bioguy
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Tiff wrote:
What do you mean? What vitamins is he deficient?
yes Tiff, sorry for the typo, i corrected it.
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| hottie99
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vit d since his kidneys can't activate cholecaciferol into activated form.. and without vit D u can't absorb calicum (it's vitamin rite?? hahaa.. i guess i've just been thinking of it as an electrolyte for so long doing step 1 junk  ), so therefore u have low calcium. also since vit D inhibits the PO4- reabsorption, since that inhibition is gone, u have high PO4- (i guess phosphate isn't a vitamin rite? hehe)
so summary:
Vit D is deficient
Calcium also deficient
PO4- is increased from lack of inhibition
are there more vitamins?? isn't there something with potassium all messed up?? hmmm 
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| Tiff
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Vitamin D & Vitamin B6
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| hottie99
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how's b6 deficient from kidney failure?? can u pls explain?? 
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| bioguy
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yes please, how is B6 deficient in Kidney failure??
and does Hemodialysis per se cause any vitamin defciency?
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| hottie99
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well the hemodialysis can't replace for the vit d activation that occurs from 1 alpha hydroxylase in kidney, rite? so unless u replace with vit d supplements, a renal failure pt on hemodialysis will be deficient in vit D --> calcium deficint, phosphate retained
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| bioguy
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Yep, I agree about the Vitamin D part.
But does Hemodialysis (long term) itself cause any vit def.?
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| bioguy
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What all vitamin/mineral deficiencies cause neuropathy (peripheral and/or central)?
Please list the vitamin, the neuropathy, and the probably mechanism (if known)
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| hottie99
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bioguy wrote:
Yep, I agree about the Vitamin D part.
But does Hemodialysis (long term) itself cause any vit def.?
not unless ur not replacing the lost vitamins and electrolytes, since the hemodialysis is just acting as a functioning kidney minus any enzymes that were in ur functioning kidney.. that's all i got on that.. isn't ther something with potassium too rite?? like we're to replace the potassium, hmm, im blanking out.. damn stress!!! 
as for neuropathy?
-Vit b12 - neuropathy wherever myelin is since B12 needed for methylation
-Vit b6 - perpihperal neuropathy from taking INH or OCP's since they deplete b6
-Vit b3 if u have B6 deficiency - B3 is derived from Trp using B6, so if B6 deficient, u must be deficient in B3 too (goljan)
-Vit E - if u deficient can cause hemolytic anemia and neuropathy in spinal tracts (posterior colum and spinocerebellar tract degeneration; also from goljan)
-can B1 be added to that? being wernicke-korsakoff has neurologic probs??? 
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| bioguy
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excellante!!!!! thats a quick review of vitamins and neuropathy.
and also Chromium def causes peripheral neuropathy/CNS damage (not so imp. i guess)
Potassium is added in peritoneal dialysis
while hemodialysis is used to treat Hyperkalemia
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| hottie99
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aaah yes, gotcha on the chromium i didnt know that; i thought chromium was something with insulin and glucose
why isn't it important?? it shold be if there's neurologic repercussions, no??
but don't we treat hyperkalemia with ca gluconate (protect heart) and then insulin with glucose (to push K into the cells) and kayexalate if all else fails?? or is it dialysis if all else fails? i know u must give the calcium gluconate b/c otherwise arrythmias will result
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| bioguy
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whoa!! i dont' know know anything about Rx of hyperkalemia, you were asking about potassium and dialysis and i found these two above points. I just started studying, so please bear with me, i am not so knowledgeable.
actually i was just reading about vitamins and saw this point that hemodialysis may cause deficiency of all water-soluble vitamins because they are removed from the blood and there is not much storage form of water soluble vitamins (except 12).
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| Tiff
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B6 def. can be a result of hemodialysis in patients with chronic disease. I believe uremic toxins interere with pyruvate kinase. Also, B6 is needed for hemoglobin synthesis. The erythropoeitn given will cause a decrease in B6.
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| hottie99
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ooh im not calling u out on anything dear, bear with me and my confusion, hehee.. i just remember reading the tx of hYPERkalemia, and that was how it was treated.. i didnt know where hemodialysis would fit in, i figure it is last resort if all else fails that's all!!
i thought K supplements were given during renal failure somehow, i wasn't understanding why, but it's ok, that is separate discussion..
thats a good point about the water soluble vitamins too, that would make sense they would have renal excretion, so if kidney is caput, hemodialysis could do that, but i would think that the patient would still be on supplements since being aware of the dialysis caused deficiencies
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| bioguy
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B6 def. can be a result of hemodialysis in patients with chronic disease. - why specifically B6, and not other vitamins?
I believe uremic toxins interere with pyruvate kinase. - whats the link between Pyruvate kinase and B6 def.?
Also, B6 is needed for hemoglobin synthesis. The erythropoeitn given will cause a decrease in B6. - Is B6 used up in hemoglobin synthesis, i believe its just a cofactor thats not used up in the reaction - why would EPO cause decrease in B6?
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| hottie99
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yeah i didnt quite get those B6 remarks.. i kno b6 is or transamination and carboxylation, so i guess if pyruvate kinase is involved in that, but i didn't think it was.. as for involvement in heme synthesis, i too thought it was just a cofactor in the reaction of succ CoA + glycine becoming delta-ALA, no?? yeah i've not heard these other theories about b6, where did read/hear/find out about this concept Tiff, if u dont mind, maybe i'm missing more than i had hoped
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| Tiff
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bioguy wrote:
B6 def. can be a result of hemodialysis in patients with chronic disease. - why specifically B6, and not other vitamins?
I believe uremic toxins interere with pyruvate kinase. - whats the link between Pyruvate kinase and B6 def.?
Also, B6 is needed for hemoglobin synthesis. The erythropoeitn given will cause a decrease in B6. - Is B6 used up in hemoglobin synthesis, i believe its just a cofactor thats not used up in the reaction - why would EPO cause decrease in B6?
Vitamin B6 is an essential cofactor for ALA synthase.
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| hottie99
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yes i understood that, i didnt get the other things.. like why only B6 def during dialysis and not other water soluble vitamins?
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| Tiff
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hottie99 wrote:
yes i understood that, i didnt get the other things.. like why only B6 def during dialysis and not other water soluble vitamins?
Well, I didn't say other water soluble vitamins wouldn't be deficient and haven't disputed that. The effects of B6 are more prominent as it is involved in more vital functions. I was just explaining B6.
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| hottie99
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aaah ok, thx much, got it now!
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| bioguy
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In India when you order for a fried chicken leg dish at a restaurant, you are also given a slice of lime + cut onions. I don't know about the onions, but I think I know what good is a slice of lime.
Any guesses?
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| bioguy
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A pt. with G6PD deficiency was having a converstion with a medical student over beer. The beer-loaded student explained to the pt. the mechanism of hemolysis in G6PD deficiency. The pt. realized that antioxidants will help him and started taking loads of Vit. E and C. What will he end up with?
(such a stupid question, i know. i made it up)
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| bioguy
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Nature!!!!
Egg yolk is replete with this vitamin, but Egg white will reduce its bioavailability.
and deficiency will lead to your head becoming an egg (bald)
what vitamin is it?
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