388 seborrhoea like lesions, mental confusion and growth retardation It is indicated to prevent and treat isoniazid, hydralazine, penicillamine and cycloserine induced neurological disturbances, mental symptoms in women on oral contraceptives, pyridoxine responsive anaemia and homocystinuria, morning sickness and hyperemesis gravidarum, convulsions in infants and children Dosage: Adults: 100 mg daily In suppression of lactation: tablets thrice daily followed by one tablet daily CYANOCOBALAMIN (METHYLCOBALAMIN) Methylcobalamin is the coenzyme form of vitamin B 12 It is neurologically active, most bioavailable and best utilized Unlike cyanocobalamin, it does not require any conversion after absorption by the body and is better retained by the liver and other tissues It has exhibited beneficial effects against brain aging, irregular sleep patterns It supports immune function and promote normal cell growth It represents one of the best values in nutritional products, given its comparably low cost and its wide range of potential benefits Methyl B 12 is the superior form of vitamin B12 Deficiency symptoms are glossitis, GIT disturbances, megaloblastic anaemia, subacute combined degeneration of spinal cord, peripheral neuritis, poor memory, mood changes and hallucinations Section 10/ Vitamins and Trace Elements Clinical Applications Bell’s palsy: It increases the recovery time for facial nerve function in Bell’s palsy Cancer: Experimental studies indicate that it inhibits the proliferation of malignant cells Diabetic neuropathy: Oral administration of methylcobalamin (500 mcg three times daily for four months) resulted in subjective improvement in burning sensation, numbness, loss of sensation and muscle cramps Immune system regulation: It has been suggested that vitamin B 12 plays an important role in immune system regulation, but the details are still obscure Rheumatoid arthritis: Vitamin B12 is a potential agent in management of RA It mainly acts by correcting abnormalities in RACD8+ T cells in autologous mixed lymphocyte reaction (AMLR) Eye function: It protects retinal neurons against N-methyl-D-aspartate receptor mediated glutamate neurotoxicity Deterioration of accommodation following visual work has also been shown to improve in individuals receiving methylcobalamin Heart rate variability: Methylcobalamin produces improvement in several components of heart rate variability, suggesting a balancing effect on the nervous system HIV: Under experimental conditions, methylcobalamin inhibited HIV-1 infection of normal human blood monocytes and lymphocytes Homocysteinemia: Elevated levels of homocysteine can be a metabolic indication of decreased levels of the methylcobalamin form of vitamin B12 Vitamins and Trace Elements 389 Male impotence: It is known to increase sperm count in male patients with impotence and nontropical sprue, alcoholism; adjunctive therapy in nutritional anaemias and anaemias of pregnancy Sleep disturbances: The use of methylcobalamin in the treatment of a variety of sleep-wake disorders is very promising Dosage: Adults: Therapeutic: to 20 mg daily in divided doses Vitamin B complex preparations are indicated in vitamin deficiency states Specific vitamin B preparations can be used as per indications mentioned above in the pharmacological write up; as an adjuvant to antibiotic therapy; combination with lactobacillus are indicated in aphthous stomatitis, thrush Preparations of vitamin B1 + B6 + B12 are indicated to prevent and treat isoniazid, hydralazine and cycloserine induced neurological disturbances, mental symptoms in women on oral contraceptives, pyridoxine responsive anaemia and homocystinuria, neuropathies, subacute combined degeneration, beriberi, anaemia, hepatitis, debility FOLIC ACID It plays a vital role in various intracellular reactions e.g conversion of serine to glycine, synthesis of thymidylate, synthesis of purines, histidine metabolism etc Due to folic acid deficiency these reactions are affected Deficiency symptoms: The characteristic feature of folic acid deficiency is megaloblastic anaemia Deficiency also leads to glossitis, enteritis, diarrhoea, general debility, weight loss and sterility It is indicated in folic acid deficiency states e.g megaloblastic anaemia, tropical Children: to 10 mg daily in divided doses VITAMIN C (ASCORBIC ACID) It functions as a cofactor in number of amidation and hydroxylation reactions The active form of vitamin C is ascorbic acid itself The main function of ascorbate is as a reducing agent in a number of different reactions Vitamin C has the potential to reduce cytochrome a and c of the respiratory chain as well as molecular oxygen The most important reaction requiring ascorbate as a cofactor is the hydroxylation of proline residues in collagen Vitamin C is, therefore, required for the maintenance of normal connective tissue as well as for wound healing since synthesis of connective tissue is the first event in wound tissue remodeling Vitamin C is also necessary for bone remodeling due to the presence of collagen in the organic matrix of bones It is also required for conversion of folic acid to folinic acid, biosynthesis of adrenal steroids, catecholamines, oxytocin and ADH; metabolism of cyclic nucleotides and prostaglandins Deficiency symptoms: In