Vitamin Thiamine deficiency

Wernicke s syndrome is a serious consequence of alcoholism and thiamine (vitamin Bx) deficiency. Certain characteristic signs of this disease, notably ophtalmoplegia, nystagmus, and ataxia, respond rapidly to the administration of thiamine but to no other-vitamin. Wernicke s syndrome may be accompanied by an acute global confusional state that may also respond to thiamine. Left untreated, Wernicke s syndrome frequently leads to a chronic disorder in which learning and memory are strongly impaired. This so-called Korsakoff s psychosis is characterized by confabulation, and is less likely to be reversible once established. 

Water-soluble vitamins removed by hemodialysis (HD) contribute to malnutrition and vitamin deficiency syndromes. Patients receiving HD often require replacement of water-soluble vitamins to prevent adverse effects. The vitamins that may require replacement are ascorbic acid, thiamine, biotin, folic acid, riboflavin, and pyridoxine. Patients receiving HD should receive a multivitamin B complex with vitamin C supplement, but should not take supplements that include fat-soluble vitamins, such as vitamins A, E, or K, which can accumulate in patients with renal failure. 

Thiamine Vitamin B, a deficiency of which in alcoholics can lead to Wernicke-Korsakolf s syndrome. 

There was a time when students of nutrition were inclined to think that certain vitamins, e g., thiamine, vitamin A, and ascorbic acid, were the "important vitamins" and that others brought up the rear of the procession. From the standpoint of ease of discovery on the basis of deficiency disease, there is some justification in this view. 

Nutritional Deficiency-Related Dementias. We have already mentioned that chronic alcoholics are subject to thiamine deficiency that can cause dementia. It usually occurs only after heavy, prolonged abuse of alcohol. In developed countries, the other key nutritional concern is vitamin deficiency. Vitamin deficiency can surprisingly strike even those with a healthy diet. Such people are missing a vital protein, intrinsic factor, which would enable them to absorb it from their digestive tract. 

Thiamine (vitamin Bi), in the form of thiamine diphosphate (TPP), is a coenzyme of some considerable importance in carbohydrate metabolism. Dietary deficiency leads to the condition beriberi, characterized by neurological disorders, loss of appetite, fatigue, and muscular weakness. We shall study a number of... 

Vitamin deficiency of Bj leads to the disease known as Beriberi. However, nowadays in the Western hemisphere, vitamin Bj deficiency is mainly found as a consequence of extreme alcoholism. In fact, the vitamin absorption by the gut is decreased and its excretion is increased by alcohol. Alcohol also inhibits the activation of vitamin Bj to its coenzyme form, thiamine pyrophosphate ester (TPP). There is no evidence of adverse effects of oral intake of thiamine [417]. The main food sources of vitamin Bj are lean pork, legumes, and cereal grains (germ fraction). It is soluble in water and stable at higher temperature and at pH lower than 5.0, but it is destroyed rapidly by boiling at pH 7.0 or above. 

Dietary deficiency of thiamine (vitamin 6,j results In an Inability to synthesize thiamine pyrophosphate, and the pathophysiology arises from Impaired glucose utilization, especially manifested In the nervous system. 

Severe thiamine vitamin Bf) deficiency results in beriberi. The symptoms can include growth retardation, muscular weakness, apathy, edema, and heart failure. Neurological symptoms, such as personality changes and mental deterioration, also may be present in severe cases. Because of the role played by thiamine in metabolic processes in all cells, a mild deficiency may occur when energy needs are increased. Since thiamine is widely distributed in food, beriberi is rare except in communities existing on a single staple cereal food. The disease does occur with some frequency in alcoholics, whose poor diet may lead to an inadequate daily intake of thiamine. 

Nearly all the water-soluble vitamins are heterocyclic compounds. Among the first to be isolated was thiamine (vitamin Bi) (62), deficiency of which causes degenerative changes in the nervous system, including the multiple peripheral neuritis characteristic of beriberi. Thiamine deficiency can arise from decomposition of the vitamin by bacteria in the gut. In mammalian metabolism the hydroxy group of thiamine is esterified to give cocarboxylase (thiamine pyrophosphate) which catalyzes the decarboxylation of a-keto acids to aldehydes, acyloins or acids, and their transformation into acyl phosphates. 

Water-Soluble Vitamins Thiamine (B,) Precursor of the coenzyme thiamine pyrophosphate. Deficiency can cause beriberi. 

