Infants thiamin

Beri-beri or clinically manifest thiamin deficiency exists in several subforms infantile beri-beri and adult beri-beri. Infantile beri-beri occurs in exclusively breastfed infants of thiamin-deficient mothers. Adults can develop different forms of the disease, depending on their constitution, environmental conditions, the relative contribution of other nutrients to the diet as well as the duration and severity of deficiency. First of all, there is a so called dry or atrophic (paralytic or nervous) form, including peripheral degenerative polyneuropathy, muscle weakness and paralysis. Second, a wet or exudative (cardiac) form exists. In this form, typical symptoms are lung and peripheral oedema as well as ascites. Finally, there is a cerebral form, that can occur as Wernicke encephalopathy or Korsakoff psychosis. Tli is latter form mostly affects chronic alcoholics with severe thiamin deficiency. 

We have determined thiamine levels of mother and infant at parturition (Bll). Thiamine in the fetal circulation is 5 times higher than in the mother s. A similar situation exists in the guinea pig (B35). 

The question of how much thiamine human beings need has been subjected to a great deal of study, and the literature on the subject will not be reviewed here. Most of the investigation has been based upon the assumption that "normal man" has a requirement at the adult level which is subject to relatively small variation and that "the normal infant" has likewise a fairly definite requirement. If this assumption is valid, it is easy to see that, when three or a half-dozen individuals have been found to give reasonably concordant results, an investigator may be satisfied that he has found the answer. 

Signs of infantile beriberi include tachycardia, vomiting, convulsions, and, if not treated, death. The deficiency syndrome can have a rapid onset in nursing infants whose mothers are deficient in thiamine. Adult beriberi is characterized by dry skin, irritability, disorderly thinking, and progressive paralysis. 

In one form of thiamine deficiency, Wernicke s syndrome may be noted. Therein is paralysis, or weakness of the muscles that causes motion of the eyeball. Oosely associated with thiamine deficiency are dietary problems of alcoholism. The psychotic disturbances of alcoholism, including delirium tremens, frequently respond to thiamine and other B complex vitamins. Injections of thiamine often produce dramatic improvements in persons suffering from beriberi. Beriberi sometimes occurs in infants who are breast-fed by mothers who suffer a thiamine deficiency. Beriberi remains of concern in the Orient where polished rice is a dietary staple. 

Recoveries 102% for thiamine and riboflavin from infant formula 101% for pyridoxine from infant formula. 

A standard reference material for infant formula has also been certified for vitamin C, riboflavin, niacin, and pyridoxine (197). Another recent study (198) indicated that off-the-shelf wheat germ is suitable for use as a secondary reference material for thiamine and niacin riboflavin was also evaluated but found to be somewhat unstable over time. Powdered orange drink was deemed suitable as a secondary reference material for vitamin C. 

GW Chase, WO Landen, RR Eitenmiller, A-GM Soliman. Liquid chromatographic determination of thiamine, riboflavin, and pyridoxine in infant formula. J AOAC Int 75 561-565, 1992. 

On the other hand, milk is not only an essential food for infants, but for children and adults as well. Children need sufficient nutrients and energy to meet the demands of growth and development. Demands for nutrients such as protein, Ca, Fe, and Zn are relatively high, and teenagers require quite large amounts of B vitamins - thiamine, riboflavin and niacin. In addition, approximately 45 percent of the adult skeleton is laid down during adolescence. 

Woollard, D.C. and Indyk-Harvey, E. Rapid determination of thiamine, riboflavin, pyri-doxine, and niacinamide in infant formulas by hquid chromatography. J. AOAC Int. 2002, 85,945-951. 

Thiamin is a water-soluble vitamin. The RDA of thiamin for the adult man is 1.5 mg. The vitamin is present in a variety of foods of plant and aiumal origin, as well as in yeast. The populations most at risk of developing a deficiency are chronic alcoholics in Western countries and those with an overdeptendence on polished rice as a staple in underdeveloped nations. The consumption of large amounts of raw seafood can also induce the deficiency. Thiamin deficiency in humans is called beriberi. The disease occurs in a variety of forms and causes different problems in infants, adults, and alcoholics. 

Beriberi occurs whenever thiamine intake is less than 0.4 mg/d for an extended period of time. It occurs where polished rice is a dietary staple, and, in Western society, in poor and elderly populations and alcoholics. Beriberi has wet, dry, and cardiac types, and an individual may have more than one type. Wet refers to pleural and peritoneal effusions and edema dry refers to polyneuropathy without effusions. Cardiomyopathy is the principal feature of the cardiac type. An infantile form occurs in breast-fed infants, usually 2-5 months of age, nursing from thiamine-deficient mothers. The symptoms of beriberi remit completely upon thiamine supplementation. A subclinical deficiency of thiamine occurs in hospital patients and the elderly. Deficiency of thiamine and other vitamins may contribute to a generally reduced state of health in these populations. 

