vitamin B1 deficiency
Introduction
Introduction to vitamin B1 deficiency Beriberi is vitamin B1 or thiaminedeficiency. Thiamine is an important vitamin involved in sugar and energy metabolism in the body. Its deficiency can lead to dysfunction of the digestive, nervous and cardiovascular systems, beriberi There are three types of clinical "dry" neuromuscular gas. The latter often occurs in the elderly, accompanied by symptoms of consumption, mainly neurological abnormalities. "Infant type" is severe and manifests as acute cardiovascular symptoms, which can cause death if not treated in time. In the absence of thiamine, increased pyruvate inhibits the activity of choline acetylase, reduces the synthesis of acetylcholine, and decreases the production of thiamine by the decrease of thiamine pyrophosphate production. The hydrolysis of acetylcholine also accelerates the nerve. The conduction is affected, so the gastrointestinal fatigue is slowed down, the secretion of digestive juice is reduced, the disorder of glucose metabolism causes the cell function to decline, and various gastrointestinal symptoms appear. The pathology shows intestinal inflation, mucosal hemorrhage, follicular swelling, mesenteric Lymph node enlargement, in addition, liver and kidney have blood stasis and steatosis basic knowledge Sickness ratio: 0.1% Susceptible people: children Mode of infection: non-infectious Complications: hyperthyroidism, hand rub, femoral hernia, erysipelas, cellulitis, acute lymphangitis, swelling, myocarditis, sepsis, sputum rash
Cause
Vitamin B1 deficiency
1. Reasons for vitamin B1 deficiency:
Breastfeeding (30%):
The common cause of breast-fed infants is the lack of vitamin b1 in the mother's diet. The larger children's diet is mainly based on refined rice. The rice is not added in time, or the rice soup is discarded when cooking, or the vegetables are soaked for too long, and the beans are added with alkali. Many, long-term intake of large amounts of carbohydrates as a staple food and the lack of meat and soy products can cause loss of vitamin b1, resulting in b1 deficiency.
Chronic disease (21%):
Pediatric vomiting, chronic diarrhea, intestinal parasitic disease can reduce the absorption of thiamine in the duodenum and small intestine; a variety of chronic diseases such as anorexia, reduce thiamine intake; interfere with sulfur when liver function is impaired The use of amines in the body.
Metabolism (15%):
Excessive metabolism, hyperthyroidism, infection, or high temperature, strenuous exercise, pregnant women, lactation and other conditions increase the body's demand for thiamine, such as the lack of appropriate thiamine supplementation in the sulphur-bearing beriberi, and, Derived thiamine deficiency can be seen in intravenous nutrition without thiamine supplementation. It has been reported that refractory lactic acidemia can be caused by thiamine deficiency after three weeks. In addition, regular fish and shellfish are sulphur-containing. Aminezyme, which can decompose thiamine, is also a causative factor. If you do not add vitamin B1-rich foods in time, it can cause vitamin B1 deficiency.
Thiamine is first phosphorylated into thiamine pyrophosphate in the body. The latter acts as a coenzyme involved in the oxidative decarboxylation of pyruvate and alpha ketoglutarate in sugar metabolism, and is also involved in the keto group transfer of pentose phosphate bypass. The lack of thiamine not only affects glucose metabolism, but also involves fatty acid and energy metabolism, causing the accumulation of pyruvate and lactic acid in tissues, and the excessive production of alanine in brain cells, aspartate, glutamic acid, - The reduction in the production of aminobutyric acid is the biochemical basis for the dysfunction of each system.
2. Pathological lesions:
Pathological lesions can be seen in multiple peripheral neuritis, segmental degeneration and myelin loss, the longest nerve of the lower extremities such as the sciatic nerve is the first to be involved, Schwann s cell edema, vacuolar degeneration or even collapse, cranial Nerve (III, VI), vagus nerve (recurrent laryngeal nerve) also have degeneration, pia mater congestion, needle tip-like hemorrhage around small arteries, diencephalon, nerve cells disappear near the cerebral ventricle, glial cells and vascular endothelial cells proliferate The heart is enlarged due to cardiac insufficiency, especially in the right ventricle. Microscopically, myocardial fibroblasts and interstitial edema are seen. In severe cases, cells are degenerated and necrotic, pulmonary arteries, and hair cells and small arteries around the body are also dilated.
