Vitamin and trace element deficiencies

Fat soluble vitamins

Vitamin A (retinol)

  • Found in dairy produce, eggs, fish oils, and liver.
  • Deficiency causes night blindness, xerophthalmia, keratomalacia (corneal thickening) and follicular hyperkeratosis.

Vitamin D (cholecalciferol)

  • Found in fish liver oils, dairy produce, and undergoes metabolism at the kidneys and the skin using UV light.
  • Deficiency causes rickets (in children) and osteomalacia (in adults). Proximal muscle weakness may be evident.

Vitamin E (alpha-tocopherol)

  • Widely distributed, green vegetables, and vegetable oils.
  • Deficiency causes haemolytic anaemia (premature infants) and gross ataxia.

Vitamin K (K1 = phylloquinine K2 = menaquinone)

  • Widely distributed but particularly in green vegetables. Synthesized by intestinal bacteria.
  • Deficiency causes coagulation defects seen as easy bruising and haemorrhage.

Water soluble vitamins

Vitamin B1 (thiamine)

  • Found in cereals, peas, beans, yeast, and wholemeal flour. It is an essential factor in carbohydrate metabolism and transketolation reactions.
  • Deficiency causes dry beri-beri (sensory and motor peripheral neuropathy), wet beri-beri (high output cardiac failure and oedema), Wernicke-Korsakoff syndrome.

Vitamin B2 (riboflavin)

  • Found in wholemeal flour, meat, fish, and dairy produce. It is a coenzyme in reversible electron carriage in oxidation-reduction reactions.
  • Deficiency gives angular stomatitis (fissuring and inflammation at the corners of the mouth), inflamed oral mucous membranes, seborrhoeic dermatitis, and peripheral neuropathy.

Vitamin B3 (niacin)

  • Found in fish, liver, nuts, and wholemeal flour.
  • Deficiency causes pellagra ( OHCM, p.250): dermatitis, diarrhoea, dementia.

Vitamin B6 (pyridoxine)

  • Widespread distribution, also synthesized from tryptophan.
  • Deficiency causes peripheral neuropathy, convulsions, and sideroblastic anaemia. Deficiency may be provoked by a number of commonly used drugs (e.g. isoniazid, hydralazine, penicillamine) and is also seen in alcoholism and pregnancy.

Vitamin B12 (cyanocobalamin)

  • Causes of a deficiency are numerous and include partial or total gastrectomy, Crohn’s disease, ileal resection, jejunal diverticulae, blind loop syndrome, and tapeworm.
  • Deficiency causes megaloblastic anaemia, peripheral neuropathy, subacute combined degeneration of the spinal cord ( OHCM, p,634), depression, psychosis, and optic atrophy.

Vitamin B9 (folic acid)

  • Deficiency can be caused by poor diet, malabsorption states, coeliac disease, Crohn’s disease, gastrectomy, drugs (e.g. methotrexate, phenytoin), excessive utilization (e.g. leukaemia, malignancy, inflammatory disease).
  • Consequences of deficiency include megaloblastic anaemia, and glossitis.

Vitamin C (ascorbic acid)

Deficiency causes scurvy (perifoillicular haemorrhage, bleeding swollen gums, spontaneous bruising, corkscrew hair, failure of wound healing), anaemia, and osteoporosis.

Trace elements


  • Deficiency results in hypochromic and microcytic anaemia, Wilson’s disease, impaired bone mineralization, Menks’ kinky hair syndrome (growth failure, mental deficiency, bone lesions, brittle hair, anaemia).
  • Usually caused by copper malabsorption.


Deficiency causes achondromatosis enterpathica (infants develop growth retardation, hair loss, severe diarrhoea, candida and bacterial infections), impaired wound healing, skin ulcers, alopecia, night blindness, confusion, apathy, and depression.


Severe deficiency can cause cardiac arrhythmias, paraesthesia and tetany.


Severe deficiency can cause cretinism (children), hypothyroidism, and goitre.

by Thomas, James; Monaghan, Tanya

on Oxford Handbook of Clinical Examination and Practical Skills, 1st Edition

Copyright©2007 Oxford University Press

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