A full-term female infant failed to gain weight and showed metabolic acidosis in the neonatal period. A physical examination at 6 months showed failure to thrive, hypotonia, small muscle mass, severe head lag, and a persistent acidosis (pH 7.0 to 7.2). Blood lactate, pyruvate, and alanine were greatly elevated. Treatment with thiamine did not alleviate the lactic acidosis. 

Infantile WE may be found in developing conntiies, primarily among breast-fed infants, nsnally in the second to fifth months of development. Wernicke s encephalopathy is very rare in developed nations. However, in 2003, Israel was faced with an epidemic of WE dne to a batch of defective soy-based vegetarian infant formula. WE was documented in 20 ont of an estimated 3500 infants who were fed the formula, later found to be deficient in thiamine (Kesler et al., 2005). 

Kesler, A., Stolovitch, C., Hoffmann, C., Avni, 1., and Morad, Y. (2005). Acute ophthalmoplegia and nystagmus in infants fed a thiamine-deficient formula an epidemic of Wernicke encephalopathy. J. Neuroophthalmol. 25 169-172. 

One example of reversible metabohc encephalopathy is that seen in thiamine deficiency. Both animal models and humans with pure thiamine deficiency develop highly specific neurological symptoms. These symptoms can be reversed completely, or dramatically improved, often within hours, by the administration of thiamine. These results are instrumental in leading to the concept of metabolic encephalopathy , a disorder without structural brain changes. From a historical standpoint, there are increasing numbers of such disorders, which are amenable to successful treatment. Sadly, for example, in the case of kemicterus, managed health care has led to an increase in the number of cases due to the early release from hospitals of newborn infants after birth, even before the onset of jaundice. 

Thiamine nitrate dietary supplement, injections Calcium glubionate dietary supplement, iodine Calcium iodate Calcium iodide dietary supplement, low-birth-wt. infants Calcium glubionate dietary supplement, margarine Peanut (Arachis hypoqaea) oil dietary supplement, medicine Glucose Inositol... 

The UPLC-MS/MS method has also been developed for fast simultaneous separation and determination of 14 different water-soluble vitamins and vitamin-like compounds in infant formula (thiamine, riboflavin, pantothenic acid, nicotinic acid, nicotinamide, pyridoxine, pyridoxal, biotin, fohc acid, cyanocobalamin, ascorbic acid, L-camitine, choline, and taurine) [91], Methotrexate was also used as an internal standard for riboflavin, cyanocobalamin, biotin, and folic acid, while nicotinamide was used as an internal standard for the other compounds. 

Concomitant deficiencies of other B vitamins, notably thiamine and pyridoxine, probably participate in the pathogenesis of the dementia of pellagra. Pyridoxine deficiency is associated with a peripheral neuropathy in adults and seizures in infants. Victor and Adams (1956) found that pyridoxine-depleted monkeys develop diffuse cerebral pathology similar to, but not absolutely the same as, that found in human pellagra. 

In two infants and a 6 year old child who received prolonged intravenous nutrition and MVI (USV Pharm.) at a dose of 1 ml per day, we found that the urinary excretion of unbound thiamine, pyridoxine and riboflavin was extremely high, suggesting that... 

Fattal-Valevski, A., Kesler, A., Sela, B.A., Nitzan-Kaluski, D., Rotstein, M., Mesterman, R., Toledano-Alhadef, H., Stolovitch, C., Hoffmarm, C., Globus, O., and Eshel, G., 2005. Outbreak of life-threatening thiamine deficiency in infants in Israel caused by a defective soy-based formula. Pediatrics. 115 e233-238. 

Pongpanich, B., Srikrikkrich, N., Dhanamitta, S., and Valyasevi, A., 1974. Biochemical detection of thiamin deficiency in infants and children in Thailand. The American Journal of Clinincal Nutrition. 27 1399-1402. 

Wyatt, D.T., Nelson, D., and Hillman, R.E., 1991. Age-dependent changes in thiamin concentrations in whole blood and eerebrospinal fluid in infants and children. American Journal of Clinical Nutrition. 53 530-536. 

AOAC 986.27 Thiamine in milk-based infant formula—fluorometric method Infant formula AOAC 1990d... 

LC-IDMS SRM 1849 Infant/adult Thiamine (Bi), niacinamide Goldschmidt... 

---