In the absence of thiamine, increased pyruvate inhibits the activity of choline acetylase, reduces the synthesis of acetylcholine, and decreases the production of thiamine by the decrease of thiamine pyrophosphate production. The hydrolysis of acetylcholine also accelerates the nerve. The conduction is affected, so the gastrointestinal fatigue is slowed down, the secretion of digestive juice is reduced, the disorder of glucose metabolism causes the cell function to decline, and various gastrointestinal symptoms appear. The pathology shows intestinal inflation, mucosal hemorrhage, follicular swelling, mesenteric The lymph nodes are enlarged, and in addition, the liver and kidneys have blood stasis and steatosis.
Prevention
Vitamin B1 deficiency prevention
Thiamine can not be produced in the human body, and the stock is limited. Although human intestinal bacteria can synthesize thiamine, but the amount is very small and mainly pyrophosphate type, the intestinal tract is not easy to absorb, so it must be taken daily from food. Into the vitamin B1.
One of the important measures to prevent beriberi is to strengthen the health supervision and guidance of food processing, to prevent the process of thiamine in grain honing, and to strengthen the nutrition and hygiene education, especially in rice-producing areas and rice-based foods. The diversity of instruments and the importance of a balanced diet.
The content of thiamine in natural foods is 0.5-1.2 mg per pork (0.1-0.2 mg for other meats), 0.4 mg for pig liver, 0.8 mg for soybeans, 0.34 mg for sorghum, 0.13 mg for white peony, vegetables. Fruit, egg contains thiamine no more than 0.1mg per 100g, so meat and soy products are good sources of thiamine. For pregnant women, nursing mothers, adolescents, and manual workers, it is advisable to add such foods. Probiotic doses of vitamin B1 can be distributed daily in areas where beriberi is endemic.
The daily requirement for vitamin B1 is 0.5mg for infants, 1 to 1.5mg for children, and 2 to 3mg for pregnant women and lactating mothers.
Adrenal cortex hormones and adrenocorticotropic hormones can counteract the physiological effects of thiamine, which hinders the oxidation of pyruvate. Excessive amounts of folic acid or niacin can impede the addition of thiamine to the liver. Diuretics can cause thiamine. The excretion increases, and the above should be noted to avoid the occurrence or aggravation of iatrogenic beriberi.
Complication
Vitamin B1 deficiency complications Complications Hyperthyroidism, sputum, sputum, erysipelas, cellulitis, acute lymphangitis, swelling, myocarditis, sepsis, plague
In addition to the above-mentioned clinical manifestations, blister-type and impregnated erosive athlete's foot are often prone to secondary bacterial infection, or various complications and complications due to self-sensitivity, papules and keratosis are easy to affect A and concurrent Hey.
(1) combined with the skin sputum infection in the rest of the body, due to long-term suffering from athlete's foot or autologous vaccination after hand rubbing, patients with athlete's foot can be combined with hyperthyroidism, handcuffs, body sputum, etc., when combined with hyperthyroidism, The deck is turbid, opaque, cloud-like, stain-like, and the surface is tarnished. The horny accumulation under the deck makes the nail thick, the deck skin is bad and the surface is uneven. The thick keratin under the deck is separated and the deck is separated from the nail bed. The keratin accumulation and pathogenic fungi can make the nails white, yellow, gray, brown, and even black. The clinical manifestations of the handkerchief are basically the same as those of the athlete's foot. When the body is mixed, there is a typical ring. The skin lesions that spread to the surrounding area have clear boundaries and slightly uplifted. They can be composed of miliary red papules, small blisters and scales. The central rash tends to subside, and there may be desquamation and sallow pigmentation spots, and consciously have varying degrees of itching.
