Vitamin B deficiency Flashcards
What is vitamin B deficiency known as?
BERI BERI
Deficiency in Thiamine (Vit B1)
List 7 risk factors of vitamin B deficiency
Diets consisting of high levels of milled rice + raw freshwater fish
High consumption of tea, coffee + betel nuts
Alcoholic state
Starvation state
Prolonged vomiting
Gastric bypass surgery: limited caloric intake post surgery
Parental nutrition without adequate thiamine supplementation
What are the 2 main types of vitamin B deficiency?
Dry Beriberi
Wet Beriberi
What is wet beri-beri?
Thiamine deficiency with CVS involvement
Peripheral vasodilation occurs causing high CO.
Kidneys detect relative loss of volume + therefore conserve salt. Salt retention causes fluid absorption into vessels, hence oedema.
High cardiac workload results in HF with general oedema.
What is dry beri-beri?
Thiamine deficiency with CNS involvement
Usually occurs with poor caloric intake + physical inactivity
Involves peripheral neuropathy
Wernicke encephalopathy+ Korsakoff syndrome are forms of dry beriberi
List 9 early symptoms of vitamin B deficiency
Fatigue Apathy Irritability Drowsiness Depression Poor concentration Anorexia N+V Abdo pain
List 5 later symptoms of wet beri-beri
palpitations SOB leg swelling dyspnoea orthopnea
List 4 later symptoms of dry beri-beri
numbness of peripheries
confusion
trouble moving legs
pain (cramps)
List 10 signs of vitamin B deficiency
Tachycardia Cardiomegaly Pallor + waxy skin Signs of malnutrion + wasting Hepatomegaly Ankle oedema Peripheral neuropathy Depressed tendon reflexes Loss of vibration sensation Tender leg muscles
How is vitamin B deficiency diagnosed?
Primarily clinical: high suspicion with chronic alcohol abuse + special diets/malnutrition
What investigations may be performed for vitamin B deficiency?
Thiamine loading test (rarely performed): administer thiamine. In deficient there is less excretion of thiamine than in normal patients.
Red cell transketolase activity is decreased (rarely done)
Maybe test blood thiamine level, pyruvate + transketolase level (as the level of these will rise in Wernicke’s encephalopathy)
MRI if Wernicke’s encephalopathy is detected
Describe management of vitamin B deficiency
Thiamine (Pabrinex) IV: admin slowly over 10 mins
Oral supplementation to continue after IV
If coexisting hypoglycaemia, ensure thiamine given before glucose
List 3 complications of vitamin B deficiency
Irreversible korsakoff syndrome (chronic memory disorder)
If untreated, HF (which can be fatal)
Anaphalaxis of IV tx
What is the prognosis in vitamin B deficiency?
Good if treated early, but Korsakoff is minimally reversible
Describe the epidemiology of vitamin B deficiency
Common in alcoholics
More common in developing countries due to malnutrition
