Beriberi
Introduction
Introduction to beriberi Beriberi is vitamin B1 or thiaminedeficiency. Thiamine is an important vitamin involved in sugar and energy metabolism in the body, and its deficiency can lead to dysfunction of the digestive, neurological and cardiovascular systems. There are three types of beriberi clinically known as "dry" nerve athlete's foot. The latter often occurs in the elderly, accompanied by symptoms of consumption, mainly neurological abnormalities. "Infant type" is severe and manifests as acute cardiovascular symptoms, which can cause death if not treated in time. basic knowledge The proportion of illness: 70% Susceptible people: no specific population Mode of infection: infection Complications: heart failure, convulsions and convulsions
Cause
The cause of beriberi
Too little vitamin intake (30%):
The daily intake of normal adult males is 1.2-1.5mg, female 1.0-1.1mg, which is related to energy demand, generally not less than 0.5mg/1000 kcal, vitamin B1 in yeast, animal tissues, beans, peanuts, wheat Class, brown rice is rich in content, grain is refined or improperly stored, moldy and degenerate, vitamin B1 can be lost, thiamine is water-soluble vitamin, not resistant to high temperature under alkaline conditions, so improper cooking can be lost with rice soup and soup Or being destroyed, in addition, loss of appetite, heavy drinking, long-term intravenous nutrition can cause insufficient intake of vitamin B1.
Increased vitamin demand (30%):
Under physiological conditions, such as growth and development, pregnancy and lactation, strong physical labor and exercise, or high carbohydrate, low fat, low protein diet structure, vitamin B1 demand increased, under pathological conditions, Vitamin B1 requirements are also increased, such as thyrotoxicosis, long-term fever, and chronic wasting diseases.
Absorption barrier (20%):
Vitamin B1 is absorbed in the small intestine according to the concentration of passive diffusion and active transport, and the amount of storage in the body is small. Chronic diarrhea, intestinal tuberculosis, intestinal typhoid and other diseases can cause vitamin B1 malabsorption, alcoholism, chronic malnutrition and folic acid deficiency. There may also be malabsorption disorders. In addition to malabsorption, patients with alcoholic liver disease are also associated with intermediate metabolic disorders in which thiamine is converted to thiamine pyrophosphate.
[Pathological description]
(1) The nervous system of the brain and spinal cord is congested, edema and degeneration, the posterior column of the spinal cord, the nerve fiber membrane in the anterior and posterior nerve roots is degenerated, and the involvement of the sciatic nerve and its branches in the peripheral nerve is most common, and appears earlier, the arm nerve, sputum Nerve, recurrent laryngeal nerve and cranial nerve, especially the vagus nerve are often involved, myelin is degeneration and hyperpigmentation, Schwann cells are vacuolar degeneration, the nerve axis can be fractured, atrophied and degenerated, and the distal nerve lesion is more Serious and first happen.
(B) the heart in the acute beriberi heart enlargement, the right side is more obvious, myocardial fiber hypertrophy has degeneration, the internal column and papillary muscle are more prominent, due to sudden death of the cycle of death, myocardial degeneration, fiber break and edema .
(3) Edema and serous exudation are common in acute beriberi, which can be limited to the lower extremities or distributed throughout the body. The sacral and calf are more common. The exudation of the serous fluid can be seen in the pericardium, thoracic cavity, and abdominal cavity.
(4) Other pathological changes include subcutaneous, peritoneal and epicardial fat disappearance, muscle atrophy dominated by the affected nerve, microscopically found muscle transverse stripes disappear, turbid swelling and fatty changes, lung, spleen, kidney, intestine, etc. Chronic obstructive congestion.
Prevention
Athlete's disease prevention
1. Wear ventilated and breathable cotton socks and replace them every day.
Second, avoid wearing rubber shoes or airtight shoes, it is best to have two pairs of shoes to wear, sandals is the best choice.
Third, do not wear shoes, slippers and socks with others.
Fourth, the sole of the foot, the itch between the toes should not be grasped by hand, and prevent infection from the fingers.
Fifth, the treatment should not stop the drug automatically. Usually, after consciously, continue to use the drug for several weeks. It is best to check and culture the mold. It is a negative for three weeks.
Complication
Beriberi complications Complications heart failure convulsions and convulsions
Rapid development can cause angulation, convulsions, heart failure, can cause death, so if there are patients with central nervous system symptoms, such as headache, nausea, vomiting, neck stiffness, should pay attention to concurrent convulsions and angulation, The latter can cause diaphragmatic spasm, affect respiratory function, and cause complications such as hypoxia. Heart failure is rapidly suppressed due to systolic function, and cardiac output is reduced, leading to sudden cardiac death.
