Vitamin B1 deficiency
Introduction
Introduction to vitamin B1 deficiency Vitamin Bldefency, also known as beriberi, is a disease caused by the lack of vitamin B1 (thiamine). It is more common in areas where rice is the main food, and can occur at any age. When the body is deficient in vitamin B1, the heat energy metabolism is incomplete, and acidic substances such as pyruvic acid are produced, which in turn damages the brain, nerves, heart and other organs. The series of symptoms that occur are collectively referred to as "beriberi". Vitamin B1 is water-soluble. In addition to the intestine bacteria in the human body, the body can not synthesize vitamin B1. It is mainly derived from food. It is often stored in other foods in the food, in cereals, nuts, animal offal, Eggs and yeast are abundant, and the content of human milk and breast milk is small. The cereals are mostly found in the ectoderm (, bran), so it is easy to be lost during refining, excessive washing can cause loss, and can also be suffered when cooking rice and alkali damage. basic knowledge The proportion of sickness: 0.01% Susceptible people: good for children Mode of infection: non-infectious Complications: hyperthyroidism, acute lymphangitis, erysipelas, cellulitis, sputum rash
Cause
Causes of vitamin B1 deficiency
Cause
(1) Insufficient intake: Insufficient vitamin B1 in the diet is a common cause. The human thiamine content is significantly lower than that of cow's milk, but it is sufficient for growth. When the mother's diet is deficient in vitamin B1, and breastfeeding alone does not add complementary food, the baby can get sick; long-term consumption of refined rice, noodles; vitamin B during rice washing, cooking, cooking, loss, destruction; some fish, Shellfish contain enzymes that destroy vitamin B1. Those who like to eat raw fish and shellfish for a long time are prone to this disease.
(B) Absorption disorders: chronic digestive disorders, long-term diarrhea and other causes of absorption disorders, leading to a lack.
(3) Increase in demand: children grow rapidly and need relatively large amount; long-term fever, infection, postoperative operation, hyperthyroidism, etc., due to strong metabolism and increased consumption, the demand for vitamin B1 also increases, if not timely supplemented , easy to cause lack.
Pathophysiology
Vitamin B1 is an important biocatalyst in the body and participates in various enzyme system activities in the form of coenzymes, especially in the process of carbohydrate oxidation capacity.
Vitamin B1 is absorbed in the small intestine and is converted to Thiamine pyrophosphate (TPP), a co-carboxylase, in the liver and kidney tissues, and participates in the oxidative decarboxylation of -keto acid during glucose metabolism. To further decompose pyruvic acid and lactic acid into water and carbon dioxide, generate energy and promote intrahepatic glycogen synthesis.
Vitamin B1 deficiency, mainly caused by glucose metabolism disorders, insufficient energy production, leading to accumulation of pyruvic acid and lactic acid in the blood, which causes changes in the structure and function of nerves, heart and brain tissues mainly supplied by glucose, and corresponding symptoms and signs, blood The increase of the concentration of pyruvic acid and lactic acid can cause the expansion of the surrounding small arteries, the diastolic blood pressure to decrease, the pulse pressure difference to increase, and the venous return flow to increase, which increases the burden on the heart.
Vitamin B1 can still inhibit the hydrolysis of acetylcholine by cholinesterase. Therefore, when vitamin B1 is deficient, the hydrolysis of acetylcholine accelerates, causing nerve conduction disorder, slowing of gastrointestinal motility, and digestive juice secretion and other digestive symptoms.
Prevention
Vitamin B1 deficiency prevention
1. Pay attention to the reasonable mix of food and improve the cooking method: do not eat rice, noodles and products that are too fine for long-term processing, often eat coarse grains and miscellaneous grains, do not use alkali to cook and process food, do not abandon rice soup and vegetable soup, do not eat without Heated raw fish, shrimp and less fern, betel nut and other foods, tea and coffee are not excessive.
2. In the treatment of other diseases, special attention should be paid to the prevention of vitamin B1 deficiency: if a large amount of glucose solution is intravenously administered to a patient, glucose will continuously consume vitamin B1 in the metabolic process and should be replenished in time.
