Intolerance vitamin

The answer is a. (Hardman, pp 1086—1089.) Intolerance of alcohol (disulfiram-like reaction) has been noted only with certain cephalosporins. Cephalosporins with the methylthiotetrazole side chain have been associated with a disulfi ram-like reaction because the methyl thiotetrazole group has a configuration similar to disulfi ram, which blocks the metabolism of alcohol at the acetaldehyde step. Accumulation of acetaldehyde is associated with the symptoms. The methyl thiotetrazole side chain also results in hypopro thrombi nemia by interfering with the synthesis of vitamin K-dependent clotting factors. 

Common but usually transient side effects are lethargy, incoordination, blurred vision, higher cortical dysfunction, and drowsiness. At concentrations greater than 50 mcg/mL, phenytoin can exacerbate seizures. Chronic side effects include gingival hyperplasia, impaired cognition, hirsutism, vitamin D deficiency, osteomalacia, folic acid deficiency, carbohydrate intolerance, hypothyroidism, and peripheral neuropathy. 

The absorption of vitamin C is saturated at high doses, and therefore intakes above 1 g/day would be associated with negligible increased uptake at tissue levels, but they increase the risk of adverse gastrointestinal effects. Indeed, acute gastrointestinal intolerance (e.g., abdominal distension, flatulence, diarrhea, transient colic) has been observed. 

The answer is B. This patient s greasy, foul-smelling stools indicate steatorrhea. Her vision problems may be a manifestation of vitamin A deficiency due to fat malabsorption. The most likely explanation is biliary insufficiency, ie, decreased bile salt production leading to poor emulsification of dietary fats. Active ileal disease is a possibility, but the WBC count would likely be elevated unless her condition was in remission. Infection with Giardia is less likely due to the absence of pathogenic organisms in her stool. Lactose intolerance can produce diarrhea but not steatorrhea. 

Dr. Rea s approach to treatment includes consistent programs of avoidance, neutralizing injections (for aller-gies/intolerances), detoxification therapies using a sauna, massages and exercise programs in controlled environments and vitamins and minerals. 

Celiac disease is the result of the development of inflammatory-allergic condition due to gluten intolerance. The disease occurs both in adults and in children in a number of countries all over the world. Its occurrence is fairly frequent, it is estimated that approximately 1% of the population suffers from it. Patients manifest not only gastrointestinal symptoms, but also symptoms which are the consequence of malabsorption syndrome, such as osteoporosis, hypochromic anemia, hypoproteinaemia, hypocalcemia, short stature in children, vitamin deficiency, secondary polysensibilization, and emotional disturbances. Moreover, it has been observed that the occurrence of autoimmunological diseases and neoplasms in patients who are not treated with gluten-free diet doubles (Swinson et al., 1983 Ventura et al., 1999). 

In a second case, a 15-year-old girl presented with a long-standing muscle weakness, exercise intolerance, hypoglycemia, lactic acidosis, and a high anion gap. For 2 subsequent years, she was treated by various methods in an effort to control her acidosis without success. At the age of 17, a muscle biopsy was collected, and her mitochondria were shown not to be able to oxidize reduced CoQ. She was then treated with vitamin K3 and vitamin C with remarkable success. 

Normally there is very little fat in the feces. However, fat content in stools may increase because of various fat malabsorption syndromes. Such increased fat excretion is steatorrhea. Decreased fat absorption may be the result of failure to emulsify food contents because of a deficiency in bile salts, as in liver disease or bile duct obstruction (stone or tumor). Pancreatic insufficiency may result in an inadequate pancreatic lipase supply. Finally, absorption itself may be faulty because of damage to intestinal mucosal cells through allergy or infection. An example of allergy-based malabsorption is celiac disease, which is usually associated with gluten intolerance. Gluten is a wheat protein. An example of intestinal infection is tropical sprue, which is often curable with tetracycline. Various vitamin deficiencies may accompany fat malabsorption syndromes. 

The fourth section deals with various aspects Digestion, Absorption, and Nutritional Biochemistry. The chapter Obesity considers current problems with respect to the ever-increasing incidence of imbalance between energy intake and utilization. Key problems of undemutrition are discussed in the chapters Protein-Energy Malnutrition and Vitamin A Deficiency in Children. The chapters Lactose Intolerance, Pancreatic Insufficiency, and Abetalipoproteinemia focus on the biochemical processes underlying food digestion and absorption. Calcium Deficiency Rickets, Vitamin B12 Deficiency, and Hemochromatosis provide discussions of absorption and utilization of vitamin D, vitamin B12, and iron, respectively. 

