Vitamin B (thiamine) Deficiency Flashcards
Define Vitamin B Deficiency?
This is known as BERI BERI
Can lead to Wernicke’s Encephalopathy
What are the risk factors for Vitamin B Deficiency?
Diets consisting of high levels of milled rice and raw freshwater fish
High consumption of tea, coffee and betel nuts
Alcoholic state
Starvation state
Prolonged vomiting
Gastric bypass surgery - due to limited caloric intake post surgery
Parental nutrition without adequate thiamine supplementation
What are the two main types of Vitamin B Deficiency?
Dry Beriberi
Wet Beriberi
What is Dry Beriberi?
Thiamine deficiency with Nervous System involvement
Usually occurs with poor caloric intake and physical inactivity
Involves peripheral neuropathy
Wernicke Encephalopathy and Korsakoff Syndrome are forms of dry beriberi
What is Wet Beriberi?
Thiamine deficiency with cardiovascular involvement
First, peripheral vasodilation occurs causing high CO
This leads to salt and water retention via RAAS
As vasodilation progresses, kidneys detect relative loss of volume and therefore conserve salt
Salt retention causes fluid absorption, into vessels, hence oedema
The high cardiac workload results in heart failure with general oedema
What is the epidemiology of Vitamin B Deficiency?
Common in alcoholics
More common in developing countries due to malnutrition
What are the presenting symptoms of Wet BeriBeri?
Palpitations
SOB
Leg swelling
What are the presenting symptoms of Dry Beriberi?
Numbness of peripheries
Confusion
Trouble moving legs
Pain
What are the signs of Vitamin B Deficiency?
Tachycardia
Ankle Oedema
Peripheral Neuropathy
What investigations do you do for Vitamin B Deficiency?
Diagnosis primarily clinical
Red cell transketolase activity is decreased - rarely done
What is the management plan for Vitamin B Deficiency?
Thiamine (Pabrinex) IV
Oral supplementation to continue after IV
If there is coexisting hypoglycaemia, ensure thiamine given before glucose
What are the possible complications of Vitamin B Deficiency?
Irreversible korsakoff syndrome
What is the prognosis for patients with Vitamin B Deficiency?
Good if treated early, but Korsakoff is minimally reversible
