Vitamin that should be first supplemented during treatment of alcoholic patient?
Correct Answer: Thiamine
Description: Ans. c (Thiamine) (Ref H-17th/442)Wernicke's encephalopathy is a condition that can produce nystagmus and a partial deficit of horizontal and vertical gaze that mimics a combined abducens and oculomotor nerve palsy. It occurs in malnourished or alcoholic patients and can be reversed by thiamine.Rx of ethylene glycol induced acidosis include prompt institution of a saline or osmotic diuresis, thiamine and pyridoxine supplements, fomepizole or ethanol, and hemodialysis.THIAMINE (VITAMIN B,) - FUNCTIONSIn the decarboxylation of a-ketoacids, such as pyruvate a-ketoglutarate, and branched-chain amino acidsCoenzyme for a transketolase reaction that mediates the conversion of hexose and pentose phosphates.# Role in peripheral nerve conductionDeficiency syndrome:# Wet beriberi (cardiovascular symptoms) can occur after 3 months of a thiamine-deficient diet. Patients present with an enlarged heart, tachycardia , high-output congestive heart failure, peripheral edema, and peripheral neuritis.# Dry beriberi presents with a symmetric peripheral neuropathy of the motor and sensory systems with diminished reflexes.# Alcoholic patients with chronic thiamine deficiency may also have CNS manifestations known as Wernicke's encephalopathy, consisting of:- Horizontal nystagmus,- Ophthalmoplegia +Loss of memory & confabulatory psychosis = Wernicke-Korsakoff synd.- Cerebellar ataxia, &- Mental impairment.# Transketolase activity measured before and after the addition of thiamine pyrophosphate. A >25% stimulation by the addition of thiamine pyrophosphate (an activity coefficient of 1.25) is taken as abnormal.# Rx: In acute thiamine deficiency with either cardiovascular or neurologic signs, 100 mg/d of thiamine should be given parenterally for 7 days, followed by 10 mg/d orally until there is complete recovery.VitaminsNutrientClinical Finding Dietary Level per Day Associated with Overt Deficiency in AdultsContributing Factors to DeficiencyThiamineBeriberi: neuropathy, muscle weakness and hyperemesis, wasting, cardiomegaly, edema, ophthalmoplegia, confabulation.<0.3 mg/1000 kcalAlcoholism, chronic diuretic useRiboflavinMagenta tongue, angular stomatitis, seborrhea, cheilosis<0.6 mg NiacinPellagra: pigmented rash of sun-exposed areas, bright red tongue, diarrhea, apathy, memory loss, disorientation (necklace sign)<9.0 niacin equivalentsAlcoholism, vitamin B6 deficiency, riboflavin deficiency, tryptophan deficiencyVitamin B6Seborrhea, glossitis convulsions, neuropathy, depression, confusion, microcytic anemia<0.2 mgAlcoholism, isoniazidFolateMegaloblastic anemia, atrophic glossitis, depression, homocysteine<100 mg/dAlcoholism, sulfasalazine, pyrimethamine, triamtereneVitamin B12Megaloblastic anemia, loss of vibratory and position sense, abnormal gait, dementia, impotence, loss of bladder and bowel control, homocysteine, methylmalonic acid<1.0 mg/dGastric atrophy (pernicious anemia), terminal ileal disease, strict vegetarianism, acid reducing drugs (e.g., H2 blockers)Vitamin CScurvy: petechiae, ecchymosis, coiled hairs, inflamed and bleeding gums, joint effusion, poor wound healing, fatigue<10 mg/dSmoking, alcoholismVitamin AXerophthalmia, night-blindness, Bitot's spots, follicular hyper-keratosis, impaired embryonic development, immune dysfunction<300 mg/dFat malabsorption, infection, measles, alcoholism, protein-energy malnutritionVitamin DRickets: skeletal deformation, rachitic rosary, bowed legs; osteomalacia<2.0 m/dAging, lack of sunlight exposure, fat malabsorption, deeply pigmented skinVitamin EPeripheral neuropathy, spinocerebellar ataxia, skeletal muscle atrophy, retinopathyNot described unless underlying contributing factor is presentOccurs only with fat malabsorption, or genetic abnormalities of vitamin E metabolism/transportVitamin KElevated prothrombin time, bleeding<10 g/dFat malabsorption, liver disease, antibiotic use
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