3. For some people with high demand: such as children, pregnancy, breastfeeding women, high temperature workers, etc., even if there is no clinical manifestation of deficiency, a certain amount of vitamin B1 can be given daily as a preventive, some people use barley porridge to prevent vitamin B1 In the absence of disease, the prevalence of vitamin B1 deficiency in the observation group was found to be 1.1%, compared with 6.7% in the control group.
Complication
Vitamin B1 deficiency complications Complications, hyperthyroidism, acute lymphangitis, erysipelas, cellulitis, bacillary rash
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 Eating vomiting coma bloating convulsions Lower extremity edema ptosis heart sounds low blunt constipation sleepiness diarrhea
Most of the babies are acutely ill, and those with nervous system are called brain-type beriberi; those with cardiac dysfunction are called heart-type (heart-shaped) beriberi; those with significant edema are called edema-type beriberi. There are also several types of symptoms that appear at the same time. In older children, edema and multiple peripheral neuritis are the main manifestations.
(A) digestive system symptoms: the most common in infants from March to June, mostly due to insufficient vitamin B1 in breast milk. Often have anorexia, vomiting, bloating, diarrhea or constipation, weight loss and so on.
(B) nervous system symptoms: infants can be manifested as nerve palsy and central nervous system symptoms. In the early stage, there were irritability, nightingale, hoarseness due to recurrent laryngeal nerve palsy, and even aphasia. Then, ambition, feeding cough, sucking weakness, drooping face, weak body, weakening of deep and shallow reflexes, and even disappearing, lethargy, severe convulsions, coma, can cause death. Older children are mainly with multiple peripheral neuritis. First, there are symmetry sensation of the lower limbs, tenderness of the gastrocnemius muscle, and then the feeling is reduced, and even disappeared. The disease progresses with ascending flaccid paralysis.
(C) cardiovascular system symptoms: infants and young children often sudden heart failure, more common after breastfeeding or sleep will wake up suddenly. It is characterized by shortness of breath, irritability, screaming, coughing, cold sweat, cyanosis, heart rate, galloping, low heart bluntness, enlarged heart, double lungs filled with wet rales, hepatomegaly, and severe death. The electrocardiogram changes with low voltage, ST-segment depression, T-wave low-level, and inversion.
(D) edema and serous exudation: older children may appear in the lower extremity edema in the early stage, and even extend to the whole body or accompanied by pericardial, thoracic, and peritoneal effusion.
Examine
Examination of vitamin B1 deficiency
Laboratory tests: the activity of transketolase in whole blood and red blood cells and the activity of transketolase after addition of thiamine pyrophosphate in vitro. This method is compared with the method for determining the amount of thiamine in urine. It is a better indicator for the diagnosis of beriberi.
Diagnosis
Diagnosis and identification of vitamin B1 deficiency
Due to the complex and diversified clinical manifestations, and the babies often have severe illnesses, they must be diagnosed and rescued as soon as possible. Diagnosis can be made based on feeding history, dietary history of the lactating mother, clinical manifestations, and a combination of epidemiological history.
If you suspect the disease, you should immediately give vitamin B1 experimental treatment. The disease is rapidly improved after treatment, which can be used as a strong basis for diagnosis. Determination of blood vitamin B1 concentration can be clearly diagnosed, but due to the complex measurement technology, clinical is not easy to promote. Vitamin B1 load test can also be used. If the amount of vitamin B1 in the urine is reduced, it can help diagnose.
In addition, the detection of whole blood pyruvic acid and lactic acid content increased significantly, red blood cell transketolase activity decreased, are helpful for diagnosis.
Diagnosis should be differentiated from diseases with similar symptoms, such as cough, shortness of breath and aspiration pneumonia; initial symptoms of vomiting and hypertrophic pyloric stenosis; brain-type beriberi and central nervous system infections such as encephalitis, Meningitis, etc.; heart-type beriberi and various diseases causing acute heart failure such as endocardial fibroelastosis, congenital heart disease, etc.; peripheral neuritis and multiple radiculitis, polio and other diseases .
If it is clinically consistent with vitamin B1 deficiency, it will improve after treatment with vitamin B1, but relapse after stopping the drug, vitamin B1 dependence caused by hereditary pyruvate carboxylase deficiency should be considered. The diagnosis of this disease is mainly based on the history of nutritional deficiencies, clinical manifestations and experimental treatment. It should be differentiated from other neuropathy and heart disease.
