Diagnosis Of Vitamin Research Articles

Soft tissues, hard times: a mordant affair.

A stern wind embraced Denmark’s capital this Saturday morning, January 15, 1972. Copenhagen had already been severely chilled by yesterday’s passing of King Frederik IX, descendant of first King Gorm. Nonetheless, there was widespread confidence in Margrethe, Frederik and Ingrid’s oldest, who today would become Denmark’s first reigning Queen — an event made possible by a plebiscite in 1956 that unanimously amended the Act of Succession. Nicole Jacobsen, resident in internal medicine, considered Margrethe a symbol of national freedom and women’s equality. Buoyed by this historic event, she began morning rounds. Mrs. T., a 52 year old, had been admitted with a two month history of weakness, constipation and headache. Typical rheumatoid erosions of hands and feet had appeared 20 years earlier; tender masses now involved affected joints. Blood pressure normal; aortic ejection murmur; and soft, tender masses of feet and hands. Elevated Ž . Ž . blood urea nitrogen BUN and creatinine Cr ; hypercalcemia, normal phosphorus, slightly elevated alkaline phosphatase, and increased urinary calcium excretion. Extensive periarticular calcifications on X-ray. Nicole ascribed respective symptoms and signs to hypercalcemia and calcification of dystrophic tissues. But why and why aortic sclerosis? Parathyroid function normal; no evidence of malignancy. From Mrs. T’s daughter, Nicole uncovered that over the past 18 months mother had subscribed to an arthritic remedy handed down from Viking folklore. This daily regimen called for several tablespoons of cod liver oil served with large glasses of milk. Nicole made the diagnosis of vitamin D intoxication. Mr. S., a 67 year old farmer, presented with nausea and

Assessing vitamin D status of callitrichids: Baseline data from wild cotton-top tamarins (Saguinus oedipus) in Colombia

Bone disease related to vitamin D deficiency is an insidious problem in captive colonies of callitrichids. Currently a diagnosis of vitamin D deficiency may be made after the appearance of clinical pathology, usually bone deformities or fractures. The development of assays for vitamin D metabolites suggests it may be possible to detect incipient vitamin D deficiency before animals are adversely affected. However, there are few data on normative levels of these metabolites in any nonhuman primates. We collected blood samples from 18 wild cotton-top tamarins (Saguinus oedipus) from Colombia and assayed them for 25-hydroxy vitamin D(25-OH-D), the major circulating form of the vitamin, which is believed to be a good indicator of status. Serum concentrations of 25-OH-D averaged 76.4 ng/ml (range 25.5–120 ng/ml). This is high compared with human norms (10–55 ng/ml), but the range is lower than that reported in the literature for captive callitrichids. Juveniles had higher serum concentrations than did adults, and pregnant females had lower concentrations than did nonpregnant females. These data confirm that healthy callitrichids have higher circulating levels of 25-OH-D than do humans, but they suggest that the extremely high levels found in some captive animals (300–600 ng/ml) may be above normal. We propose that serum concentrations of 25-OH-D of 50–120 ng/ml can be considered normal for cotton-top tamarins and perhaps other callitrichids. If serum values much below 50 ng/ml are found during clinical evaluation, the possibility of incipient vitamin D deficiency should be considered. Zoo Biol 16:39–46, 1997. © 1997 Wiley-Liss, Inc.

Vitamin D deficiency in infants and young children born to migrant parents.

To determine the current modes of presentation for the development of nutritional vitamin D deficiency in Melbourne children. A retrospective descriptive review was undertaken of the case records of children less than 5 years of age discharged from three Melbourne hospitals with a diagnosis of vitamin D deficiency or hypocalcaemia from January 1992 to January 1994. The study identified 13 infants and young children whose hospital admission was related to nutritional vitamin D deficiency. Significant morbidity and a broad spectrum of biochemical and clinical features were noted at presentation. All children had migrant parents and were either exclusively or predominantly breast fed. Ten infants (77%) were less than 1 year at presentation. Associated deficiencies of iron and B12 were present in five cases. Of the five mothers tested, serum 25-hydroxy vitamin D3 was low in four. Nutritional vitamin D deficiency is a continuing health problem in infants and young children born to migrant parents living in Melbourne. Paediatricians, obstetricians and general practitioners, particularly those managing women and infants from migrant communities, should be aware of this condition. Vitamin D supplementation to high-risk women during pregnancy and to their infants should be considered.

The vitamin K controversy.

