1

Heme Metabolism and Nutrition 2 What is ?

•heme is a coordination complex consisting of an iron ion coordinated to a • are most commonly recognized as components of hemoglobin, but they are also found in a number of other hemoproteins such as myoglobin, •heme is most synthesized in the liver and bone marrow 3 4 5 Types of

• Yellow discoloration of the skin, earliest sign is scleral icterus • Due to increase in 6 Pre-hepatic/Hemolytic Jaundice

Unconjugated Bilirubin in serum

Urine Urobilinogen

Dark urine due to increase in urine urobilinogen Will there be unconjugated bilirubin in the urine?

Risk for bilirubin gallstones 7 Hepatic/Hepatocellular Jaundice

In both Conjugated Bilirubin and Unconjugated Bilirubin in the serum

or Urine Urobilinogen

Dark urine due to increased conjugated bilirubin 8 Post-hepatic/Cholestatic Jaundice

Conjugated Bilirubin in serum

Urine Urobilinogen

Pale stools Increase in alkaline phosphatase Vitamin Name Function Deficiency A Retinol Fat soluble, antioxidant, constituent of visual pigments Night blindness, corneal degeneration B1 Thiamine In thiamine pyrophoshate (TPP), cofactor of dehydrogenase enzymes alcoholics, pyruvate dehydrogenase, alpha- ketoglutarate dehydrogenase B2 Riboflavin Components of FAD and FMN B3 Niacin Components of NAD+ and NADP+ Derived from tryptophan B5 Pantothenic Acid Essential component of CoA and fatty acid synthase B6 Pyridoxine Converted to pyridoxal phosphate (PLP), cofactor in transamination, Convulsions, hyperirritability, decarboxylation reactions, synthesis of neurotransmitters and peripheral neuropathy B7 Biotin Cofactor for carboxylation enzymes Pyruvate carboxylase, Acetyl- CoA carboxylase B9 Folate Converted to tetrahydrofolate (THF), synthesis of DNA/RNA Megaloblastic anemia, increase precursors homocysteine B12 Cobalamin Cofactor for methionine synthase, important for DNA synthesis Megaloblastic anemia, increase homocysteine E Tocopherol, Fat soluble, antioxidant Tocotrienol K Phytomenadione, Fat soluble, antioxidant,activated by epoxide reductase, cofactor for Deficiency is clotting factors II, Phylloqionone gamma-carboxylation of coagulation factors VII, IX, X, proteins C and S Vitamin Name Function Deficiency

C Ascorbic Acid Antioxidant, necessary for hydroxylation of proline and Scurvy - swollen gums, bruising, petechiae, lysine in collagen synthesis, B-hydroxylase poor wound healing, vit. C causes sCurvy due to a defect in Collagen synthesis D Cholecalciferol Converted to 1,25-(OH) dihydroxyvitamin D3, increases Rickets (children), osteomalacia (adults) (D3) intestinal resorption of calcium and phosphate Ergocalciferol (D2)