(2) Foot and ankle combined with bacterial infection, at this time, local secretions increase, and pale yellow purulent secretions may appear, and the infected site is red, swollen, hot, and painful. If there is no timely and appropriate anti-inflammatory treatment, lymphatic vessels may appear. Inflammation, erysipelas and cellulitis.
1 acute lymphangitis, commonly known as red line, Chinese medicine for the "red line rash", because of the acute inflammation caused by the invasion of the lymphatics from the damaged skin, the performance of the upper part of the skin of the foot of the foot is infected with a red line , and soon extended, occurs in the secondary bacterial infection of impregnated erosive or blister-type ankle, the clinical manifestations of acute, occur in the inner side of the calf, at the beginning, red, swollen, hot, pain, etc. in the lesion Symptoms, soon there is a red line from the calf to the direction of the fossa or groin, the nearby lymph nodes are swollen, tender, often accompanied by varying degrees of chills, fever, loss of appetite, general malaise and other systemic symptoms, the red line is thicker The condition is heavier. If it does not dissipate, the affected lymph nodes will gradually become purulent and ulcerate. In the acute stage, the white blood cell and neutrophil counts in the blood are often increased.
2 erysipelas, erysipelas is a relatively serious acute inflammation, erysipelas in the calf area is also known as "flowing fire", it is due to the invasion of the skin of the type II hemolytic streptococcus into the medium or small lymphatics, causing skin and subcutaneous tissue Acute inflammation of the lymphatic vessels and surrounding soft tissues, after the onset, rapid expansion, high fever, chills, headache, joint pain, general malaise and other systemic symptoms, the rash begins to be red, swollen, hard, burning spots, Quickly spread around and become a large scarlet damage, faded and tender, the edge of the rash is slightly higher, and the boundary with normal skin is clear. When it spreads outward, the red color in the center of the rash gradually fades, turning brown and slightly Desquamation, the skin of the affected part is swollen, the feeling of fever, the surface is tense and tender and shiny, and some patients may suffer from blistering or bullae containing serous or purulent secretions, called vesicular or bullous erysipelas When the symptoms are extremely serious, the affected part can develop gangrene and become gangrenous erysipelas. After a few days, the rash does not expand and begins to subside, and the body temperature also follows. After the fall, the rash and body temperature returned to normal, leaving a slight pigmentation and desquamation, but some serious patients may develop visceral lesions such as myocarditis, nephritis, and even sepsis due to bacterial spread and toxins. When the body temperature increases, the total number of white blood cells can be increased to 20,000 / mm 3 or higher, and the neutrophil classification can reach 80% -95%.
3 cellulitis, Chinese medicine called sputum, generally caused by secondary streptococcal infection, can also refer to acute diffuse suppurative inflammation caused by staphylococcus, Escherichia coli, etc., which can occur in the skin The shallower part can also occur in the deep part of the fascia or between the muscles. The infection is red, swollen, hot, painful, and the color of the lesion is dark red. The boundary is not clear. If the lesion is shallow, the tissue is shallow. It is loose, swollen and painful; the lesion is deep, the tissue is dense, the swelling is not obvious and the pain is severe. In very acute cases, bullae can appear, and the symptoms of inflammation are rapidly aggravated without treatment. Local suppuration or hemorrhagic necrosis Even gangrene, patients often have chills, fever and other systemic symptoms, white blood cell counts often increase.
