 3 days
      • Recheck in 4-6 weeks after tx
    • Iron Polysacchairde 150mg
      • Every other day
    • Iron Gluconate 324mg (68mg as iron) q48hrs
      • +/- Vitamin C
      • Re-assess in 2 weeks w/ cbc/RC, Hgb in 6-8 if anemic
• Vitamin B1 (Thiamine) Deficiency
  • Aka Beriberi or Wernicke Encephalopathy
  • Orthopedics, Neurology, and Ophthalmology Word Doc
  • Prevention
    • 100-200mg daily for 3-5 days, over 30 mins, IV ≥ Oral
• Vitamin B3 (Niacin) Deficiency
  • Aka Pellegra
• Vitamin B6 (Pyridoxine) Deficiency
• Vitamin B9 (Folate) Deficiency
  • Treatment
    • 1-5mg daily for 1-4m
    • Re-assess in 4 months
• Vitamin B12 (Cyanocobalamin) Deficiency
  • Macrocytic Anemia
  • Treatment
    • Pernicious anemia 1000mcg daily IM over 1 week
      • 1000-2000mcg daily for life
    • Other
      • Once monthly IM or 1000-2000mcg daily for 1 week and then monthly
    • Re-assess in 1-2 months, then 6 months, annually
• Vitamin C Deficiency
  • Within 3 months of deficiency, alcoholics, drug abusers
    • Impaired wound healing, perifollicular hemorrhages
  • Follicular hemorrhage, bleeding/receding gums, arthralgias
    • Vasomotor Instability (hot flashes) late
    • Hemolytic Anemia and Edema late
  • Diagnosis: Serum/Leukocyte Ascorbic Acid Levels
  • Treatment:
    • Oral/injectable Vitamin C
      • Toxicity at high levels (ab pain, diarrhea, nausea)
• Vitamin D Deficiency
  • Vitamin D 25-50 = Insufficiency
  • Vitamin D <25 = Deficiency
    • Vitamin D 12-30
      • Cholecalciferol 25-50mcg (1000-2000IU) daily for 6-12 weeks
    • Vitamin D <12
      • Cholecalciferol 75-125mcg daily for 6-12 weeks
      • Cholecalciferol 50k IU weekly oral x 6-12 weeks, then monthly
      • Recheck in 3-6 months
  • Calcium supplementation ≥1000mg per day

• Trace Mineral Deficiencies

  • RF for deficiency: malabsorption, bowel resection, poor nutritional intake, and parenteral nutrition
  • Chromium
    • Impaired glucose control in diabetics
  • Copper
    • Brittle hair, Skin depigmentation, Neurologic dysfunction, sideroblastic anemia, osteoporosis
    • Treatment
      • Cupric Sulfate
        • IV:2 mg IV for 5 days
        • Oral 8mg daily for 1 week, 6mg for 2nd week, 4mg 3rd week, 2mg after
      • Stop Zinc
  • Selenium
    • Thyroid dysfunction, cardiomyopathy, immune dysfunction
  • Zinc
    • Alopecia, Pustular skin rash, Hypogonadism, Impaired wound healing and taste, immune dysfunction