Nutritional disorders

Scurvy

• Due to lack of vitamin C
• Poor, pregnant, odd diet?
• Signs
  • Listlessness, cachexia, anorexia
  • Gingivitis, loose teeth, halitosis
  • Bleeding from gums, nose, hair follicles, into joints, ladder, gut

Beriberi

• Two types;
  • Wet beriberi – heart failure
  • Dry beriberi – neuropathy
• Due to thiamine deficiency

Pellagra

• Lack of nicotinic acid
• Classical triad – dementia, diarrhoea, dermatitis
• Also associated with neuropathy, depression, insomnia, tremor, rigidity, ataxia
• May occur in carcinoid syndrome and with anti-TB drugs (isoniazid)

Xerophthalmia

• Vitamin A deficiency
• Major cause of blindness in the tropics
• Conjunctivae become dry and develop oval or triangular spots, corneas become soft and cloudy

Wernicke’s encephalopathy

• Thiamine deficiency (Vit B1)
• Classical triad of opthalmoplegia, ataxia, confusion
• Focal areas of damage occur, including Periaqueductal grey punctuate haemorrhages
• Causes;
  • Alcoholism, eating disorders, malnutrition, prolonged vomiting
• Treatment;
  • Urgent thiamine
  • Give IV pabrinex
  • Anaphylaxis can occur so have resuscitation facilities to hand
  • If there is co-existing hypoglycaemia make sure thiamine is given before the glucose, as Wernicke’s can be precipitated by thiamine in the hypoglycaemic patient
• Prognosis
  • Untreated death occur in 20% and Korsakoff’s psychosis in 85%