(3) sputum rash is a systemic or localized skin allergic reaction caused by dermatophytes and its metabolites outside the lesion through blood circulation. The occurrence of sputum rash is closely related to the degree of inflammation of local rickets. Local inflammation The more obvious, the more likely it is to develop sputum rash, so impregnated erosive and blister-type ankles are relatively easy to occur, and the occurrence of sputum rash is related to the type of pathogenic bacteria, pro-animal skin such as gypsum-like fungi. The athlete's foot caused by sputum bacteria is easy to cause sputum rash, while the loved person's red Phytophthora, the infection of flocculent epidermidis generally does not cause sputum rash, the occurrence of sputum rash and the severity of the disease and individual patient sensitivity and The strength of the allergic reaction is positively correlated. The sputum rash has multiple manifestations and can be expressed as:
1 sweat herpes type, acute onset, mung bean-sized thick-walled blister on both sides of the finger, palm or ankle, etc., the blister is filled with slurry, can be dispersed, or clustered, no redness around the blisters, generally does not fuse or expand Symmetrical distribution, no blistering after a few days to form punctate desquamation, blister can recurrent, consciously itchy, more common in summer, the primary lesions are mostly impregnated erosive ankle.
2 erysipelas-like, skin lesions are erysipelas-like erythema, generally not hard, sharp edges, relatively regular, no pain or a little pain, no lymphangitis, generally no systemic symptoms, damage is more common in the lower leg, can develop to the upper part of the lower limbs, Sometimes there are multiple erythema, with normal skin in the middle, and patients with severe ankles.
3 pimples type, is a sudden cluster of papules, maculopapular rash or hair follicle rash, which occurs mostly in the limbs or spreads throughout the body.
4 eczema type, sudden on the limbs, especially the large erythema of the lower limbs, papules, vesicles and other erythematosus rashes, the distribution is symmetrical.
In addition to these types of performance, sputum rash can also be expressed as polymorphous erythema rose pityriasis and so on.
Symptom
Vitamin B1 deficiency symptoms Common symptoms Vitamin B1 deficiency easy to fall wrist drooping abdominal distension hair twitching hypoproteinemia eyelid drooping voice dull appetite loss
The symptoms of infantile beriberi are changeable. It is not easy to make early diagnosis. In addition to clinical manifestations, you should pay attention to the easy-to-use rice production area in the residential area. Recently, there is a beriberi epidemic, feeding history, suspicious symptoms of the lactating mother, and the following diseases should be excluded. Viral encephalitis, meningitis, acute laryngitis, hand and foot snoring, acute poisoning, tetanus, congenital heart disease, etc.
The clinical manifestations of beriberi in older children are also very different in different individuals. They should ask about eating habits, whether they have chronic wasting diseases, participate in labor or physical exercise, etc., and have detailed physical examination to prevent missed diagnosis.
Examine
Vitamin B1 deficiency check
1. Laboratory inspection:
(1) Thiamine loading test: oral administration of 5 mg or intramuscular injection of 1 mg of vitamin B1, leaving 4 hours of urine, measuring the amount of thiamine, normal in 100 g or more, beriberi patients less than 50 g, or even zero.
(2) The content of pyruvic acid and lactic acid in the blood was measured, and the beriberi patients were significantly elevated, which helped to confirm the diagnosis, and the carbon dioxide binding force decreased significantly in most cases.
(3) The keto-transferase activity of red blood cells was measured, and the activity of the enzyme was significantly reduced in patients with beriberi.
The latter two results in the above trials are more credible because the degree of actual thiamine deficiency can be estimated from the metabolic disorder caused by thiamine deficiency, while the stress test only reflects the immediate level after thiamine uptake, but does not reflect The storage and distribution of thiamine in tissues can not express the biochemical changes caused by thiamine deficiency.
2, X-ray inspection
It shows that the heart expands to the sides, especially to the right.
3, ECG
It shows that the amplitude of P wave and QRS wave is increased, T wave is lower or inverted, QT is prolonged in new period, infants can have hypotension, occasionally sinus arrhythmia, and pulse map is double vein.
Diagnosis
Diagnosis and identification of vitamin B1 deficiency
Clinically, the following diseases such as viral encephalitis, meningitis, acute laryngitis, hand and foot snoring, acute poisoning, tetanus, and congenital heart disease should be excluded.