Discussion about the efficacy and safety of vitamin K prophylaxis has recently restarted. In this review, new developments in diagnosis of vitamin K deficiency (including vitamin K plasma levels and protein induced by vitamin K absence [PIVKA]-II detection) and therapy of early, classic, and late hemorrhagic disease of the newborn are highlighted. Special attention is brought to the efficacy of preventing early and late hemorrhagic disease. The recently described association between intramuscular vitamin K administration and cancer is debated. The very high plasma levels, the intramuscular injection itself, or the adjuvants in the solution might all be responsible. These factors are all absent in oral administration. Therefore, we recommend repeated oral administration for preventing classic and late hemorrhagic disease of the newborn. Additionally, we recommend maternal supplementation of vitamin K for preventing early hemorrhagic disease of the newborn, especially when the mother is using medications that interfere with vitamin K metabolism.

3: Diagnosis of Vitamin E deficiency

Nutrition BulletinVolume 10, Issue 1 p. 10-11 3: Diagnosis of Vitamin E deficiency First published: January 1985 https://doi.org/10.1111/j.1467-3010.1985.tb01172.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume10, Issue1January 1985Pages 10-11 RelatedInformation

The diagnosis of vitamin D deficiency rickets.

A clinical, radiological and biochemical study of 300 Cape coloured out-patients in order to clarify the diagnosis of rickets and to establish its incidence in the specific ethnic group selected, is presented. 95 Cases (31.6%) were diagnosed as suffering from rickets. Analysis of the results indicates that radiological examination is necessary to confirm or exclude the clinical diagnosis. The most useful biochemical parameter is the serum level of alkaline phosphatase.

Comparison of Schilling Test and Plasma Level of Cyanocobalamin Co 57

Because of several undesirable features of the widely used Schilling test, results of this test and plasma levels of cyanocobalamin Co 57 were compared in 111 patients. The plasma test resulted in good separation of values between normal subjects and patients with vitamin B12 absorption defects. One patient with malabsorption had an unexplained falsely normal plasma concentration. On the other hand, over 5% of normal and over 50% of uremic patients had false-positive results of the Schilling test and normal plasma levels. The plasma test is more helpful than the Schilling test for patients with renal insufficiency and mental disturbances. It is a helpful adjuvant to the Schilling test to avoid mistakes in interpretation and repetitive tests. However, because of the consequences of missing a diagnosis of vitamin B 12 deficiency, the plasma test cannot be recommended exclusively as a substitute for the urine test at this time.

VITAMIN D DEPENDENCY: AN INHERITED POSTNATAL SYNDROME WITH SECONDARY HYPERPARATHYROIDISM

Three French-Canadian children in a large inbred pedigree each developed hypocalcemic, hypophosphatemic rickets in the latter half of their first year of life; there were also manifestations of generalized renal tubular dysfunction. These abnormalities, which mimic advanced Vitamin D deficiency, disappeared only when Vitamin D2 or D3 was given at about 100 times the recommended daily allowance; this indicated the diagnosis of Vitamin D dependency. Enamel hypoplasia was a prominent clinical finding; only those teeth which calcify postnatally were affected, indicating that the condition found does not affect Vitamin D-dependent nutrition in utero. The level of parathyroid hormone was elevated in serum before treatment; it fell to normal either after treatment with Vitamin D, or during intravenous infusion with a calcium solution sufficient to produce hypercalcemia. Vitamin D dependency appeared to be inherited as an autosomal recessive trait in this pedigree, but we could observe no phenotypic signs in presumably obligate heterozygotes. One of the three cases in the pedigree arose from outbreeding, suggesting that the mutant allele is probably not particularly rare in the population under our surveillance.

Vitamin D Intoxication

Vitamin D intoxication (VDI) may result from supplementation rarely, but it has been reported more frequently in recent years. This may be attributable to an increase in vitamin D supplement intake due to an understanding of the role of vitamin D (25OHD) in the pathogenesis of several diseases. The symptoms and findings associated with VDI are closely related to serum calcium concentration and duration of hypercalcemia. In patients with VDI, hypercalcemia, normal or high serum phosphorus levels, normal or low levels of alkaline phosphatase (ALP), high levels of serum 25OHD, low serum parathyroid hormone (PTH), and high urine calcium/creatinine are usually present. Serum 25OHD levels above 150 ng/ml are considered as VDI. The main goal of treatment for VDI is correction of the hypercalcemia. When the calcium concentration exceeds 14 mg/dl, emergency intervention is necessary because of the adverse effects of hypercalcemia on cardiac, central nervous system, renal, and gastrointestinal functions. However, since vitamin D is stored in fat tissues, effects of toxicity may last for months despite the removal of the exogenous source of vitamin D. Treatment for VDI includes: discontinuation of intake, a diet with low calcium and phosphorus content, intravenous hydration with saline, loop diuretics, glucocorticoids, calcitonin, and bisphosphonates. In conclusion, the diagnosis of vitamin D deficiency rickets (VDDR) without checking serum 25OHD level may cause redundant treatment that leads to VDI. All patients who are clinically suspected of VDDR should be checked for serum vitamin D status and questioned for previous vitamin D administration before starting vitamin D therapy. On the other hand, parents of all infants should be asked whether they are using dietary or oral supplements, and serial questioning may be required during supplementation to avoid excessive intake.

