1. Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 53 Vitamins and Minerals

2. 2 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamins  Organic molecules needed in small quantities for normal metabolism and other biochemical functions, such as growth or repair of tissue  Attach to enzymes or coenzymes and help them activate anabolic (tissue-building) processes

3. 3 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamins (cont’d)  Essential part of enzymatic reactions  Natural sources from both plants and animals  Insufficient amounts result in various deficiencies

4. 4 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamins (cont’d)  Vitamin K and vitamin B complex obtained by synthesis by normal bacteria in the small intestine  Vitamin D can be synthesized by the skin when exposed to sunlight

5. 5 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Water-Soluble Vitamins  B-complex group and vitamin C  Can be dissolved in water  Easily excreted in the urine  Cannot be stored by the body in large amounts  Daily intake required to prevent deficiencies

6. 6 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Fat-Soluble Vitamins  Vitamins A, D, E, K  Present in both plant and animal foods  Stored in the liver and fatty tissues  Excreted via the feces  Daily intake not required

7. 7 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Fat-Soluble Vitamins (cont’d)  Deficiency occurs only after prolonged deprivation  Can become toxic if excessive amounts are consumed

8. 8 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamins: Other Issues  Nutrient megadosing  Toxic hypervitaminosis  RDAs  DRIs  Percentage Daily Values

9. 9 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin A  Fat soluble  Vitamin A (retinol) food sources: liver, fish, dairy products, egg yolks, dark green leafy vegetables, and yellow-orange vegetables and fruits  Vitamin A comes from carotenes, which are found in plants (green and yellow vegetables and yellow fruits)

10. 10 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin A (cont’d)  Required for growth and development of bones and teeth  Essential for night and normal vision  Necessary for other processes  Reproduction  Integrity of mucosal and epithelial surfaces  Cholesterol and steroid synthesis

11. 11 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin A: Indications  Dietary supplement  Infants and pregnant and nursing women  Deficiency states  Hyperkeratosis of the skin  Night blindness  Other conditions  Skin conditions  Acne, psoriasis, keratosis follicularis

12. 12 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin A: Toxicity  Ingestion of excessive amounts causes toxicity  Irritability, drowsiness, vertigo, delirium, vomiting, other symptoms  Increased intracranial pressure in infants  Generalized peeling of the skin and erythema over several weeks

13. 13 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin D  Fat soluble  “Sunshine vitamin”  Responsible for proper utilization of calcium and phosphorus  Actually a group of analog steroid chemicals

14. 14 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin D (cont’d)  Different chemicals, produce same effect  Vitamin D 2 (ergocalciferol)  Plant vitamin D  Obtained through dietary sources  Vitamin D 3 (cholecalciferol)  Produced in the skin by ultraviolet irradiation (sunshine)

15. 15 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin D (cont’d)  Vitamin D 2 -containing foods  Fish liver oils, saltwater fish  Fortified foods: milk, orange juice, cereals  Animal livers, eggs, butter, dairy products  Endogenous synthesis in the skin

16. 16 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin D: Function  Regulates absorption of and use of calcium and phosphorus  Necessary for normal calcification of bone and teeth

17. 17 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin D: Indications  Dietary supplement  Treatment of vitamin D deficiency  Treatment and correction of conditions related to long-term deficiency: rickets, tetany, osteomalacia  Prevention of osteoporosis  Other uses

18. 18 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin D: Toxicity  Long-term ingestion of excessive amounts causes toxicity  Hypertension, weakness, fatigue, headache, many others  GI tract effects  CNS effects

19. 19 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Forms of Vitamin D  calcifediol (Calderol)  calcitriol (Rocaltrol)  dihydrotachysterol (Hytakerol)  ergocalciferol (Drisdol)

20. 20 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin E  Fat soluble  Tocopherols  Dietary plant sources  Fruits, grains, fortified cereals, vegetable oils, wheat germ, nuts  Animal sources  Eggs, chicken, meats, fish

21. 21 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin E: Function  Exact biologic function of vitamin E is unknown  Believed to act as an antioxidant

22. 22 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin E: Indications  Dietary supplement  Antioxidant  Treatment of deficiency  Highest risk of deficiency in premature infants

23. 23 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin E: Adverse Effects  Very few acute adverse effects  GI tract  CNS effects

24. 24 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin K  Fat soluble  Three types: K 1, K 2, K 3  Dietary sources of K 1  Green leafy vegetables (broccoli, cabbage, spinach, kale), cheese, soybean oils  Vitamin K 2 synthesized by intestinal flora

