Vitamin administration

Itching associated with retention of bile acids is ameliorated by treatment with the bile acid binding resin cholestyramine. Fat soluble vitamin (A, D and K) deficiency may require administration of supplements. Direct toxic effects of alcohol associated with dietary deficiency may require soluble B vitamin administration. 

The daily food intake should be spread over five meals. However, it is almost impossible to achieve an optimum supply of water-soluble and fat-soluble vitamins. Administration of multivitamin preparations is therefore recommended. Sodium chloride intake should not exceed 7-8 g/day. (s. pp 278, 730, 734, 741)... 

Little information is available concerning alterations in vitamin requirements in ARF. Reduced plasma concentrations of vitamin A, ascorbate, vitamin D, and vitamin E have been reported in patients with ARF, whereas vitamin K concentrations are relatively increased. Losses of vitamins via dialysis also must be considered. Traditional HD clears several water-soluble vitamins such as folic acid, vitamins C and B12, and pyridoxine, but not the highly protein-bound vitamins A and D. The clinical significance of these findings in ARF is unknown. Currently, it seems prudent to administer vitamins at least daily in doses recommended by the Nutrition Advisory Group of the American Medical Association for patients receiving PN (see Chap. 137)." Administration of ascorbic acid should be restricted to under 200 mg/day to avoid secondary oxalosis which may worsen renal function." If the enteral route is used for nutritional support, vitamin administration should at least meet the recommended daily allowances (RDAs). 

Vitamin E protects polyunsatnrated fatty acids from oxidative degradation at the double bonds. It is probable that an excessive intake of polyunsaturated fatty acids low in tocopherol, e.g. corn oil and cottonseed oil, is a relative indication for E-vitamin administration. The tocopherol might diminish the tendency to form free radicals, which are supposed to have pathogenic effects. Tocopherols occur in wheatgerm oil and also in leaves of vegetables, egg yolk and meat. Tocopherol is also synthesised for therapeutic purposes. 

Vitamin deficiency occurs when there is malabsorption because of a lack of intrinsic factor (pernicious anttemia). following gastrectomy (no intrinsic factor), or in various small bowel diseases, where absorption is impaired. Because the disease is nearly always cau.sed by malabsorption. oral vitamin administration is of little value, and replacement Iherapy, usually for life, involves injections of vitamin (left). Hydroxocobulamin is the form of choice for ilierapy because it is retained in Ihe body longer than cyanocobalamin (cyanocobalamin is bound less to plasma proteins and Ls more rapidly excreted in urine). 

However, the changes in excretion patterns took place gradually, which would not be expected if this were the sole explanation for the high renal losses during intravenous vitamin administration. 

Nevertheless, despite the decline of cardiovascular risk in North America after the introduction of folate food fortification (Yang et al. 2006), large clinical trials in patients with coronary heart disease (CHD) failed to demonstrate any benefit from B vitamins administration (Clarke et al. 2010). Despite... 

Another important observation derived from RCTs was the unexpected association of B vitamins with increased cardiovascular risk. Evidence suggests an interaction between folic acid and baseline Hey, with potential harmful effects in patients with plasma Hey >12 rmol/F. Although there is no clear explanation of these findings, it can be hypothesized that B vitamins may in some way induce proatherogenic pathways by Hcy-independent mechanisms (Figure 3.1). Despite these experimental data, it remains questionable whether B vitamins administration can adversely affect plaque progression since clinical studies have reported beneficial or at least neutral effects of B vitamins on carotoid intima-media thickness (cIMT). However, other data (Fange et al. 2004),... 

Clinical trials have failed to document any significant clinical benefit on cardiovascular risk with B vitamins administration. 

A number of studies have shown that vitamins moderate the induction of chromosomal aberrations by radiation. Vitamins C and E given orally to mice either 2 h before, immediately after, or 2 h after 1 Gy (100 rad) of y-ray TBI significantly reduce the frequencies of micronuclei and chromosomal aberrations in BM cells. Vitamin E is the more effective (95). Administration of vitamins C and E within 5 min of irradiation is as effective as pretreatment. Protection by vitamin C has also been shown in humans. Whereas chronic treatment of rats using vitamin C (100 or 300 mg/(kg/d)) for six months prior to TBI protects against chromosomal aberrations, vitamin E is not radioprotective in this setting (96). 

