Oral supplementation

Infants maybe sensitive to doses of vitamin A [11103-57-4] in the range of 75,000—200,000 lU (22.5—60 mg), although the toxic dose in adults is probably 2—5 million lU (90.6—1.5 g). Intakes in this range from normal food suppHes without oral supplements are simply beyond imagination (79). Vitamin D [1406-16-2] toxicity is much more difficult to substantiate clinically. Humans can synthesize active forms of the vitamin in the skin upon irradiation of 7-dehydrocholesterol. Toxic symptoms are relatively nonspecific, and dangerous doses seem to He in the range of 1000—3000 lU/kg body wt (25—75 flg/kg body wt) (80). Cases of toxicity of both vitamins E and K have been reported, but under ordinary circumstances these vitamins are considered relatively innocuous (81). 

Fohc acid is safe, even at levels of daily oral supplementation up to 5—10 mg (97). Gastrointestinal upset and an altered sleep pattern have been reported at 15 mg/day (98). A high intake of foHc acid can mask the clinical signs of pernicious anemia which results from vitamin deficiency and recurrence of epilepsy in epileptics treated with dmgs with antifolate activity (99). The acute toxicity (LD q) is approximately 500 and 600 mg per kg body weight for rats and mice, respectively (100). 

Dietary deficiency in the absence of absorption defects can be effectively reversed with oral supplementation of 1 p.m of vitamin B 2 daily. If deficiency is related to a defect in vitamin absorption, daily doses of 1 pg adininistered subcutaneously or intramuscularly are effective (33). However, a single intramuscular dose of 100 pg of cobalamin once per month is adequate in patients with chronic gastric or ileal damage. Larger doses are generally rapidly cleared from the plasma into the urine and are not effective unless the patient demonstrates poor vitamin retention. 

The enzymes pancreatin and pancrelipase, which are manufactured and secreted by the pancreas, are responsible for the breakdown of fats, starches, and proteins. These enzymes are necessary for the breakdown and digestion of food. Both enzymes are available as oral supplements. 

Camitine deficiency can occur particularly in the newborn—and especially in preterm infants—owing to inadequate biosynthesis or renal leakage. Losses can also occur in hemodialysis. This suggests a vitamin-fike dietary requirement for carnitine in some individuals. Symptoms of deficiency include hypoglycemia, which is a consequence of impaired fatty acid oxidation and hpid accumulation with muscular weakness. Treatment is by oral supplementation with carnitine. 

Other disorders in which glycoproteins have been implicated include hepatitis B and C, Creutzfeldt-Jakob disease, and diarrheas due to a number of bacterial enterotoxins. It is hoped that basic smdies of glycoproteins and other glycoconjugates (ie, the field of glycobiology) will lead to effective treatments for diseases in which these molecules are involved. Already, at least two disorders have been found to respond to oral supplements of sugars. 

Greenberg, E.R. et al.. Mortality associated with low plasma concentration of beta carotene and the effect of oral supplementation, JAMA, 275, 699, 1996. 

Gaziano, J.M. et al.. Discrimination in absorption or transport of (3-carotene isomers after oral supplementation with either all-trans or 9-cis (3-carotene, Am. J. Clin. Nutr., 61, 1248, 1995. 

Dieber-Rotheneder, M., Puhl, H., Waeg, G., Striegl, G. and Esterbauer, H. (1991). Effect of oral supplementation with a a-tocopherol on the vitamin E content of human LDL and its oxidation resistance. J. Lipid Res. 32, 1325-1332. 

In a screening study with 78 subjects, the lag phase varied from 34 to 114 min. Interestingly, only a weak correlation was found between the a-tocopherol content and the lag phase (r=0.2, P < 0.01, n = 78). Increasing the a-tocopherol content of individual LDL samples in vitro or by oral supplementation led always to a proportional increase of oxidation resistance, according to the equation y=kx+a. The slope k is the eflScacy of... 

Elevation of lung gjutathione by oral supplementation of L-2-oxathiazolidine-4-carboxylate protects against oxygen toxicity in protein-energy malnourished rats. FASEB J. 6, 3101-3107. 

Assess nutritional status. Is the patient gaining or maintaining weight according to age Are any oral supplements or tube feedings being used ... 

Haloperidol 20 x oral haloperidol daily dose 10-15 x oral haloperidol dose, With initial dosing, oral supplementation... 

Polymeric formulas typically have low osmolality of 300 to 500 mOsm/kg. These formulas also usually supply essential vitamins and minerals in amounts similar to the Adequate Intakes or Recommended Dietary Allowances for these nutrients when the formula is delivered in amounts adequate to meet the macronutrient requirements of most patients. Many polymeric formulas are inexpensive relative to oligomeric formulas. Most polymeric formulas are lactose-free and gluten-free, as are most modern tube feeding products. Products designed to be used as oral supplements generally are polymeric and often have sucrose or other simple sugars added to improve taste. 

Gross GJ, Hazen SL, and Lockwood SF. 2006. Seven day oral supplementation with Cardax (disodium disuccinate astaxanthin) provides signihcant cardioprotection and reduces oxidative stress in rats. Molecular and Cellular Biochemistry 283(1-2) 23-30. 

