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THIAMINE DEFICIENCY

Keith Megara Osores, Adtrià Pladevall, Maria Plana i Maria Poch

PATIENT:

  • 59 year old male
  • Heavy drinker

.

SYMPTOMS:

  • Confusion and disorientation
  • ataxia
  • Abnormalities in eye movements

.

DIAGNOSIS:

  • Afebrile
  • Heart rate: 110 beats per minute
  • Normal blood pressure
  • Positive blood alcohol level

CLINICAL CASE

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Thiamine (Vitamin B1)

pyrimidine ring with amino group

sulphur thiazole ring

THIAMINE

Alpha-ketoglutarate dehydrogenase

Picture sources: 1. https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/nutricion_2317045 2.https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwjtkoi97LLmAhVDzRoKHSwvDgcQjRx6BAgBEAQ&url=https%3A%2F%2Fwww.namrata.co%2Fsubjective-questions-vitamin-b1-thiamine-solved%2F&psig=AOvVaw0pILgs4kZL86YKxZ2d81uQ&ust=1576334153994484 3.https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwjT293R7LLmAhWMxIUKHfAUAZIQjRx6BAgBEAQ&url=http%3A%2F%2Fblog.nutricionequina.com%2Fvitamina-b1-tiamina%2F&psig=AOvVaw36RJmeazx34O-XB_-iNZTd&ust=1576334187549220

PYRUVATE DEHYDROGENASE

Pyruvate Acetyl-CoA

Glycolysis Krebs cycle

Pyruvate dehydrogenase

Pyruvate decarboxilation and union to the lipoic acid of the next enzime

Acetylcholine

Synthesis

Myelin

Picture sources: 1. https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwjzr5Cn7rLmAhVEVhoKHW_ACvgQjRx6BAgBEAQ&url=https%3A%2F%2Fpixabay.com%2Fes%2Fillustrations%2Fmitocondrias-celular-la-biolog%25C3%25ADa-3016868%2F&psig=AOvVaw1VJzsTt5inWoLDMancKBnw&ust=1576334646753061 2. https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwianf3N7rLmAhULxYUKHRX1DiEQjRx6BAgBEAQ&url=https%3A%2F%2Fen.wikipedia.org%2Fwiki%2FPyruvate_dehydrogenase_complex&psig=AOvVaw0rkU2IHAh-Tjbw4JfnGaR3&ust=1576334717079205

ALPHA-KETOGLUTARATE DEHYDROGENASE

Citric acid cycle

Glutamate

Gamma–aminobutyric

acid (GABA)

Aspartate

Acetyl CoA NADH+FADH2 ATP

Picture source: 1.https://en.wikipedia.org/wiki/File:Citric_acid_cycle_with_aconitate_2.svg 2. https://www.flaticon.es/icono-gratis/energia-renovable_355423

TRANSKETOLASE

Glucose

Phentose phosphate

pathway

Glucose-6-phosphate

TRANSKETOLASE

Transketolase

Ribose-5-phospate NADPH

+

Nucleic acids

Complex sugars

Coenzymes

Steroids

Amino acids

Fatty acids

Glutathione

WHAT HAPPENS IF WE DON'T HAVE THIAMINE?

THIAMINE DEFICIENCY

  • Loss of appetite
  • Fatigue
  • Reduced reflexes
  • Muscle weakness
  • Blurry vision
  • Changes in heart rate

Picture sources: 1.https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/ninguna-entrada_1159417?term=no&page=1&position=17, 2.https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/dieta_706164?term=comida&page=1&position=7 3. https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/latido-del-corazon_1142131?term=corazon%20medico&page=1&position=9 4. https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/sonando_1826064?term=sue%C3%B1o&page=1&position=17

CAUSES OF THIAMINE DEFICIENCY

  • Poor nutrition

  • Old age

  • Diabetes

  • Alcohol dependence

  • Dialysis

Picture sources: 1. https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/pastillas_822092?term=pill&page=1&position=3 2.https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/confundido_1698558 3.https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/grafico_1378622