25. 25 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin K: Functions  Essential for synthesis of blood coagulation factors in the liver  Vitamin K–dependent clotting factors  II  VII  IX  X

26. 26 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin K: Indications  Dietary supplementation  Treatment of deficiency states (rare)  Antibiotic therapy  Malabsorption  Given prophylactically to newborn infants  Reverses the effects of certain anticoagulants (warfarin)

27. 27 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Forms of Vitamin K  Vitamin K 1 (phytonadione, AquaMEPHYTON)

28. 28 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Water-Soluble Vitamins  Vitamin B complex  Thiamine (B 1 )  Riboflavin (B 2 )  Niacin (B 3 )  Pantothenic acid (B 5 )  Vitamin C  Ascorbic acid  Pyridoxine (B 6 )  Folic acid (B 9 )  Cyanocobalamin (B 12 )

29. 29 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Water-Soluble Vitamins (cont’d)  Can dissolve in water  Excessive amounts excreted in the urine, not stored in the body  Toxic reactions are very rare  Act as coenzymes or oxidation-reduction agents

30. 30 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 1 (Thiamine)  Water soluble  Food sources  Enriched whole grain breads and cereals, liver, beans, yeast  Deficiencies  Beriberi  Wernicke’s encephalopathy

31. 31 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 1 (Thiamine): Deficiencies  Beriberi  Brain lesions, polyneuropathy of peripheral nerves, serous effusions, cardiac anatomic changes  Wernicke’s encephalopathy  Also known as cerebral beriberi

32. 32 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 1 (Thiamine): Causes of Deficiencies  Poor diet  Extended fever  Hyperthyroidism  Liver disease  Alcoholism  Malabsorption  Pregnancy and breast-feeding

33. 33 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 1 (Thiamine): Functions  Essential for:  Carbohydrate metabolism  Many metabolic pathways, including Krebs cycle  Maintains integrity of:  Peripheral nervous system  Cardiovascular system  GI tract

34. 34 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 1 (Thiamine): Indications  Treatment of thiamine deficiency  Beriberi  Wernicke’s encephalopathy  Peripheral neuritis associated with pellagra  Metabolic disorders

35. 35 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 1 (Thiamine): Indications (cont’d)  Dietary supplement  Malabsorption induced by alcoholism, cirrhosis, GI disease  Oral insect repellant  Other uses

36. 36 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 2 (Riboflavin)  Water soluble  Food sources  Green leafy vegetables  Eggs, dairy products  Nuts, legumes  Meats, liver  Yeast, enriched whole-grain products

37. 37 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 2 (Riboflavin): Causes of Deficiency  Alcoholism is a major cause  Deficiency also caused by:  Intestinal malabsorption  Long-term infections  Liver disease  Malignancy  Probenecid therapy

38. 38 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 2 (Riboflavin): Functions  Converted into enzymes essential for tissue respiration  Required to activate vitamin B 6 (pyridoxine)  Converts tryptophan into niacin  Maintains erythrocyte integrity

39. 39 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 2 (Riboflavin): Deficiency  Deficiency results in:  Cutaneous, oral, and corneal changes Cheilosis (chapped or fissured lips) Cheilosis (chapped or fissured lips) Seborrheic dermatitis Seborrheic dermatitis Keratitis Keratitis

40. 40 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 2 (Riboflavin): Indications  Dietary supplement  Treatment of deficiency  Microcytic anemia  Acne  Migraine headaches  Many other uses

41. 41 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 2 (Riboflavin): Adverse Effects  No adverse or toxic effects  Large doses will discolor urine to a yellow-orange

42. 42 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 3 (Niacin)  Water soluble  Food sources  Beans, turkey, tuna, liver, yeast  Enriched whole-grain breads and cereals, wheat germ  Also synthesized from tryptophan (an essential amino acid obtained from protein digestion)

43. 43 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 3 (Niacin): Functions  Once ingested, converted to nicotinamide  Nicotinamide is converted to two coenzymes  These enzymes are required for:  Glycogenolysis, tissue respiration  Lipid, protein, and purine metabolism

44. 44 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 3 (Niacin): Indications  Antihyperlipidemic drug  Lowers serum cholesterol and triglyceride levels by reducing VLDL synthesis  Doses required for this effect are higher than those required for its nutritional and metabolic effects

45. 45 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

46. 46 Vitamin B 3 (Niacin): Deficiency  Pellagra: niacin deficiency  Mental: various psychotic symptoms  Neurologic: neurasthenic syndrome  Cutaneous: crusting, erythema  Inflammation of mucous membranes: oral, vaginal, and urethral lesions; glossitis  GI: diarrhea or bloody diarrhea

