Vitamin supplementation/therapy

We found that supplementation of vitamin A in the form of an aerosol is an effective, safe, and routinely manageable method to enhance vitamin A and RBP concentrations. Consequently, this modality of treatment may serve as an alternative vitamin A therapy during chronic or acute episodes of malnutrition, malabsorption, or in case of insufficient compliance to other therapies and might be useful in respiratory diseases associated with vitamin A deficiency. 

The results of these three large trials are consistent and lead to the conclusion that there is no clinical benefit from vitamin supplementation in patients with cardiovascular disease (CVD). 4s suggested by Loscalzo (69), the results indicate that either homocysteine is not a important atherogenic determinant or the vitamin therapy might have other adverse effects that offset its homocysteine-lowering effects, such as cell proliferation through synthesis of thymidine, hypermethylation of DNA, or increased methylation potential leading to elevated levels of ADMA. 

The Medical Research Council/British Heart Foundation study controlled the activity of antioxidants in the protection of a large group of patients (10,629) suffering from coronary disease who were treated daily with vitamin supplementation (vitamin E 600 mg, vitamin C 250 mg, and /3-carotene 20 mg). Similar high dosages were used in Age-Related Eye Disease Study (vitamin E 400 Ul, vitamin C 500mg, and /3-carotene 15 mg). In both studies the results were not positive. In these last two studies as in any of the studies reported in Table 9 the OS was measured to determine the real need of an antioxidant therapy. 

Vitamin requirements for ESKD patients receiving dialysis differ from those of a healthy person because of dietary modifications, kidney dysfunction, and dialysis therapy. The plasma concentrations of vitamins A and E are elevated in ESKD, while those of the water-soluble vitamins (81,82,8g, 812, niacin, pantothenic acid, folic acid, biotin, and vitamin C) tend to be low in this population, in large part due to the fact that many are dialyzable. The goal for vitamin supplementation in this population should be to prevent subclinical and frank deficiency and to avoid pathology from overdosage. Special vitamin supplements have been formulated for the dialysis population, which primarily include 8 vitamins with C and folic acid. 

Treatment of osteomalacia from vitamin D deficiency is vitamin D therapy, with dose depending on severity. Supplements of 800 to 4000 units/day or 50,000 units weekly for 8 weeks may be necessary. For sprue, a gluten-free diet is necessary. With intestinal malabsorption, high oral doses (50,000 to 100,000 units/day) or daily intramuscular injections of 10,000 units of vitamin D may be initially required. With disordered vitamin D metabohsm caused by anticonvulsants or rifampin, supplemental vitamin D (4000 units/day) can be effective. Sun exposure can also be useful. Serum calcium and 25(OH) vitamin D monitoring is necessary with high vitamin D doses. 

Since these drugs are not absorbed, side effects are confined to the intestine and include abdominal discomfort, diarrhoea or constipation. With long-term therapy, fat-soluble vitamin supplements are necessary. 

VITAMIN Bj2 therapy Vitamin B is available for injection or oral administration combinations with other vitamins and minerals also can be given orally or parenterally. The choice of a preparation always depends on the cause of the deficiency. Although oral preparations may be used to supplement deficient diets, they are of limited value in the treatment of patients with deficiency of intrinsic factor or deal disease. Even though small amounts of vitamin may be absorbed by simple diffusion, the oral route of administration cannot be rehed upon for effective therapy in the patient with a marked deficiency of vitamin Bj and abnormal hematopoiesis or neurological deficits. Therefore, the treatment of choice for vitamin Bj -deficiency is cyanocobalamin administered by intramuscular or subcutaneous injection. 

As part of the nursing process, assess the patient for vitamin deficiencies and determine what caused the deficiency. Some deficiencies are caused by changes in the body that affect absorption of vitamins. Other deficiencies are due to a poor or an unbalanced diet. After administering prescribed vitamin therapy, the patient should be educated about the importance of eating well-balanced meals and taking vitamin supplements if necessary. 

These patients receive an infusion of a solution that contains hyperosmolar glucose, amino acids, vitamins, electrolytes, minerals, and trace elements. In addition, the patient might be given fat emulsion supplemental therapy to increase the number of calories and to receive fat-soluble vitamins. The infusion is given through a central venous hne such as the subclavian or internal jugular vein to prevent irritation to the peripheral veins. 

The question of vitamin supplementation obviously requires an affirmative answer when one considers therapy for overt, specific deficiency syndromes such as scurvy, rickets, beriberi, pellagra, megaloblastic anemia, ariboflavinosis, and convulsions due to pyridoxine deficiency. In some syndromes, biochemical evidence of deficiency occurring before overt symptoms is accepted as indication for general preventive supplementation. For example, the hydroxyphenyluria of premature infants and decreased serum phosphate and citrate, are taken as indications for early... 

Waters, D. D., E. L. Alderman, J. Hsia, B. V. Howard, F. R. Cobb, W. J. Rogers, P. Ouyang et al. 2002. Effects of hormone replacement therapy and antioxidant vitamin supplements on coronary atherosclerosis in postmenopausal women A randomized controlled trial. JAMA 288 2432-2440. 