Symptom
Beriberi symptoms common symptoms foot odor wet beriberi pain heart failure appetite loss sleepiness ataxia fatigue heart enlarge dry athlete's foot
The beriberi disease is divided into three types: dry beriberi, wet beriberi and infantile beriberi. The following symptoms are required:
nervous system
Central and peripheral nervous system damage, called dry beriberi. Peripheral nervous system lesions caused by vitamin B1 deficiency typically show 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 soreness, 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.
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.
Baby beriberi
1, the incidence of infantile beriberi is often very sudden, the brain is mainly called brain type; sudden heart failure is called heart type. The symptoms of older children are similar to adults, with edema and polyneuritis. In elderly children with peripheral neuritis, it is difficult to stand up when the sputum is present, the knee reflex disappears, and the gastrocnemius muscle is squeezed.
2, often fatigue, mental fatigue, loss of appetite, vomiting, diarrhea or constipation, with abdominal pain, bloating, weight loss, growth retardation and so on. Early edema of the lower extremity can occur, even to the whole body, or with pericardial, thoracic, and peritoneal effusion.
3, often first irritability, crying hoarse, and even loss of voice, and then look apathy, slow response, feeding cough, lethargy, severe coma and convulsions. Sometimes coma and horror can happen suddenly.
4, often sudden heart failure, baby irritability, screaming, cough, shortness of breath, cold sweat, lips (toe) bruising.
5, pregnant mother lack of vitamin B1, neonatal can suffer from congenital beriberi, manifested as crying weakness, look wilting, weak sucking power, edema, lethargy.
Examine
Beriberi examination
1, blood routine, urine routine, vitamin B1 load test urine output decreased.
2, blood pyruvate, thiamine check, blood pyruvic acid, increased lactic acid concentration, red blood cell transketolase activity decreased.
3. ECG examination.
Laboratory diagnosis, including determination of pyruvic acid and thiamine concentration in blood and urine, or determination of ketolase activity in red blood cells to aid diagnosis, commonly used are the following two:
1 Determination of urinary thiamine excretion: the amount of vitamin B1 secreted in urine varies with intake, so the determination of vitamin B1 excretion in urine has certain reference value for evaluating thiamine levels in human body, but is susceptible to taking diuretic The influence of factors such as agents, there are many methods of measurement, the most sensitive is high performance liquid chromatography (HPLC) method, the collection of 24h urine specimens is more reliable than random urine samples, in addition, can also be given once through the gut 5 mg of vitamin B1 is loaded, and then the amount of urinary excretion is measured within 4 hours. For example, a 4-hour excretion <20 g is a vitamin B1 deficiency, and the method can be used to estimate the degree of vitamin B1 deficiency in the tissue.
2 erythrocyte transketolase test: thiamine part is present in red blood cells in the form of coenzyme of ketolase, thiamine deficiency can reduce the activity of transketolase, erythrocyte transketolase test is by adding exogenous thiamine Pyrophosphate (TPP), to determine the activity of transketolase, the results are expressed by the activity coefficient, the activity coefficient of more than 1.3 suggests vitamin B1 deficiency; less than 1.0 is interpreted as normal, red blood cell transketolase determination is reliable and suitable for the determination of vitamins in human body Enzyme function test of B1 condition.
Diagnosis
Diagnosis of beriberi
diagnosis
Mainly based on the history of nutritional deficiencies and clinical manifestations, the diagnosis of peripheral neuritis can be determined by the following method:
1 test, when the patient takes a posture, it feels pain in the calf and difficulty in standing up. It is often used to support the knee to help stand up.
2 There is pain when the gastrocnemius muscle is squeezed.
3 foot back, sputum, lower tactile touch and pain sensation.
4, the knee reflex is abnormal, mostly diminished or disappeared.
The basis for the diagnosis of fulminant beriberi heart disease is:
1 There are more than 3 months of vitamin B1 nutritional deficiency and signs of peripheral neuritis.
2 High-volume heart failure that occurs suddenly, accompanied by polydipsia.
3 heart enlargement, rhythm rules, no other causes can be investigated.
4 For the suspicious case immediately for the treatment test, the symptoms of the disease quickly improved after treatment.
Differential diagnosis
Vitamin B1 deficiency in peripheral neuritis manifestations must be differentiated from lead poisoning, arsenic poisoning and infection caused by diphtheria, bacillary dysentery, leprosy, etc., edema must be differentiated from nephritis, malnutrition and physiological edema, urine routine examination, Determination of plasma protein and examination of the presence or absence of concomitant peripheral neuropathy may be helpful in the diagnosis. Patients with heart failure should be associated with other high-output heart disease with heart failure (such as hyperthyroidism, anemia) and Toxicity, identification of viral myocarditis.
In alcoholics, vitamin B1 deficiency can be accompanied by liver disease and alcoholism, sometimes difficult to distinguish, and careful diagnosis is needed.