Propionyl CoA inhibits A(-acetylglutamate synthetase competitively with respect to acetyl CoA, forming A(-propionylglutamate and reducing the synthesis of A(-acetylglutamate. This is an obligatory activator of carbamyl phosphate synthetase, the first enzyme of urea synthesis. Vitamin B12 deficiency may result in some degree of protein intolerance and hyperammonemia. 

The cephalosporins are contraindicated in patients with known allergies or intolerances to any of the cephalosporins. Because the penicillins and cephalosporins have a common chemical structure, cross-allergies occur with these drugs. Thus before initiating therapy with a cephalosporin, careful inquiry should be made concerning previous hypersensitivity reactions to the other drugs. Because a secondary vitamin K deficiency can develop with cephalosporin use, the cephalosporins are contraindicated in patients with hemophilia. Cefaclor is also contraindicated in any patient with previous drug-related joint and skin reactions. 

Patients with sarcoidosis are intolerant of vitamin D possibly even to the tiny amoimt present in a normal diet, and to that synthesised in their skin by sunlight. The intolerance may be due to overproduction of calcitriol (see above) by macrophages activated by interferon the overproduction is reversed by corticosteroid, which is also used in the treatment of severe hypervitaminosis D (see below). 

Kolz R, Lonsdorf G, Burg G. Unvertraglichkeitsreaktionen nach parenteraler Gabe von Vitamin Bl. [Intolerance reactions following parenteral administration of vitamin B.j Hautarzt 1980 31(12) 657-9. 

Acute intoxication has been observed after ingestion of vitamin A-rich liver from the polar bear, halibut, or shark, or after the use of fish oil supplements used to lower plasma lipids. In adults, toxic doses have been in the range of one or more million units of vitamin A, but in children as low as 10 000 micrograms RE, or even in a few children under 650 micrograms RE/day (12). Symptoms occur at 6-24 hours after ingestion and include acute drowsiness, irritability, vertigo, headache, delirium and convulsions, intolerance of food, and diarrhea (SEDA-8, 344). 

Methylmalonic aciduria Methylmalonyl-CoA isomerase or vitamin Bu coensyme Methylmalonic acid (4 glydne) Methylmalonic acid Metbylmalmiic add increased in CSF, keto-nuria, protdn intolerance Coma, extensOT spasna. retarded devdopment, metabolic addosis (vitamin Bu treats ment) Chromatography Aeetest sticks (01, R9. Rll, R12. S41. S53)... 

Because of the lipase deficiency, fat-soluble vitamin (A, D, E, and K) deficiencies may occur. Whether lipase activity or bile acids (e.g., in micelle formation) are involved in fat-soluble vitamin absorption with steatorrhea is unclear. Vitamin and zinc deficiencies also may occur as aresult of pancreatic enzyme deficiency. Although pancreatic involvement is predominantly exocrine in nature, insulin deficiency with glucose intolerance also occurs in CF patients, especially as they advance in age. Carbohydrate intolerance is characterized by low insulin concentrations and enhanced peripheral sensitivity to insulin but not by the presence of islet cell or anti-insulin antibodies. Carbohydrate intolerance in CF is not usually associated with the ketosis as commonly occurs in type 1 diabetes. This complication involves an increase in the number of insulin receptors with decreased affinity for insulin. Despite a concomitant increase in tissue affinity for insulin, 8% of CF children over 12 years of age require insulin therapy. 

Administration. Most children and adults do not ingest sufficient dietary calcium and require supplements (see Tables 88-5 and 88-6). Individuals with certain characteristics or conditions—such as lactose intolerance nondairy vegetarian diet malnutrition low-fat diets and glucocorticoid, antiresorptive, or parathyroid therapy—also require evaluation for calcium supplementation. To ensure adequate calcium absorption, 25(OH) vitamin D concentrations should be maintained in the normal range." ... 

Formula or breast-feeding and age at initiation of solid foods Supplemental vitamin, mineral, or herbal intake Food allergies or intolerance Underlying pathology with nutritional effects... 

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