Nutritional disordersNutritional disorders

Premed 3Premed 3

PathophysiologyPathophysiology

Dr. ROOPADr. ROOPA

Protein energy malnutritionProtein energy malnutrition There are two imp . ConditionsThere are two imp . Conditions MarasmusMarasmus kwashiorkarkwashiorkar

Water soluble vitaminsWater soluble vitamins

B1 – ThiamineB1 – Thiamine B2 – RiboflavinB2 – Riboflavin B3 – NiacinB3 – Niacin B6 – PyridoxineB6 – Pyridoxine B12 – CobalaminB12 – Cobalamin Folic acidFolic acid Vitamin C – Ascorbic acidVitamin C – Ascorbic acid

Water soluble vitaminsWater soluble vitamins

Regular intake is necessaryRegular intake is necessary B12 – stored in liver in large amountsB12 – stored in liver in large amounts

- deficiency takes years to develop- deficiency takes years to develop Toxicity rareToxicity rare Excreted in the urineExcreted in the urine Sources: vegetables, cereals, grains, meat, Sources: vegetables, cereals, grains, meat,

dairy products, fruitsdairy products, fruits

Thiamine deficiency (B1)Thiamine deficiency (B1)

Sources: liver, eggs, whole grain cereal, rice,wheatSources: liver, eggs, whole grain cereal, rice,wheat Outer layers of grain and the seed- lowers thiamine Outer layers of grain and the seed- lowers thiamine

content.content. Common in Western countries: alcoholism, diet of Common in Western countries: alcoholism, diet of

nonenriched rice.nonenriched rice. 1. Dry Beri-beri causes wasting and partial paralysis 1. Dry Beri-beri causes wasting and partial paralysis

resulting from damaged peripheral nerves( peripheral resulting from damaged peripheral nerves( peripheral neuropathy)neuropathy)

neuropathy of the peripheral limbsneuropathy of the peripheral limbsmuscle atrophymuscle atrophy

2.Wet beriberi( cardiovascular syndrome) 2.Wet beriberi( cardiovascular syndrome) affects the heart; it is sometimes fatal, as it affects the heart; it is sometimes fatal, as it causes a combination of heart failure and causes a combination of heart failure and weakening of the capillary walls, which causes weakening of the capillary walls, which causes high cardiac output failure, the peripheral high cardiac output failure, the peripheral tissues to become edematous.tissues to become edematous.

Thiamine deficiency (B1)Thiamine deficiency (B1)

3. Wernicke-Korsakoff deficiency3. Wernicke-Korsakoff deficiency- alchoholics- alchoholics-brain stem, diencephalon degenerates-brain stem, diencephalon degenerates-hemorrhage in the brain-hemorrhage in the brain-Wernicke’s triad:-Wernicke’s triad:

confusionconfusionataxia( loss of muscular cordination)ataxia( loss of muscular cordination)ophthalmoplegiaophthalmoplegia

-memory loss, confabulation( the replacement -memory loss, confabulation( the replacement of a gap in a person's memory by a falsification that of a gap in a person's memory by a falsification that he or she believes to be true. he or she believes to be true.

RIBOFLAVIN (B2)RIBOFLAVIN (B2)

Rare deficiencyRare deficiency Always added to bread, cereal productsAlways added to bread, cereal products Deficiency: Angular stomatitisDeficiency: Angular stomatitis

cheilosis (cracked lips)cheilosis (cracked lips)

glossitis (inflammation of the tongue)glossitis (inflammation of the tongue)

increased blood vessels in the cornea( corneal increased blood vessels in the cornea( corneal neovascularisation)neovascularisation)

seborrheic dermatitisseborrheic dermatitis

NIACIN(B3)NIACIN(B3)

Niacin, tryptophan deficiencyNiacin, tryptophan deficiency Important part of nicotinamide adenine Important part of nicotinamide adenine

dinucleotides (NAD, NADP)dinucleotides (NAD, NADP) PELLAGRA:three DsPELLAGRA:three Ds

dementiadementia

dermatitisdermatitis

diarrheadiarrhea

PYRIDOXINE (B6)PYRIDOXINE (B6)

May lead to deficiency of GABAMay lead to deficiency of GABA Convulsions in kidsConvulsions in kids Seen also in alcoholism, antiTB drug useSeen also in alcoholism, antiTB drug use Glutamate ( glutamic acid decarboxylase and Glutamate ( glutamic acid decarboxylase and

pyridoxal phosphate as a cofactor)----GABApyridoxal phosphate as a cofactor)----GABA B6 deficiency can result in SIDEROBLASTIC B6 deficiency can result in SIDEROBLASTIC

ANEMIAANEMIA

Cobalamin (B12)Cobalamin (B12)

Reduced DNA replicationReduced DNA replication Reduced cell divisionReduced cell division Found almost always in MALABSORPTION, Found almost always in MALABSORPTION,

Pernicious anemia, Pernicious anemia, Crohn’s disease, Fish tapeworm infection Crohn’s disease, Fish tapeworm infection

(Diphyllobotrium latum, vegetarians.(Diphyllobotrium latum, vegetarians. MEGALOBLASTIC ANEMIA + MEGALOBLASTIC ANEMIA +

NEUROLOGIC ABNORMALITIESNEUROLOGIC ABNORMALITIES

FOLIC ACID FOLIC ACID

Absorbed in the small intestine.Absorbed in the small intestine. Sources: leafy vege., liver, kidney.Sources: leafy vege., liver, kidney. May be due to malabsorption or due to May be due to malabsorption or due to

increase demandincrease demand Cancer therapy, alcoholic, dietersCancer therapy, alcoholic, dieters MEGALOBLASTIC ANEMIA MEGALOBLASTIC ANEMIA Open neural defectOpen neural defect

ASCORBIC ACIDASCORBIC ACID

Serves as cofactor of the synthesis of proline Serves as cofactor of the synthesis of proline and hydroxyproline ---- collagen synthesisand hydroxyproline ---- collagen synthesis

SCURVYSCURVY Poor wound healingPoor wound healing Abnormal bleedingAbnormal bleeding Bone changes Bone changes

Biotin (B7)Biotin (B7)

Co factor in carboxylation reactions.Co factor in carboxylation reactions. Dermatitis, alopecia, nausea, loss of appetite.Dermatitis, alopecia, nausea, loss of appetite.