Huang, L. L., H. R. Coleman et al. (2008). Oral supplementation of lutein/zeaxanthin and omega-3 long chain polyunsaturated fatty acids in persons aged 60 years and older, with or without age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 49(9) 3864—3869. 

Yolton, D., B. DeRuyter et al. (2002). Failure of oral supplement containing lutein to change macular pigment density. Optom. Vis. Sci. 79(12) 104. 

Nierenberg DW, StukelTA, Baron JA, DainBJ and Greenberg ER. 1991. Determinants of increase in plasma concentration of 3-carotene after chronic oral supplementation. Am J Clin Nutr 53 1443-1449. 

An endemic zinc deficiency syndrome among young men has been reported from Iran and Egypt, and is characterized by retarded growth, infantile testes, delayed sexual maturation, mental lethargy, anemia, reduced concentration of zinc in plasma and red cells, enlarged liver and spleen, and hyperpigmentation oral supplementation of 30 mg Zn daily had a prompt beneficial effect (Prasad 1979 Elinder 1986). 

Oral supplement Sweetened for taste Patients who require supplementation to an... 

Disease state-specific formulations are designed to meet specific nutrient requirements and to manage metabolic abnormalities. Unfortunately, scientific and clinical research supporting their efficacy is minimal, except for low carbohydrate formulations supplemented with specific fatty acids and antioxidants for patients with acute respiratory distress syndrome. Oral supplements are not intended for tube feeding. They are sweetened to improve taste and are therefore hypertonic. 

Whether it is possible to raise carnosine levels in human brain is unknown. One study in rats has shown that oral administration of chicken extract (a major source of carnosine in humans too) did provoke an increase in brain carnosine levels a single dose of the chicken extract led to an increase in carnosine levels within 30 min in plasma, but 1 or 2 h duration were required for increased levels of carnosine to be observed in the cerebral cortex, hypthalamus, and hippocampus (Tomonaga et ah, 2007). It is uncertain whether these effects result from direct uptake of the carnosine from plasma or a consequence of de novo synthesis. In a study using senescence-accelerated mice (SAMP8), it was found that oral supplementation with creatine provoked, at 25 weeks of age, a transient 88% increase in muscle carnosine content, accompanied by a 40% increase in anserine content, which coincided with an improvement in resistance to contractile fatigue (Derave et ah, 2008). At 60 weeks, no differences were detectable between the creatine-supplemented and control animals in terms of their muscle... 

The effectiveness of various therapeutical modalities of supplemental vitamin A has been examined in numerous studies using tablets or capsules. On the basis of these studies, increased consumption of dietary vitamin A has been advocated (World Health Organization, 1984,1992). In India and Indonesia, the provision of extra vitamin A resulted in considerable reduction of mortality (ca. 40%) in preschool children (Bhandari et al 1994 Humphrey et al, 1996). While the efficacy of excessive oral doses over more than 8-12 weeks has been questioned, it is evident that an insufficient, low dose given once per week is apparently of little effect on morbidity or mortality (Ramakrishnan et al, 1995a,b). Indeed, recurrent diarrheal episodes or the existence of malnutrition may explain the poor efficacy seen with oral supplementation with low doses (Ramakrishnan et al., 1995a). 

Erhardt, J. G., Mack, H., Sobeck, U., and Biesalski, H. K. (2002). p-Carotene and a-tocopherol concentration and antioxidant status in buccal mucosal cells and plasma after oral supplementation. Br. ]. Nutr. 87,471-475. 

Parenteral administration of 27 to 60 jLig/kg of selenium to laboratory animals has been shown to inhibit doxorubicin-induced decreases in myocardial vitamin E and GSH peroxidase levels and to reduce changes in myocardial function that are consistent with acute doxorubicin-induced cardiotoxicity. Oral supplementation of sodium selenite also protects against acute doxorubicin-induced cardiotoxicity in rabbits. 

In pernicious anemia, vitamin B12 should be given as intramuscular injection or high-dose oral supplements. Intramuscular injections of 100 to 1000 pg of cyanocobalamin for 5 d and 100 to 1000 pg of cyanocobalamin each month thereafter is a sufficient protocol for treating pernicious anemia (see Baik and Russell, 1999). 

Voisine P Bianchi C, Khan TA, et al. Normalization of coronary microvascular reactivity and improvement in myocardial perfusion by surgical vascular endothelial growth factor therapy combined with oral supplementation of L-arginine in a porcine model of endothelial dysfunction. J Thorac Cardiovasc Surg 2005 129(6) 1414-1420. 

Vitamins are essential nutrients, which must be supplied exogenously. They are organic compounds with indispensable biological activities as coenzymes in a multitude of cellular metabolic processes. Vitamin A, retinoids (vitamin A-derivatives), carotenoids, vitamin D, vitamin E, and vitamin K are fat-soluble, vitamin C and vitamins of the B-complex are water-soluble. This is of importance for gastrointestinal absorption in oral supplementation as well as the transdermal penetration for topical applications. 

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