Vitamin B1 deficiency
Introduction
Introduction Vitamin B1, Thiamine, is an active form of thiamine pyrophosphate (TPP), which can cause a series of nervous system symptoms of circulatory system, called 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.
Cause
Cause
The cause of vitamin B1 deficiency:
(1) Insufficient intake: The daily intake of normal adult males is 1.2-1.5 mg, and females 1.0-1.1 mg, which is related to energy demand, generally not less than 0.5 mg/1000 kcal. Vitamin B1 is abundant in yeast, animal tissues, beans, peanuts, wheat, brown rice, cereals are fine or improperly stored, moldy and deteriorated, and vitamin B1 can be lost. Thiamine is a water-soluble vitamin that is not resistant to high temperatures under alkaline conditions, so improper cooking and cooking can be lost or destroyed with rice soup and soup. In addition, loss of appetite, heavy drinking, long-term intravenous nutrition can cause insufficient intake of vitamin B1.
(2) Increase in demand: Under physiological conditions, such as the period of vigorous growth and development, pregnancy and lactation. Strong physical labor and exercisers, or high-carbohydrate, low-fat, low-protein diets, vitamin B1 demand increased. In pathological conditions, such as thyrotoxicosis, long-term fever, and chronic wasting disease, vitamin B1 demand also increases.
(3) Absorption disorders: chronic diarrhea, intestinal tuberculosis, enteric typhoid and other diseases can cause vitamin B1 malabsorption. Alcohol abuse, chronic malnutrition and folate deficiency may also present with malabsorption.
(4) Decomposition increase: Eat some foods containing thiamine enzymes, such as sashimi, oysters, shrimp, coffee, tea and other plants, which can oxidize vitamins and reduce the level of thiamine in the body.
(5) Increased excretion: When using diuretics, vitamin B1 can be lost too much. In addition, hemodialysis, peritoneal dialysis, or diarrhea can also cause loss of vitamin B1.
Examine
an examination
Related inspection
Vitamin B1 (VitB1, VB1) ECG Vitamin B1
Diagnosis of vitamin B1 deficiency:
Early vitamin B1 deficiency can be manifested as loss of appetite, fatigue, headache, muscle aches, weight loss and so on. As the condition worsens, typical cardiovascular and neurological symptoms (peripheral neuritis) can occur.
(a) the nervous system
Central and peripheral nervous system damage, called "dry beriberi". The typical manifestation of vitamin B1 deficiency is a feeling of rising symmetry, impaired motor and reflex function. The onset starts from the distal end of the limb, and the lower extremity is more common in the upper limb. It may have burning or abnormal feeling. It is distributed in the sock type and gradually develops to the proximal end of the limb. It turns out that the allergic area is gradually dull, even painful, warm and vibrating. The feeling disappears in turn. With muscle strength decline, muscle cramps, with gastrocnemius muscles, difficult to get up and down stairs. Then the feet, the toes droop, the muscles contract, and bedridden. The reflex function of the ankle, knee, etc. is initially hyperactive, but generally decreases or disappears later, and some patients still cannot recover completely after healing. Central nervous system damage can involve the vagus nerve, optic nerve, oculomotor nerve, abductor nerve, auditory nerve, recurrent laryngeal nerve, and phrenic nerve. Expressed as "Wenicke-Korsakoff" syndrome. Symptoms include vomiting, nystagmus (more than vertical tremor), ophthalmoplegia, fever, ataxia, changes in consciousness, and coma, accompanied by memory loss, decreased learning ability, and fiction.
(two) cardiovascular system
Cardiovascular damage is called wet beriberi. It is characterized by enlarged heart, dilated blood vessels, tachycardia at rest, shortness of breath, chest pain, and edema. If not treated in time, it can cause acute heart failure, often sudden, sudden illness, extremely difficult breathing, rapid heart rate, heart dullness to the two sides, heart sounds are pendulum, systolic murmur in the anterior region, pulmonary artery second Heart sounds. The arterial pressure is slightly lower, the pulse pressure difference is large, the venous pressure is significantly increased, and the neck and femoral artery pulsation is enhanced. The liver is swollen, the whole body is swollen, and there is oliguria. ECG shows tachycardia, PR interval is shortened, T wave is biphasic or inverted, low voltage, QT interval is prolonged. Infants and young children are mainly affected by the heart, manifested as loss of appetite, vomiting, irritability, insomnia, rapid development can cause angulation, convulsions, heart failure, can cause death. The mother of the child is often a recessive or clinical manifestation of beriberi patients.
Diagnosis
Differential diagnosis
Differential diagnosis of vitamin B1 deficiency:
Diagnosis should be differentiated from diseases with similar symptoms, such as cough, shortness of breath and aspiration pneumonia, acute laryngitis; initial symptoms of vomiting and hypertrophic pyloric stenosis; brain beriberi and central nervous system infection 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 Identification of 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.