vitamin C deficiency scurvy develops It is characterized by ecchymosis, petechiae, swollen and bleeding gums, subperiosteal haemorrhage, bones are painful to touch, impaired wound healing, anaemia, loosening of teeth and gingivitis 390 It is indicated for treatment of scurvy, for prophylaxis of vitamin C deficiency, to acidify urine, anaemia of vitamin C deficiency, as antioxidant to protect natural colour and flavour of many foods, dental caries and increased capillary fragility Dosage: Adults: Prophylaxis : 50-500 mg daily Pregnancy and lactation: 100-150 mg daily CALCIUM Calcium is the most abundant body constituent (approx 2% of body weight) It controls excitability of nerves and muscles and regulates permeability of cell membranes It act as intracellular messenger for hormones and autacoids and help in coagulation of blood Plasma calcium level is precisely regulated by three hormones e.g parathormone, calcitonin and calciferol (which is a active form of vitamin D) They control its absorption, exchange with bone and excretion Calcium is present in three forms e.g., as free calcium ion, bound to plasma protein albumin and in diffusable complexes The endocrine system, through parathyroid hormone and calcitonin, helps in keeping the concentration of ionized plasma calcium in normal level Decrease in plasma levels of ionized calcium leads to increased parathyroid hormone secretion Parathyroid hormone tends to increase plasma calcium level by increasing bone resorption, increasing intestinal absorption and increasing reabsorption of calcium in kidney Vitamin D acts by stimulating Section 10/ Vitamins and Trace Elements intestinal absorption of calcium and decreasing the renal excretion Calcium play vital role in excitation - contraction coupling in myocardium Calcium mediates contraction in vascular and other smooth muscles Calcium is required for exocytosis and a l s o i n v o l v e d i n neurotransmitters release Calcium also help in maintaining integrity of mucosal membranes and mediating cell adhesions Hypercalcemia may occur in hyperthyroidism, vitamin D intoxication and renal insufficiency, which can be treated by administration of calcitonin, edetate sodium, oral phosphate etc Hypocalcemia may occur in hypothyroidism, malabsorption, osteomalacia secondary to leak of vitamin D or vitamin D resistance, pancreatitis and renal failure Hypocalcemia can be treated b y c h l o r i d e , g l u c onate, g l u c e p t a t e , lactate and carbonate salts of calcium TRACE ELEMENTS NICKEL It is an essential trace element for mammals, but little is known about its role or requirement in human metabolism In humans, serum levels of nickel are about 1.1 to 1.6 mcg/l This level increases in conditions such as stroke and acute myocardial infarction A dietary requirement for adults is about 30 mcg/day Nickel occurs mainly in plant foods, especially grains and vegetables with little in animal food sources or fats Vitamins and Trace Elements CHROMIUM Less than mg of chromium is found in the body, with the highest concentrations occurring in the adrenal glands, brain, skin, muscles and fat The total body content of chromium is estimated to be to 10 mg The recommended safe limit for daily chromium intake by adult is 0.05 to 0.2 mg MANGANESE The body contains only 20 mg of manganese, found mostly in the bones and glands The plasma level is low, about 2.5 mcg/dl The best sources of manganese are wheat bran, dried legumes, seeds, nuts and leafy green vegetables, other good sources are cereal grains, coffee and tea The adequate range in adult diet is 2.5 to 5.0 mg/day Manganese is a cofactor of enzymes involved in energy metabolism and is required for hemoglobin synthesis, thiamin utilization and tendon and bone formation Unlike nutrients that fulfil unique func- 391 tions, other minerals sometimes can substitute for manganese MOLYBDENUM Molybdenum is found primarily in the liver, kidneys, bone, skin and adrenal glands Organ meats, legumes and grains are good sources The adequate range of molybdenum intake for adults is 75 to 250 mcg/day It is equally excreted in the urine and the faeces Because molybdenum is a copper antagonist, high levels of copper decrease the absorption of molybdenum It is equally excreted in the urine and the faeces Molybdenum is a cofactor for enzymes involved in protein synthesis SELENIUM Selenium is an essential trace element in the human body This nutrient is an important part of antioxidant enzymes that protect cells against the effects of free radicals that are produced during normal oxygen metabolism Selenium is also essential for normal functioning of immune system and thyroid gland This page intentionally left blank ... hydroxylation of proline residues in collagen Vitamin C is, therefore, required for the maintenance of normal connective tissue as well as for wound healing since synthesis of connective tissue is the... is required for hemoglobin synthesis, thiamin utilization and tendon and bone formation Unlike nutrients that fulfil unique func- 391 tions, other minerals sometimes can substitute for manganese... impaired wound healing, anaemia, loosening of teeth and gingivitis 390 It is indicated for treatment of scurvy, for prophylaxis of vitamin C deficiency, to acidify urine, anaemia of vitamin C deficiency,