Homocysteine arises from dietary methionine. High levels of homocysteiae (hyperhomocysteinemia) are a risk factor for occlusive vascular diseases including atherosclerosis and thrombosis (81—84). In a controlled study, semm folate concentrations of <9.2 nmol/L were linked with elevated levels of plasma homocysteiae. Elevated homocysteine levels have beea associated also with ischemic stroke (9). The mechanism by which high levels of homocysteine produce vascular damage are, as of yet, aot completely uaderstood. lateractioa of homocysteiae with platelets or eadothehal cells has beea proposed as a possible mechanism. Clinically, homocysteine levels can be lowered by administration of vitamin B, vitamin B 2> foHc acid. 

PTH has a dual effect on bone cells, depending on the temporal mode of administration given intermittently, PTH stimulates osteoblast activity and leads to substantial increases in bone density. In contrast, when given (or secreted) continuously, PTH stimulates osteoclast-mediated bone resorption and suppresses osteoblast activity. Further to its direct effects on bone cells, PTH also enhances renal calcium re-absorption and phosphate clearance, as well as renal synthesis of 1,25-dihydroxy vitamin D. Both PTH and 1,25-dihydroxyvitamin D act synergistically on bone to increase serum calcium levels and are closely involved in the regulation of the calcium/phosphate balance. The anabolic effects of PTH on osteoblasts are probably both direct and indirect via growth factors such as IGF-1 and TGF 3. The multiple signal transduction... 

The pharmacological and/or adverse effects of a drug can be reversed by co-administration of drugs which compete for the same receptor. For example, an opioid receptor antagonist naloxone is used to reverse the effects of opiates. Drugs acting at the same site with opposite effects also can affect each other, e.g. the reduction in the anticoagulant effect of warfarin by vitamin K. 

Panthenol is frequently used in ointments and solutions for the treatment of burns, anal fissures, and inflammation of the conjunctiva. The vitamin has to be substituted in patients on total parenteral nutrition and in those who regularly undergo dialysis. Hypervitamin-osis has not been observed for doses up to 5 g/d (22). Furthermore, the administration of pantothenic acid leads to improved surgical wound healing due to its antiinflammatory properties. 

Wernicke s syndrome is a serious consequence of alcoholism and thiamine (vitamin Bx) deficiency. Certain characteristic signs of this disease, notably ophtalmoplegia, nystagmus, and ataxia, respond rapidly to the administration of thiamine but to no other-vitamin. Wernicke s syndrome may be accompanied by an acute global confusional state that may also respond to thiamine. Left untreated, Wernicke s syndrome frequently leads to a chronic disorder in which learning and memory are strongly impaired. This so-called Korsakoff s psychosis is characterized by confabulation, and is less likely to be reversible once established. 

A common problem associated with the administration of the bile acid sequestrants is constipation. Constipation may be severe and may occasionally result in fecal impaction. Hemorrhoids may be aggravated. Additional adverse reactions include vitamin A and D deficiencies, bleeding tendencies (including gastrointestinal bleeding) caused by a depletion of vitamin K, nausea, abdominal pain, and distention. 

The nurse must assess the patient for additional evidence of bleeding until the PT is below 1.5 times die control value or until the bleeding episodes cease. The PT generally returns to a safe level within 6 hours of administration of vitamin Kt. Administration of whole blood or plasma may be necessary if severe bleeding occurs because of the delayed onset of vitamin Kx. 

Mild diarrhea and itching have been reported with the administration of vitamin B12. Other adverse reactions that may be seen include a marked increase in RBC production, acne, peripheral vascular thrombosis, congestive heart failure, and pulmonary edema... 

Lactic acidosis (buildup of lactic acid in the blood) may also occur with die administration of metformin. Although lactic acidosis is a rare adverse reaction, its occurrence is serious and can be fatal. Lactic acidosis occurs mainly in patients with kidney dysfunction. Symptoms of lactic acidosis include malaise (vague feeling of bodily discomfort), abdominal pain, rapid respirations, shortness of breath, and muscular pain. In some patients vitamin B12 levels are decreased. This can be reversed with vitamin B12 supplements or with discontinuation of the drug therapy. Because... 

Hypolipoproteinemias Abetaiipoproteinemia No chylomicrons, VLDL, or LDL are formed because of defect in the loading of apo B with lipid. Rare blood acylglycerols low intestine and liver accumulate acylglycerols. Intestinal malabsorption. Early death avoidable by administration of large doses of fat-soluble vitamins, particularly vitamin E. 

True. Excessive alcohol use can lead to serious damage to mental health. Depression, anxiety, delusions and negative changes in personality can occur. Korsakoff s psychosis occurs in some excessive users of alcohol. This form of dementia results in disorientation, loss of memory and lowered intellectual abilities. It is reversible in some sufferers through the administration of thiamine (vitamin Bj. 

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