Roentgenologic manifestations of vitamin D intoxication.

The roentgenographic appearance of certain lesions associated with the prolonged and excessive use of vitamin D preparations of high potency has been referred to in many previous publications (1–4) and has been described in detail in an excellent review of the subject by Christensen, Liebman, and Sosman (5). The changes usually described include abnormal periarticular deposits of calcareous material and the absorption of bone, which is usually referred to in the roentgenologic literature as generalized osteoporosis. Because these lesions have been discovered in a relatively small number of patients who have ingested vitamin D in massive doses, the present study was undertaken to determine, if possible, what other pathologic or physiologic factors may contribute to their production. Material Studied A review was made of the clinical records and of all the available roentgenograms of 56 patients in whom a diagnosis of vitamin D intoxication was made at the Mayo Clinic. The clinical diagnosis in each instanc...

Value of Determination of Bisulphite-binding Substances of Blood in the Diagnosis of Vitamin B 1 Deficiency

DEFICIENCY of vitamin B1 is associated with increase of the bisulphite-binding substances1,2, The increase is chiefly due to pyruvic acid and alpha-ketoglutaric acid. As the bisulphite-binding aldehydeand keto-compounds increase in many different diseases, it is rather difficult to decide whether this augmentation can be used as an indicator of aneurin deficiency. The various authors disagree on this point3. Wilson4 and others recommend the examination of the increase after administration of glucose. Chesler et al.5 are of the opinion that the ratio of lactic and pyruvic acid is the decisive factor, the ratio being normally 7.7 average and 5.8–6.6 with aneurin-deficiency.

VARIATIONS IN THE CUTANEOUS MANIFESTATIONS OF VITAMIN A DEFICIENCY FROM INFANCY TO PUBERTY

In a former paper 1 dealing with the nature and age distribution of the cutaneous manifestations of vitamin A deficiency, it was pointed out that infants and children of prepubertal age did not often exhibit hyperkeratosis of the hair follicles, lesions believed to be a specific sign of this nutritional disease. Thus, of 91 patients with vitamin A deficiency between 2 months and 15 years of age, only 6, or 6.6 per cent, had follicular hyperkeratosis, while of 103 patients from 16 to 30 years of age, 47, or 45.6 per cent, presented follicular signs of the disease. It was thought significant, however, that 26 members, or 28.6 per cent, of the first group, who did not manifest lesions of the hair follicles, showed generalized xerosis of the skin. The diagnosis of vitamin A deficiency in all but a few instances was based on the presence of xerophthalmia. There

Minimum Vitamin A Requirements in Infants as Determined by Vitamin A Concentration in Blood.

In previous communications we reported that the vitamin A concentration in the blood is a good indicator of the size of the vitamin A stores in the rat. Thus, low levels of the vitamin in the blood were usually associated with little or no storage in the liver, the chief depot of vitamin A, whereas high concentrations in the blood were accompanied by large stores. Intermediate blood values were of less significance as they were associated with either small or large amounts of vitamin A in the liver. Studies carried out in infants coincided, in general, with the results of our experiments in rats and indicated the practical importance of the vitamin A blood level in the diagnosis of vitamin A deficiency. In a series of 93 normal infants, ranging in age from 3 weeks to 6 months, the lowest concentration of vitamin A in the blood was found to be 45 international units per 100 cc plasma. Further observations have indicated that 40 international units may be regarded as the lower limit of the normal range of the vitamin A concentration of the blood for infants under 6 months of age. Values below this level were obtained in infants who, either were suffering from disorders interfering with the absorption of the vitamin as, for example, cystic fibrosis of the pancreas, coeliac disease and congenital obliteration of the bile ducts, or were receiving diets devoid of vitamin A. Required to bring about normal blood levels in young infants having low concentrations of the vitamin in the blood as a result of a diet devoid of vitamin A.