47. 47 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 3 (Niacin): Adverse Effects  Adverse effects seen when higher doses are used in the treatment of hyperlipidemia  Flushing  Pruritus  GI distress

48. 48 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 6 (Pyridoxine)  Water soluble  Sources  Whole grains, wheat germ, yeast  Fish, organ meats, poultry, meats, eggs  Peanuts, nuts, vegetables, bananas

49. 49 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 6 (Pyridoxine) (cont’d)  Composed of three compounds  Pyridoxine  Pyridoxal  Pyridoxamine

50. 50 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 6 (Pyridoxine): Function  Necessary for many metabolic functions  Protein, lipid, and carbohydrate utilization  Conversion of tryptophan to niacin  Necessary for integrity of peripheral nerves, skin, mucous membranes, hematopoietic system

51. 51 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 6 (Pyridoxine): Deficiency  Signs and symptoms  Sideroblastic anemia  Neurologic disturbances  Seborrheic dermatitis  Cheilosis (chapped, fissured lips)  Glossitis, stomatitis,  Epileptiform convulsions  Hypochromic microcytic anemia

52. 52 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 6 (Pyridoxine): Causes of Deficiency  Inadequate intake  Poor absorption  Uremia, alcoholism, cirrhosis, hyperthyroidism, malabsorption, heart failure  Drug induced (isoniazid, hydralazine, others)

53. 53 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 6 (Pyridoxine): Indications  Used to prevent and treat deficiency

54. 54 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 6 (Pyridoxine): Toxicity  Toxic effects occur with large doses, especially neurotoxicity

55. 55 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 12 (Cyanocobalamin)  Water soluble  Synthesized by microorganisms present in the body  Food sources  Liver, kidney, fish, shellfish, poultry, milk  Eggs, blue cheese, fortified cereals  Contained in minimal amounts in plants

56. 56 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 12 (Cyanocobalamin): Function  Present as two different coenzymes  Required for many metabolic pathways  Fat and carbohydrate metabolism  Protein synthesis  Growth, cell replication  Hematopoiesis  Nucleoprotein and myelin synthesis

57. 57 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

58. 58 Vitamin B 12 (Cyanocobalamin): Deficiency  Deficiency leads to:  Neurologic damage  Pernicious anemia  Deficiency states caused by:  Malabsorption  Poor dietary intake (vegetarians)

59. 59 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 12 (Cyanocobalamin): Oral Absorption  Oral absorption of vitamin B 12 (extrinsic factor) requires presence of the intrinsic factor  The intrinsic factor is a glycoprotein secreted from the gastric parietal cells

60. 60 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin B 12 (Cyanocobalamin): Oral Absorption (cont’d)  The extrinsic and intrinsic factors form a complex that is then absorbed by the intestines

61. 61 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

62. 62 Vitamin C (Ascorbic Acid)  Water soluble  Natural sources  Citrus fruits and juices, strawberries  Tomatoes, potatoes  Broccoli, spinach, Brussels sprouts  Cabbage, green peppers  Liver  Can also be synthesized

63. 63 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin C (Ascorbic Acid): Functions  Acts in oxidation-reduction reactions  Required for several metabolic activities  Collagen synthesis  Maintenance of connective tissue  Tissue repair  Maintenance of bone, teeth, and capillaries  Folic acid metabolism  Erythropoiesis

64. 64 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin C (Ascorbic Acid): Functions (cont’d)  Enhances absorption of iron  Required for the synthesis of:  Lipids  Proteins  Steroids  Aids in cellular respiration  Aids in resistance to infections

65. 65 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin C (Ascorbic Acid): Deficiency  Prolonged deficiency results in scurvy  Gingivitis and bleeding gums  Loss of teeth  Anemia  Subcutaneous hemorrhage  Bone lesions  Delayed healing of soft tissues and bones

66. 66 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin C (Ascorbic Acid): Indications  Dietary supplement  Prevention and treatment of scurvy  Urinary acidifier

67. 67 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Vitamin C (Ascorbic Acid): Megadoses  Megadoses may cause:  Nausea, vomiting, headache, abdominal cramps  Acidified urine, with possible stone formation  Discontinuing megadoses may result in scurvy-like symptoms

68. 68 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Minerals  Inorganic elements or salts  Bind with enzymes or other organic molecules  Help to regulate many bodily functions

69. 69 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Minerals (cont’d)  Building blocks for many body structures  Required for intracellular and extracellular body fluid electrolytes  Macrominerals  Microminerals, or trace elements

