Date post: | 13-Aug-2015 |
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Biochemical & Nutritional Aspects of IV/IM Injection
of Vitamins
Dr Theikdi Oo
M.B.,B.S (Ygn), Dip.Med.Sc (Family Medicine)
Sources of Water-soluble Vitamins
Recommended Daily Allowance of Water-soluble Vitamins
Thiamine (Vitamin-B1)
Sources – fortified bread & cereals, fish, lean meat and milk Daily requirements – 1.2-1.5 mg (0.8mg per 2000 Cals)
Biochemical functions – as coenzyme for pyruvate dehydrogenase (Pyruvate → acetyl CoA), for α-ketogluterate dehydrogenase (α-ketogluterate → succinyl CoA), for transketolase (in Pentose Phosphate Pathway), for α-keto acid dehydrogenases (for amino acid catabolism)
Biochemical Function of Thiamine
Major co-enzyme in energy metabolism pathway, Citric Acid Cycle
Uses of Thiamine
Certainly effective for – Metabolic disorders Thiamine deficiency Wernicke-Korsakoff syndrome (WKS)
Possibly effective for – Cataracts Kidney disease in people with diabetes Painful menstruation (dysmenorrhea)
* WebMD – vitamins and supplements
Thiamine Deficiency
Pyridoxine (Vitamin-B6)
Sources – meat, fish, potato, banana, vegetables and intestinal microflora synthesis
Daily requirements – 1.4 mg (♂), 1.2 mg (♀)
Biochemical functions – transamination (coenzyme for SGOT & SGPT), decarboxylation (L-Glutamate → ϒ-amino butyrate), deamination, heme synthesis, production of niacin, as an integral part of glycogen phosphorylase
Biochemical Function of Pyridoxine
1. Transamination
2. Decarboxylation
3. Heme synthesis (coenzyme of ALA synthesis in formation of α-amino-β-keto adipic acid)
Uses of Pyridoxine
Effective for – Sideroblastic anaemia Pyridoxine dependent seizures Pyridoxine deficiency
Likely effective for – High blood homogentisate level
Possibly effectively for – Macular degeneration Hyperkinetic cerebral dysfunction Kidney stones (oxalate) Premenstrual syndrome Tardive dyskinesia Vomiting in pregnancy Lung CA prevention in those who smoke
* WebMD – vitamins and supplements
Deficiency of Pyridoxine
Neurological manifestation Demyelination of nerves Seizures
Dermatological manifestation Pellagra (d/t ↓ed niacin biosynthesis)
Hematological manifestation Hypochromic microcytic anemia (d/t ↓ed
heme synthesis)
Cobalamin (Vitamin-B12)
Sources – animal products, bacterial colonization
Daily requirement – 1.5-3 μg
Biochemical function – methionine & cysteine metabolism, isomerization of methty melonyl CoA
Biochemical Functions of Cobalamin
Biochemical Functions of Cobalamin
Uses of Cobalamin
Effective for – Cobalamin deficiency Pernicious anemia
Likely effective for – Cyanide poisoning Homocysteinuria
Possibly effective for - Macular degeneration (ARMD)
Not enough evidence – Alzheimer’s disease
* WebMD – vitamins and supplements
Deficiency of Cobalamin
Deficiency of Cobalamin
Deficiency of Cobalamin
Ascorbic Acid
Sources – citrus fruits, fresh fruits, fresh & frozen vegetables
Daily requirement – 50-60mg (according to age)
Biochemical functions –
Collagen synthesis (hydroxylation of proline & lysine),
Catabolism of tyrosine, Catacholamine & steroid hormone
synthesis, Bile acid formation, Anti-oxidant action (inhibit nitrosamine), Reducing agent(Fe2+ absorption), ? Immunity
Uses of Ascorbic Acid Effective for – Vitamin C deficiency
Likely effective for – Iron absorption Newborns with tyrosinemia
Possibly effective for – ARMD (age related macular degeneration) Reduce hardening of atherosclerotic vessels Anti-cancer Chronic regional pain $ Lead poisoning Methemoglobinemia Osteoarthrosis
* WebMD – vitamins and supplements
It is not only the vitamins that is unnecessarily being injected…..
Glucose Undoubtedly certain “Energy supply” for our body
systems Sources – ………..
Biochemical functions of glucose – key substrate in glycolysis/glycogenesis/HMS/uronic acid pathways, precursor for lipogenesis/cholesterol synthesis through supplying “Acetyl CoA” from glycolysis pathway, and many others …..
Energy value from 1 ampoule of 25%(50%) glucose = 20(40) Cals
No matter how important these vitamins are, over-use/misuse of such elements are not without
RISKS …..
also because of routes of administration (through IV/IM
injection)
Side effects of Injections – You should not ignore them!
For IM injection - Abscess Pain Nerve palsy (anatomically unsound injection site) Provocation of poliomyelitis Hematoma (especially in hemophiliacs)
For IV injection - Phlebitis Transmission of blood borne infection Infective endocarditis (impurities from cutting materials) And so on…..
Every thing should be in balance – bad if either less or more.
Toxicity of Thiamine Excess
Anaphylaxis (rare orally), skin irritation*
Mild & transient dizziness and flushing
* WebMD – vitamins and supplements
Toxicity of Pyridoxine Excess
Doses > 2mg (RDA) would leads to seizures in infants Neuropathy in adults (probably)
Drug interaction Amiodarone (↑ed photosensitivity) Phenobarbital (↑ed breakdown) Phenytoin (↑ed breakdown) Levodopa (↑ed peripheral conversion of
dopamine)* WebMD – vitamins and supplements
Toxicity of Cobalamin Excess
Hypokalemia (as forming red cells take up K+ into the cells)
Allergic reactions
* WebMD – vitamins and supplements
Toxicity if excess – dose > 2000 mg (renal stone d/t ↑ed oxalate synthesis, diarrhea, etc.,)
Other Vitamins
Vitamins Sources RDA Biochemical Functions
Use (other than deficiency)
Riboflavin Milk, milk products,
cereals, bread
1.3 mg (♂)
1.2 mg (♀)
Electron transfer Cataract, homocysteinemia,
migraine prophylaxis
Niacin Meats, cereals 17 mg (♂)
13 mg (♀)
Electron transfer High chol:, OA, Alzheimer’s d/s, prevention of cataract,
…
Pantothenic Acid
Animal, plants 5-10 mg Acyl carrier as Coenzyme A
Topical dexpanthenol after radiation Tx
Biotin Egg yolk, bacterial flora (avidin in white
of egg - ↓ absorption)
100-300 mg
Carboxylation reactions
Seborrheic dermatitis in infants
Folic Acid Liver, green leafy vegetables, fortified cereals
200 μg Transfer of one-carbon units, synthesis of
methionine, purines, thymine
Homocysteinemia, to counter anti-folate agents, to prevent birth defects, ARMD, depression, gum
problem in preg:/phenytoin Tx
Vitamins Deficiency Excess
Riboflavin Angular stomatitis Relatively safe
Niacin Pellagra Commom minor S.E (flushing (↑ by alcohol), GI upset), ↑
RBS, irregular HR when > 3G taken, allergy, ↑ GB d/s &
gout attack
Pantothenic Acid Burning foot $ (rare) Should be avoided in hemophilia and stomach
obstruction (Dexpanthenol)
Biotin Depression, hallucination, m/s pain, dermatitis
(–)
Folic Acid Megaloblastic A°, glossitis, fatigue/ loss of well-being
Avoid using after angioplasty, precipitate SACD in B12 def:, may ↑ seizure frequency in
epilepsy, may ↑ risk of cancer
Thank You for Your Attention…..