INTRADERMAL DYE TEST FOR VITAMIN C DEFICIENCY

Experimental and clinical investigations during the past few years have definitely established the value of studies of the cevitamic acid level in blood and urine in appraisal of the vitamin C balance. While determination of the cevitamic acid level in the plasma and the urine is not technically difficult, it seemed desirable to have a simple procedure that would enable the physician in his office to confirm a diagnosis of vitamin C deficiency before it became clinically manifest (subclinical scurvy). The values for cevitamic acid in the urine and the plasma have been shown to have a definite correlation with the degree of tissue saturation. Since the determination of cevitamic acid is dependent on the reduction of a blue dye, 2:6-dichlorphenolinclophenol, to its leuko form, the possibility of studying the reduction of the dye directly in the tissues suggested itself. While this was under consideration Rotter 1 of Budapest published

THE RESPONSE TO THE FEEDING OF CEVITAMIC ACID IN NORMAL AND DEFICIENT SUBJECTS AS MEASURED BY A VITAMIN C EXCRETORY TEST

Article1 May 1938THE RESPONSE TO THE FEEDING OF CEVITAMIC ACID IN NORMAL AND DEFICIENT SUBJECTS AS MEASURED BY A VITAMIN C EXCRETORY TESTELAINE P. RALLI, F. A. C. P., GERALD J. FRIEDMANELAINE P. RALLI, F. A. C. P.Search for more papers by this author, GERALD J. FRIEDMANSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-11-11-1996 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe criterion for the diagnosis of scurvy had been, until recently, the appearance of the symptoms of scurvy. As a result of the experimental work in vitamin C, three new diagnostic procedures have now come into use: the capillary resistance test, the concentration of vitamin C in the blood and the urinary excretion of vitamin C.1, 2, 3, 4, 5There is still some controversy as to the value of capillary resistance tests as an index of vitamin C deficiency. We have studied the capillary resistance of 25 young normal adults by the Dalldorf method5and found no definite relation...Bibliography1. ABBASYHARRISRAYNARRACK MALJSNJR: Diagnosis of vitamin C subnutrition by urine analysis, Lancet, 1935, xxv, 1399. CrossrefGoogle Scholar2. HAWLEYSTEPHENSANDERSON EEDJG: The excretion of vitamin C in normal individuals, Jr. Nutr., 1936, xi, 135. CrossrefGoogle Scholar3. HAWLEYSTEPHENS EEDJ: Rate of urinary excretion of test doses of ascorbic acid, Proc. Soc. Exper. Biol. and Med., 1936, xxxiv, 854. CrossrefGoogle Scholar4. FARMERABT CJAF: Ascorbic acid content of the blood, Proc. Soc. Exper. Biol. and Med., 1935, xxxii, 1625. CrossrefGoogle Scholar5. DALDORF G: A sensitive test for subclinical scurvy in man, Am. Jr. Dis. Child., 1933, xlvi, 794. Google Scholar6. ANDERSONHAWLEYSTEPHENS GKEEDJ: Capillary fragility and vitamin C, Proc. Soc. Exper. Biol. and Med., 1936, xxxiv, 778. CrossrefGoogle Scholar7. RALLIFRIEDMANKASLOW EPGJM: An excretory test for vitamin C deficiency and subnutrition, Proc. Soc. Exper. Biol. and Med., 1937, xxxvi, 52. CrossrefGoogle Scholar8. BIRCHHARRISRAY TWLJSM: A microchemical method for determining the hexuronic acid (vitamin C) content of foodstuffs, Biochem. Jr., 1933, xxvii, 590. Google Scholar9. WRIGHT IS: The present status of the clinical use of cevitamic acid, Am. Jr. Med. Sci., 1936, cxcii, 719. CrossrefGoogle Scholar10. HAWLEYFRAZERBULTONSTEPHENS EEJLDJ: The effect of ingestion of acid and alkali upon amount of vitamin C found in urine, Proc. Soc. Exper. Biol. and Med., 1936, xxxiv, 218. CrossrefGoogle Scholar11. YOUMANSCORLETTEAKEROYDFRANK JBMBJHH: Studies on vitamin C excretion and saturation, Am. Jr. Med. Sci., 1936, cxci, 319. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: New York, N. Y.*Received for publication July 30, 1937.From The Laboratories of the Department of Medicine, New York University College of Medicine and the Third (New York University) Medical Division, Bellevue Hospital. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1938Volume 11, Issue 11Page: 1996-2006KeywordsAttentionCapillariesExcretionHematologic testsHospital medicineVitamin CYoung adults Issue Published: 1 May 1938 PDF downloadLoading ...