A 20 year old alcoholic malnourished patient presented to hospital with respiratory distress. His pulse was 112/minute. Patient had edema, hypeension, systolic murmur along the left sternal edge. Bilateral murmur along the left sternal edge. Bilateral crepitations were felt in the lungs. A diagnosis of congetsive high output cardiac failure was made. Which vitamin is deficient?

vitamin B 1 - water soluble vitamin It has a specific coenzyme TPP (thiamine pyrophosphate ) this help in carbohydrate metabolism . TPP Dependent enzyme pyruvate dehydrogenase - conversion of pyruvate to acetyl CoA. alpha -Ketoglutarate dehydrogenase - CTA CYCLE Transketolas - (HMP shunt) The branched chain ALPHA - keto acid dehydrogenase -: oxidative decarboxylation pyrophosphate of branched chain amino acids . RDA ( Recommended dietary allowance) Adult - 1 - 1.5 mg/day Children - 0.7 - 1.2 mg /day The requirement increases in pregnancy and lactation (2 mg/ day), old age and alcoholism. Deficiency of vitamin b 1 is known as beriberi In adults, two types of beri-beri WET BERI - BERI - This is characterized by edema of legs, face, trunk and serous cavities. Dyspnea and palpitation are present The systolic blood pressure is elevated while diastolic is decreased Pulse is fast and bouncing Death is due to hea failure Dry beri-beri - This is associated with neurological manifestations resulting in peripheral neuritis. edema is not seen muscle become week so patient has difficulty in walking. Infantile beri-beri infant born to mother who is suffering from thiamine deficiency Brest milk is contain low thiamine Sleeplessness , vomiting , convulsions Bouts of screaming resembles to abdominal colic These all symptoms are due cardiac dilation Death occur suddenly due to hea failure Wernickes Korsakoff syndrome Seen in chronic alcoholics insufficient intake or impaired intestinal absorption of thiamine will lead to this syndrome Symptoms of wernickes encephalopathy - G - GLOBAL CONFUSION O - OPHTHALMOPLEGIA A - ATAXIA Korsakoff syndrome - chronic neurological complication Amnesia - mainly anterograde amnesia Confabulations - false story and honest lying Thiamin Nutritional Status Can Be Assessed by Erythrocyte Transketolase Activaity