Thiamine (= Vitamin B ) (pyrimidinylmethyl thiazole) dietary deficiency yields beriberi involving oedema, pain, neuritis, paralysis death detected by Christiaan Eijkman as polyneuritis in hens fed polished rice isolated from polishings by Jansen Donath... 

Vitamin deficiencies, including Bj2, nicotinic acid, thiamine Therapeutic dose replacement... 

TanPhaichitr V (1985) Epidemiology and clinical assessment of vitamin deficiencies in Thai children. In Eeckels RE, Ransome-Kuti O, Kroonenberg CC (eds) Child health in the tropics. Martinus Nijhoff Publishers, Dordrecht, pp 157-166 TanPhaichitr V (1999) Thiamin. In Shils ME, Olsen JA, Shike M et al (eds) Modem nutrition in health and disease, 9th edn. Lippincott Willitims Wilkins, Baltimore, MD Todd KG, Butterworth RE (1999) Early microglitil response in experimental thiamine deficiency tm immunohistochemical analysis. Glia 25(2) 190-198 Torvik A (1985) Two types of brain lesions in Wernicke s encephalopathy. Neuropathol Appl Neutobiol 11(3) 179-190... 

In addition, other possible causes of dementia also need to be excluded, especially the treatable forms of cognitive impairment, such as that due to depression, chronic drug intoxication, chronic central nervous system infection, thyroid disease, vitamin deficiencies (i.e.. Bn and thiamine), central nervous system angitis, and normal-pressure hydrocephalus (Bird, 2008). Individuals who do not meet these criteria but have short-term memory loss and have only minimal impairment in other cognitive abilities and are not functionally impaired at work or at home are considered to have mild cognitive impairment (Petersen et al., 2001). 

Rodriguez-Martin JL, Qizilbash N, and Lopez-Arrieta JM (2001) Thiamine for Alzheimer s disease. Cochrane Database of Systematic Reviews 2 CD001498. Thomson AD (2000) Mechanisms of vitamin deficiency in chronic alcohol misusers and the development of the Wernicke-Korsakoff syndrome. Alcohol Alcoholism 35(Suppl 1) 2-7. 

Neal RA. Vitamin deficiencies Thiamin. Hansen RG and Munro HN. 129. 1970. Nashville, GSMHA and National Institute of Health. Proc. Workshop on Problems of Assessment and Alleviation of Malnutrition in the US. 

The two most common vitamin deficiencies seen in patients chronically consuming alcohol are folic acid and thiamine. 

By 1950 the outline of the main pathway for tryptophan metabolism was therefore established, and it was becoming apparent that the over-all conversion of tryptophan to nicotinic acid was markedly reduced in many B-vitamin deficiencies. Thus this occurred in pyridoxine deficiency (50, 387, 732, 784), riboflavin deficiency (387,455, 675), and thiamine deficiencj (455, 675) but not in pantothenate or folic acid deficiencies (455). 

Beriberi, a neurologic and cardiovascular disorder, is caused by adi etary deficiency of thiamine (also called vitamin B,). The disease has been and continues to be a serious health problem in the Far East because rice, the major food, has a rather low content of thiamine. This deficiency is partly ameliorated if the whole rice grain is soaked in water before milling some of the thiamine in the husk then leaches into the rice kernel. The problem is exacerbated if the rice is polished, because only the outer layer contains significant amounts ot thiamine. Beriberi is also occasionally seen in alcoholics who are severely malnourished and thus thiamine deficient. The disease is characterized by neurologic and cardiac symptoms. Damage to the peripheral nervous system is expressed as pain in the limbs, weakness of the musculature, and distorted skin sensation. The heart may be enlarged and the cardiac output inadequate. 

A thorough nutrition-focused history and physical examination is the most valuable means of screening patients for vitamin deficiency or toxicity (Table 135-9). It is uncommon to see a single vitamin deficiency usually multiple vitamin deficiencies occur with general malnutrition. Single vitamin deficiencies do occur, however. Thiamine deficiency may result in lactic acidosis and encephalopathy, whereas pernicious anemia due to vitamin B12 deficiency has been reported with increasing frequency, especially in the elderly. Recently, the incidence of vitamin D deficiency has increased in children. Laboratory assessment may be useful to confirm the clinical suspicion of a deficiency state. The first indication of a deficiency is usually a fall in circulating serum concentrations of the vitamin or its coenzyme. 

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