70. 70 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

71. 71 Calcium  Most abundant mineral element in the body  Accounts for 2% of body weight  Highest concentration in bones and teeth  Efficient absorption requires adequate amounts of vitamin D

72. 72 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Calcium: Food Sources  Found in many foods  Especially milk and dairy products  Fortified cereals  Calcium-fortified orange juice  Sardines, salmon

73. 73 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Calcium Requirements  Calcium requirements high for:  Growing children  Women who are pregnant or breast-feeding

74. 74 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Calcium: Function  Essential for normal maintenance and function of:  Nervous, muscular, skeletal systems  Cell membrane and capillary permeability  Catalyst in many enzymatic reactions

75. 75 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Calcium: Function (cont’d)  Essential in many physiologic processes  Transmission of nerve impulses  Contraction of cardiac, smooth, and skeletal muscles  Renal function, respiration, and blood coagulation  Several other functions

76. 76 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Calcium Deficiency  Calcium deficiency: hypocalcemia  Infantile rickets  Adult osteomalacia  Osteoporosis  Many other conditions associated with calcium deficiency

77. 77 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Calcium: Causes of Deficiency  Inadequate intake of calcium or vitamin D  Hypoparathyroidism  Malabsorption syndrome  Many other causes

78. 78 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Calcium: Indications  Used to treat various deficiency states  Dietary supplement for women during pregnancy and lactation

79. 79 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Calcium: Toxicity  Hypercalcemia may occur with therapy  Anorexia  Nausea  Vomiting  Constipation  Severe hypercalcemia can cause:  Cardiac irregularities  Delirium  Coma

80. 80 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Calcium: Drug Interactions Chelation  Calcium salts will bind (chelate) with tetracyclines to produce an insoluble complex

81. 81 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Magnesium  One of the principal cations of intracellular fluid  Essential for enzyme systems associated with energy metabolism  Required for:  Nerve physiology  Muscle contraction

82. 82 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Magnesium (cont’d)  Dietary sources  Green leafy vegetables  Meats, seafood, milk, cheese, yogurt  Bran cereal, nuts  Required in higher amounts for those with diets high in protein-rich foods, calcium, and phosphorus

83. 83 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Magnesium: Causes of Deficiency  Hypomagnesemia  Malabsorption  Alcoholism  Long-term IV feedings  Diuretics  Metabolic disorders (hyperthyroidism, diabetic ketoacidosis)

84. 84 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Magnesium: Indications  Nutritional supplement  Treatment of magnesium deficiency  Anticonvulsant in magnesium deficiency  Preeclampsia and eclampsia  Tocolytic drug for inhibition of uterine contractions in premature labor  Cardiac dysrhythmias  Many other uses

85. 85 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Magnesium: Adverse Effects  Adverse effects caused by hypermagnesemia  Tendon reflex loss  Difficult bowel movements  CNS depression  Respiratory distress  Heart block  Hypothermia

86. 86 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Phosphorus  Widely distributed in foods  Milk  Yogurt  Cheese  Peas  Meat  Fish  Eggs  Dietary deficiency is rare

87. 87 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Phosphorus Deficiency  Deficiency caused by nondietary causes  Malabsorption  Extensive diarrhea or vomiting  Hyperthyroidism  Long-term use of aluminum or calcium antacids  Hepatic disease

88. 88 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Phosphorus: Functions  Required precursor for the synthesis of essential body chemicals  Building block for body structures  Required for the synthesis of:  Nucleic acid  ADP  AMP  ATP

89. 89 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Phosphorus: Functions (cont’d)  Responsible for cellular energy transfer  Necessary for the development and maintenance of the skeletal system and teeth  Several other functions

90. 90 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Phosphorus: Indications  Treatment of deficiency states  Dietary supplement

91. 91 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Phosphorus: Adverse Effects  Diarrhea  Nausea and vomiting  Other GI disturbances  Confusion  Weakness  Breathing difficulties

92. 92 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Zinc  Trace element  Essential in metabolic reactions of proteins and carbohydrates  Important for normal tissue growth and repair, especially wound repair  Found in  Red meats, liver, oysters, milk products, eggs, beans, nuts, whole grains, fortified cereals, certain seafoods

93. 93 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications  Assess nutritional status  Assess baseline lab values (H&H, WBC, RBC, protein, albumin levels)  Assess history and medication history  Assess for contraindications

94. 94 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Follow specific guidelines for administration, especially if parenteral  Provide nutritional counseling about necessary foods to include in the diet

95. 95 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Monitor for therapeutic responses  Will vary for each vitamin and mineral  Monitor for adverse effects