Nutritional Pathology Online
As a doctor today I prescribe Thiamine (Vitamin B1) rich foods:
Prevent Beriberi, Wernicke's Encephalopathy, and Korsakoff's Psychosis.
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In my series of diseases related to nutritional deficiency my today's short post is on Thiamine deficiency.
Thiamine deficiency is an important nutritional disorder in Asia and Africa, specially where people mainly consume polished rice.
Thiamine deficiency in humans affects the cardiovascular, muscular, nervous, and gastrointestinal systems.
With increased awareness of the disease and improved nutrition in many countries, this disorder is less common now than in previous generations.
Lesions resulting from Thiamine Deficiency:
Human diseases in which thiamine deficiency plays an important role are Beriberi, Wernicke's encephalopathy, and Korsakoff's psychosis.
In fatal cases of beriberi the findings are variable. On gross examination the most common lesions are emaciation, muscle atrophy, dilatation (with or without hypertrophy) of the right side of the heart, generalized edema, serous effusions, and chronic passive congestion of the viscera.
Death may be caused by high-output cardiac failure, by acute pulmonary edema, or by pneumonia, or other complicating infections.
The edema is caused in part by cardiac failure, but hypoproteinemia is probably a contributory factor in many cases.
This cardiovascular picture is particularly characteristic of the so-called wet type of beriberi, which is usually acute.
Microscopically loss of striation and fatty degeneration of the myocardial fibers are noted.
There is diffuse edema, often with slight lymphocytic infiltration of the intestinal tissue of many organs.
Skeletal muscles show hyaline and fatty degenerative changes.
Degenerative changes in nerves are more characteristic of the dry or chronic form of the disease, which is seen chiefly in adults.
Myelin degeneration and, in severe cases, fragmentation of the axis cylinders are seen in the affected nerves, which may be those of the extremities, the vagus, or the cranial nerves.
In thiamine-deficient pigeons, axis cylinder degeneration begins distally and progresses until the neurons are involved.
If thiamine is given before neuron death , regeneration of axis cylinders occurs at the usual normal rate. In dogs similar degenerative changes have been described in the central nervous system.
Wernicke's Disease is associated with chronic alcoholism and is characterized by ganglion cell degeneration and focal demyelinating lesions and hemorrhage in the nuclei surrounding the ventricles and aqueduct, particularly in the nuclei of the extrinsic muscles of the eye.
There is also some reparative proliferation of neuroglial cells.
An apparently identical lesion may be produced in thiamine-deficient pigeons.
In view of the experimental evidence, thiamine deficiency is now believed to be the most important etiologic factor in Wernicke's disease and in the pathologically similar Wernicke-Korsakoff’s syndrome.
Adding thiamine to the diet causes prompt clearing of the neurologic symptoms.
Wernicke-Korsakoff's psychosis, the result of brain damage after recovery from coma in Wernicke's syndrome, improves more slowly, and underlying psychotic elements often remain.
MRI plays an important role in the diagnosis of acute Wernicke's Encephalopathy.
Characteristic lesions are present in the mammillary bodies (atrophy) and surrounding areas around the third ventricle.
Pathology of Vitamin A deficiency:
Importance of Vitamin A in our daily diet
Operational criteria for the classification of chronic alcoholics: identification of Wernicke's encephalopathy.
Thiamine deficiency in patients with congestive heart failure receiving long-term furosemide therapy: a pilot study
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