KARINA CHANDRA

ACX’15
BLOK NUTRISI
VITAMIN DEFICIENCY
VITAMIN
Vitamin adalah bahan yg organic, berbeda dengan mineral yg anorganik. Tidak bisa disintesis atau dibentuk
dalam tubuh jadi harus didapatkan dari makanan.
Ppt : Chemically unrelated organic compounds that are Water Soluble
essential for normal metabolism, Cannot be synthesized,
therefore must be ingested • Vitamin C
• Vitamin B
Fat Soluble
– B1- Thiamine
• Vitamin A
– B2- Riboflavin
• Vitamin D
– B3- Niacin
• Vitamin E
– B5- Pantothenic acid
• Vitamin K
– B6- Pyridoxine
– B7- Biotin
– B9- Folic acid
– B12- Cobalamine
VITAMIN DEFICIENCY
• Ppt : Gross deficiencies are recognized by clinical syndromes, Are seen in poorer areas, In special
populations
• Yg menglami vitamin defisiensi biasanya pd orang tua baik karena asupan yg kurang atau cadangan
menurun, vegans karena bahan2 yg ada pada hewani tidak didapatkan di nabati, alcoholism,
malabsorption yaitu gangguan penyerapan pd perforasi usus dimana gejalanya kadang diare, mules,
konstipasikarena usus meradang shg tidak mampu menyerap, parenteral nutrition jangka panjang
missal pd org dgn gangguan usus dimana ususnya diangkat dipotong shg ususnya ukurannya kurang
dari 1 cm mutlak mendapat nutrisi parenteral, kemiskinan)
VITAMIN A

• First fat soluble vitamin to be Vitamin A deficiency : kasus jarang dan

discovered
• Part of compounds called retinoids
• Untuk penglihatan, immune response,
pertumbuhan epitel and repair jadi pd
orang
tersembunyi, terselubung oleh penyakit lain
bukan krn defisiensi
Complications
• Dry skin, dry hair, kuku broken nails-
may be first sign

• Can store 1 year of reserve • Night blindness

• RBP = retinol binding protein-bonds • Xeropthalmia-no tears-predisposes to

to Vitamin A in blood blindness
• Hyperkeratosis-goose bump skin

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VITAMIN D
• Few foods contain vitamin D (fatty fish and
eggs)
• Dermal synthesis or fortified foods (milk)
are the main source
• Two forms of Vitamin D
– Ergocalciferol  Vitamin D2
– Cholecalciferol  Vitamin D3
(harus didapatkan yg aktif yg
berguna untuk penyerapan kalsium)
KARINA CHANDRA
ACX’15
BLOK NUTRISI
Vitamin D Deficiency
• Hospitalized patients, orang yg
tirah baring lama karena tidak
sempat kontak dgn sinar
matahari, gerak dan tekanan
berguna untuk kalsium supaya
aktif
• Chronic kidney disease – tidak
aktif jadinya kl ginjal rusak
• GI malabsorption pd inflamasi
usus shg gangguan penyerapan
• Gastric bypass
• Cystic fibrosis
• Extensive burns : luka bakar
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 KARINA CHANDRA
ACX’15
BLOK NUTRISI

VITAMIN E : kasus karang krn banyak makanan yg mengandung vit E misalnya kecambah

• Vitamin E is a fat soluble Vitamin E Deficiency

compounds
• Anemia
• Isomers of tocopherol and
• Poor Balance
tocoretinol
• Muscle Weakness
• Antioksidan yg sangat kuat
• Sight Problems
• Harus dikonsumsi dengan vitamin
C bersama-sama jangan satu2 • Nervous system problems – sensation loss, pain, and
tingling – in the arms, hands, legs, and feet may
signify vitamin E deficiency.

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 KARINA CHANDRA
ACX’15
BLOK NUTRISI
VITAMIN K

• Found in green, leafy vegetables and Vitamin K Deficiency

oils, pd sayu hijau, daun-daun
• Deficiency due to
• Plays a role in coagulation cascade
– Chronic illness, multiple abdominal
• Body’s reserve lasts one week surgeries, liver or biliary disease,
alcoholism, drugs
• Diserap di ileum terminal dengan
bantuan bakteri kolfatonin (ga • Clinical Manifestations
denger jelas nama bakterinya) untuk
vitamin K diserap dalam bentuk – Bleeding, hematoma, echymosis
aktifnya jadi pada bayi pst diberikan
vit K langsung krn ususnya msh
steril belum ada bakteri.

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 KARINA CHANDRA
ACX’15
BLOK NUTRISI
VITAMIN B1

• Thiamin
• Sebagai Coenzyme untuk metabolism energi
karena itu biasanya setelah disuntikkan maka
tubuh rasanya enak sekali karena dia dlm bntk
koenzim siap pakai. Biasanya pd orang tua
• Essential for mucous membranes, nervous
system, cardiovascular and muscular function.
• As a dietary supplement in adults, 1-2 mg of
thiamine per day
• 100 mg im for treating and preventing
symptoms of alcohol withdrawal (Wernicke-
Korsakoff syndrome)
• Defisiensi thiamin = beri-beri, wernicka
syndrome (kasus jarang biasanya pada
alkoholisme)

VITAMIN B2

• Riboflavin : sbg ekuivalen pereduksi

untuk sumber energy di siklus kreb (TCA
cycle) masuk bersama FAD & NAD ke
kompleks 2 (ada 5 kompleks di rantai
pernafasan fosforilasi oksidasi: 1, 2, 3 untuk
masuknya ekuivalen, 4 untuk pertukaran, 5
pembentukan ATP)
• Formed by the intestinal flora and is easily
absorbed
• Required for the health of the mucus
membranes in the digestive tract and helps
with the absorption of Iron and Vitamin B6.