Low levels of serum folate are often associated with low levels of erythrocyte folate (intracellular). The mean corpuscular volume (MCV) of erythrocytes may increase slightly with low folate levels, though overt macrocytic anaemia occurs infrequently. Carbamazepine (CBZ) therapy may cause leukopenia and neutropenia. In a randomized trial in patients on CBZ, subjects on folic acid had higher leucocyte counts and less neutropenia compared with subjects without vitamin supplements. Other studies found no connection between folate and AED-induced haematological abnormalities. 

Folate deficiency usually takes 3-5 years to evolve in patients with epilepsy. Therefore, prophylactic B vitamin supplements may be recommended for patients at risk. As long as physiological doses are used, vitamin therapy should be safe. 

Although animal studies and small studies in humans have shown this strong association of vitamin K deficiency with vascular calcification, this has not been utilized as a standard therapy for vascular calcification. It is still unclear if vitamin K replenishment can affect the morbidity and mortality associated with vascular and valvular calcification in humans. Further studies are needed to determine the appropriate formulation of vitamin K (K1 vs. K2), dose, and duration of vitamin K therapy that would lead to beneficial effects in prevention of vascular calcification. Because of their very low toxicity and potentially beneficial effects on attenuation of arterial calcification, vitamin K supplementation can be considered in susceptible patients, such as patients with end-stage renal disease who are on hemodialysis. 

Several studies have explored relationships between vitamin A transport and visual dark adaptation in patients with chronic liver disease. In one study (Vahl-quist et al., 1978a), patients with liver disease and low plasma RBP levels (below 20 xg/ml) were found to have impaired dark adaptation, suggesting that these patients had peripheral vitamin A deficiency symptoms secondary to their inability to mobilize vitamin A from the liver. In these patients, vitamin A therapy did not affect either the reduced dark adaptation ability or the low plasma RBP levels. In another study (McClain et al., 1979) many patients with alcoholic cirrhosis, with significantly depressed serum levels of zinc, vitamin A, RBP, and TTR, manifested impaired dark adaptation. Some of these patients did not correct their abnormal dark adaptation with vitamin A supplementation but did with zinc therapy. In a third study (Russell et al., 1978) vitamin A therapy of patients... 

In a 6-month randomised, double-blind trial to evaluate the effectiveness of two doses intramuscular vitamin D3 therapy (600,000 lU and 300,000111 weekly) in the treatment of tropical calcific pancreatitis, neither h5rpercalcaemia nor hypervitaminosis D was observed Both low- and high-dose vitamin D3 supplementations (800lU and 4370 lU daily) in multiple sclerosis patients being treated with interferon beta were not associated with any serious adverse events [46 ]. 

Renal tubular acidosis Disorder of membrane iranspm ot hydrogen ion arrd bicatbon ate by kidney tubules. Inability of kidney to excrete an add urine persistent meta boltc acidosis results kidney stones increased urinery calcium and phosphate osteomalacia, potassium depletion. Oral administration ni sodium bicarbonate or citrate supplemental potassium and/or calcium untl body states repleted possibfy vitamin D therapy. 

The recent clinical trials suggest that vitamin A supplementation has more of an impact upon the severity of infections rather than the incidence of infections. In addition, vitamin A appears to have more effect upon the morbidity and mortality of diarrheal rather than respiratory disease. As a specific disease-targeted therapy, high dose vitamin A supplementation seems to have little effect upon acute lower respiratory infections. The reasons for these differences are unclear since vitamin A deficiency is known to affect mucosal epithelia of both the gastrointestinal and respiratory tracts [3]. Vitamin A supplementation also seems to have age-specific effects, as most trials have not shown an impact of vitamin A therapy on morbidity and mortality on infants under six months of age. 

Waters DD, Alderman EL, Hsia J, Howard BV, Cobb FR, Rogers WJ, et al. Effects of hormone replacement therapy and antioxidant vitamin supplements on coronary arteriosclerosis in postmenopausal women a randomized controlled trial. J Am Med Assoc 2002 288(19) 2432- 0. 

Whether supplementation of vitamin B12 is useful in the therapy of a number of neurological disorders is still subject to discussion and further investigations. 

Due to bleeding risk, individuals on anticoagulant therapy or individuals who are vitamin K-deficient should not take vitamin E supplementation without close medical supervision. Absent of that, vitamin E is a well-tolerated relatively non-toxic nutrient. A tolerable upper intake level of 1,000 mg daily of a-tocopherol of any form (equivalent to 1,500 IU of RRR a-tocopherol or 1,100 IU of all-rac-a-tocopherol) would be, according to the Food and Nutrition Board of the Institute of Medicine, the highest dose unlikely to result in haemorrhage in almost all adults. 

When obtaining the drug history, the nurse must always question the patient about the use of herbs, teas, vitamins, or other nutritional or dietary supplements. Many patients consider herbs as natural and therefore safe It is also difficult for some to report the use of an herbal tea as a part of the health care regimen. Display 1-4 identifies teaching points to consider when discussing the use of herbs and nutritional supplements with patients. Although a complete discussion about the use of herbs is beyond the scope of this book, it is important to remember that the use of herbs and nutritional supplements is commonplace in many areas of the country. To help the student become more aware of herbal therapy and nutritional supplements, Appendix B gives... 

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