RHC-FE ( Ferrous Fumarate + Folic Acid + Vit C + Vit B12 + Zinc)

FERROUS FUMARATE

FF (33% IRON) is less water soluble than Ferrous Sulfate and is tasteless as compared to Ferrous Fumarate which leaves Metallic taste in mouth.

Ferrous Fumarate is a form of the mineral iron. Iron is important for many fuctions in the body, specially for the transportation of Oxygen in the Blood.

Ferrous Fumarate is used as a dietary supplement , and to prevent and to treat iron deficiencies and iron deficiency anemia.

Don’t use Ferrous Fumarate if suffering from

Haemochromatosis

Hemosiderosis or Hemolytic Anemia

Take Ferrous Fumarate on an empty stomach for the best results. If stomach upset  occurs, take FF with Food or following a meal.

Symptoms of a Ferrous Fumarate overdose include decreased energy: vomiting:abdominal pain: fever: coma.

FOLIC ACID

It occurs as Yellow crystals which are insoluble in Water but it’s Sodium salt is freely soluble in Water.

Chemically it is Pteroyl Glutamic Acid.

Dietary Sources -:

Liver

Green Leafy Vegetables

Egg

Meat

Milk

Daily requirement -:

In adult                          -   <0.1 mg

During Pregnancy, Lactation or any condition of high metabolite activity    -    0.8 mg is considered appropriate.  

Utilization -:

Folic Acid is present in Blood as polyglutamates.

It is transported in Blood mostly as Methyl THFA.

Folic acid is rapidly extracted by tissues and stored in Cells as Polyglutamates.

Alcohol has been shown to interfere with release of Methyl THFA from Hepatocytes.

The total body store of Folates is 5 – 10 mg.

Deficiency -:

Folate deficiency occurs due to – inadequate dietary intake

Malabsorption

Biliary Fistula

Chronic alcoholism

Increased demand – In Pregnancy & Lactation, Rapid growth periods, Hemolytic Anemia

Manifestations of Deficiency -:

Megaloblastic Anemia – Indistinguishable from that due to B12 deficiency

Epithelial damage – Glossitis, Enteritis, Diarrhoea and Steatorrhoea

General debility

Weight loss

Sterility

Adverse effects -:

Oral Folic acid is entirely nontoxic.

Injections rarely cause sensitivity reactions.

INDICATIONS (USES) -:

IN MEGALOBLASTIC ANEMIA

IN PERNICIOUS ANEMIA

During periods of increased demand such as

PREGNANCY & LACTATION

MALABSORPTION SYNDROMES

ANTIEPILEPTIC THERAPY

PROPHYLAXIS

METHOPREXATE TOXICITY

FOLIC ACID SHOULD NOT BE GIVEN ALONE TO PATIENTS WITH B12 DEFICIENCY – HEMATOLOGICAL RESPONSE MAY OCCUR BUT NEUROLOGICAL DEFECT MAY PROGRESS.

VITAMIN C (ASCORBIC ACID)

Ascorbic acid is a 6 Carbon organic acid with structural similarity to Glucose.

Citrus foods and Black currents are the richest sources other’s are – Tomato, Potato, Green chillies, Cabbage & other Vegetables.

Human Milk is the richer in Vitamin C                 ( 25-50 mg/L ) than Cow’s Milk.

Absorption and fate -:

It is completely absorbed from G.I.T and widely distributed extra & intracellularly.

The usual intake of Vitamin C is 60 mg/day.

Increasing proportions are excreted in urine with higher intakes and body is not able to store more than 2.5gm.

Physiological role and Actions -:

Vitamin C is essential for formation and stabilization of collagen triple helix

Hydroxylation of Camitine

Conversion of Folic acid to Folinic acid

Biosynthesis of Adrenal steroids

Catecholamines Oxytocin & ADH

It direcly stimulates Collagen synthesis and is very important for maintainance of intercellular Connective tissue.

Deficiency symptoms -:

Severe Vitamin C deficiency causes SCURVY.

It can lead to  increased capillary fragility swollen and bleeding gums, petechial hemorrhage, deformed teeth, brittle bones, impaired wound healing, Anemia and Growth retardation

Adverse effects -:

Mega doses given for long period can cause rebound Scurvy on stoppage.

The risk of Urinary oxalate stones may be increased.

INDICATIONS (USES) -:

PREVENTION & TREATMENT OF SCURVY

POSTOPERATIVELY TO ENHANCE WOUND HEALING

ANEMIA – ASCORBIC ACID EHANCES IRON ABSORPTION AND IS COMBINED WITH FERROUS SALTS TO MAINTAIN THEM IN REDUCED STATE

TO ACIDIFY URINE – IN U.T.I

VITAMIN B12

Vitamin B12 occurs as water soluble, thermo stable red crystals.

It is synthesized in nature only by micro- organisms.

Plants and animals acquire it from them.

Dietary sources -:

Liver, Kidney, Sea Fish, Egg Yolk, Meat, Cheese are the main Vitamin B12 containing constituents of Diet.

The only Vegetable source is Legumes (pulses) which get it from micro-organisms harboured in their root nodules.

DAILY REQUIREMENT             -          1-3 hgm

PREGNANCY & LACTATION      -          3-5 hgm

Metabolic functions -:

Vitamin B12 is intricately linked with Folate metabolism in msny ways.

Megaloblastic Anemia occurring due to deficiency of either is indistinguishable.

Vitamin B12 is essential for all growth and multiplication.

It also effects P urine and Pyrimidene synthesis.

Utelization of Vitamin B12

It is present in Food as Protein conjugates and is released by cooking or by proteolysis in Stomach facilitated  by Gastric acid.

It is transported in Blood in combination with a specific β globulin transcobalamin 2.

Vitamin B12 is specifically taken up by Liver and stored about 2/3 to 4/5 of Body’s content is present in Liver.

It is not degraded in the body. It is excreted mainly in Bile (3-7 ugm/Day)

Deficiency -:

Vitamin B12 deficiency occurs due to,

Addisonian pernicious Anemia which is an Auto immune disorder.

Chronic Gastritis, Gastric Carcinoma, Gastrectomy etc.

Malabsorption

Consumption of Vitamin B12 by abnormal flora in Intestine (Blind loop syndrome) or Fish tape worm.

Nutritional deficiency.

Increased demand – Pregnancy & Lactation

Adverse effects -:

Very Rare

Allergic Reactions may occur

INDICATIONS (USES)

Vitamin B12 is added along with Folic acid and Iron preparations because reinstitution of brisk Haemopoisis may unmark deficiency of these factors.