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 KARINA CHANDRA
ACX’15
BLOK NUTRISI
VITAMIN B3

• Niacin : masuk di 2 kompleks yaitu 1 dan

3 jd diperlukan lebih banyak
• Two other forms
- Nicotinamide
- Inositol hexa nicotinate
• Niacin deficiency  Pellagra (Dermatitis,
diarrhea, dementia) pada org yg makan
jagung terus menerus tiap hari, bukan nasi,
roti
• Therapy with 100 mg niacin or more with
meals (for alcoholics or migraine)

VITAMIN B5 : sangat jarang terjadi gangguan dan gejala tidak khas (ga dibahas, dilewatin aja gitu ..)

• Pantothenic acid Vitamin B5 Deficiency

• An important role in the secretion of • Fatigue, headaches, nausea, tingling in the hands,
hormones, such as cortisone because of depression, personality changes and cardiac
its supporting the adrenal gland.  instability
• Frequent infection, numbness, paresthesia ,muscle
weakness and cramps.
• Increased insulin sensitivity, lowered blood
cholesterol, decreased serum potassium, and failure
of adrenocorticotropin to induce eosinopenia.

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 KARINA CHANDRA
ACX’15
BLOK NUTRISI

VITAMIN B6

• Pyridoxine Vitamin B6 Deficiency

• Required for the balancing of • Irritability, nervousness and insomnia, general
hormonal changes in women as weakness, dermatitis and acne, asthma and
well as assisting the immune allergies
system and the growth of new
• Nails get ridged, an inflamed tongue,
cells.
osteoporosis and arthritis.
• B6 bersamaan dengan asam folat
• Kidney stones may also appear.
dan B12 berguna untuk
pembentukan sel baru, sintesis
protein, terkait kadar
homosistein (senyawa yg dpt
menimbulkan gangguan di
kardiovaskular)
• Hampir mirip dgn vitamin B12 tp
efek tidak sekuat vit B12

FOLIC ACID

• Found in green leafy vegetables, Folic Acid Deficiency

fruits, cereals, nuts, mats (pd
sayur2an dan buah2an)
• Folic acid (the supplement form)
has same effect but more
bioavailable than folate
• Jika defisiensi asam folat bisa
menyebabkan megaloblastic
anemia
• Pada perempuan yang akan
menikah dan punya anak usahakan
perbanyak makan makanan yg
mengandung asam folat shg
tercukupi
In pregnancy
• Menurunkan resiko neural tube defect pd sumsum
tulang belakang
• Appears dose dependent
In Cardiovascular Disease
• Elevated homocysteine associated with increased risk
of CV disease
• Folic acid, B6, B12 kalau kadarnya cukup dapat
menurunkan kadar homocysteine, kalau kurang
maka kadar homocystein naik bisa menyebabkan
resiko kardiovaskular
• B12 masalahnya hanya di hewani, sama sekali tidak
ada di nabati shg pd org yg strict vegan pastikan vit
B12, zinc, selenium harus ada

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 KARINA CHANDRA
ACX’15
BLOK NUTRISI
VITAMIN B12

• Deficiency causes Vitamin B12 Deficiency

– Neurologic disease • Psychiatric

– Megaloblastic anemia, – Irritability, personality

pernicious anemia change

– May be important cause of – Mild memory impairment,

hyperhomocysteinemia (CV dementia
disease)
– Depression
• Subtle deficiency even without anemia
– Psychosis
may cause dementia and balance
problems • Cardiovascular : kaitan
homocystein
• Bisa menyebabkan pernisiosa
– Possible increased risk of
myocardial infarction and
stroke
• Hematologic
– Megaloblastic anemia
– Pancytopenia (leukopenia,
thrombocytopenia)
• Neurologic
– Paresthesias
– Peripheral neuropathy

Peripheral neuropati sama seperti gejala – Combined systems disease

diabetes dmn pasien mengeluhkan (demyelination)
kesemutan di tangan dan kaki. Jd harus • May be inadequate dose in
dipikirkan apakah dia defisiensi vit B12
dan kadar gula darah diperiksa. Jd – Orang tua
pastikan asupan B12 tercukupi dan kadar – Atrophic gastritis
gula darah merupakan salah satu DD
– Vegans
– Gastric bypass
– Alcoholics
– Poor dietary intake
– Inadequate intake
– Malabsorption

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 KARINA CHANDRA
ACX’15
BLOK NUTRISI

Gangguan gaster : vit B12 memerlukan intrinsic

factor untk penyerapan jd kl ga ada maka vit B12
yg diberikan secara oral tidak bisa diserap.
Malabsorpsi : gangguan penyerapan. Misalnya
terminal ileum antara perbatasan ileum dan kolon
diambil pd kasus tumor atau penyerapan sudah
tidak ada shg harus diberikan scr parenteral

VITAMIN C

• Ascorbic Acid Vitamin C Deficiency

• A water-soluble vitamin • Dry and splitting hair
• Untuk pertumbuhan and repair • Gingivitis and bleeding gums
of tissues
• Rough, dry, scaly skin
• Kofaktor untuk sintesis kolagen
(in skin, cartilage, tendons, • Decreased wound-healing rate :
ligaments, and blood vessels) pd pasien pasca operasi, setelah
selesai operasi kmd tidak sembuh
• Needed for healing wounds atau pasien dgn luka bakar
• For repairing and maintaining • Easy bruising
bones and teeth.
• A decreased ability to ward off
infection
• A severe form of vitamin C
deficiency is known as scurvy.
Low levels of vitamin C have been
associated with a number of conditions
including
• High blood pressure
• Gallbladder disease
• Stroke
• Cancers
• Atherosclerosis
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