THIAMINE DEFICIENCY DISEASES

Beriberi

THIAMINE DEFICIENCY DISEASES

Wernicke-Korsakoff Syndrome

Picture sources: 1. https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/cerebro_882998?term=brain&page=1&position=16 2. https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/whisky_123617?term=alcohol&page=3&position=1 3. https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/jaqueca_1497115?term=dolor&page=1&position=3 4. https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwjeh5i_6LLmAhUDaBoKHSK_DqIQjRx6BAgBEAQ&url=https%3A%2F%2Ffactdr.com%2Fhealth-conditions%2Fberiberi%2F&psig=AOvVaw0fd1h4wc8RDpENyGqCH6LA&ust=1576333085471553 5. https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwjRnYjh6LLmAhUGWBoKHY8nDr0QjRx6BAgBEAQ&url=https%3A%2F%2Fwww.semanticscholar.org%2Fpaper%2FWernicke-Korsakoff-Syndrome-in-Primary-Peritoneal-Kim%2F80e6bf71ea06d542f14f1335e08c5d1305e4f2dc&psig=AOvVaw3qDVF76VCC1m-JtWuDX3Qm&ust=1576333147318095

TREATMENT AND PREVENTION

Intravenous thiamine

Thiamine rich foods

TREATMENT AND PREVENTION

Soybeans

Tuna

Whole grains

Peas

Pork

Picture sources: 1.https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/arroz_1460196?term=wholegrain&page=1&position=1 2. https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/cerdo_2194807?term=pork&page=1&position=5 3. https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/atun_1728782 4. https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/soja_884334?term=soy&page=1&position=12 5. https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/chicharos_680959?term=peas&page=1&position=4 6.https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/comprobado_190411?term=tick&page=1&position=6 7.https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwjyyZK96rLmAhUG8BoKHc0rDhsQjRx6BAgBEAQ&url=https%3A%2F%2Fbiowet.pl%2Fproductos%2Fvitaminum-b1%2F%3Flang%3Des&psig=AOvVaw3KXOpsJhI39uC5_BpSwwzG&ust=1576333617299558

KEY POINTS

CONCLUSION

NO thiamine NO ATP

Picture sources: 1. https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/derecho_1635621?term=arrow&page=8&position=54

2. https://www.flaticon.es/download-icon, https://www.flaticon.es/icono-gratis/archivo_1091752

STUDIES:

Recent studies show a close relation between thiamine deficiency and

Alzheimer

STUDIES

Cancer

Picture sources: https://www.iconfinder.com/icons/2202443/alzheimer_cannot_remember_forgetful_man_memory_loss_old_icon, https://emojiterra.com/es/cerebro/, https://medicalxpress.com/news/2019-07-dont-basis-cancer-therapies.html

BIBLIOGRAPHY:

BIBLIOGRAPHY

En.wikipedia.org. (2019). Thiamine. [online] Available at: https://en.wikipedia.org/wiki/Thiamine [Accessed 01 Dec. 2019].

Emedicine.medscape.com. (2019). Beriberi (Thiamine Deficiency): Practice Essentials, Pathophysiology, Etiology. [online] Available at: https://emedicine.medscape.com/article/116930-overview [Accessed 13 Nov. 2019].

Emedicine.medscape.com. (2019). Beriberi (Thiamine Deficiency): Practice Essentials, Pathophysiology, Etiology. [online] Available at: https://emedicine.medscape.com/article/116930-overview [Accessed 13 Nov. 2019].

Emedicine.medscape.com. (2019). Beriberi (Thiamine Deficiency): Practice Essentials, Pathophysiology, Etiology. [online] Available at: https://emedicine.medscape.com/article/116930-overview [Accessed 13 Nov. 2019].

Emedicine.medscape.com. (2019). Beriberi (Thiamine Deficiency) Treatment & Management: Approach Considerations, Activity. [online] Available at: https://emedicine.medscape.com/article/116930-treatment [Accessed 17 Nov. 2019].

Emedicine.medscape.com. (2019). Wernicke-Korsakoff Syndrome: Background, Etiology, Pathophysiology. [online] Available at: https://emedicine.medscape.com/article/288379-overview#a3 [Accessed 5 Dec. 2019].

Anon, (2019). Responses of the mitochondrial alpha-ketoglutarate dehydrogenase. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2753422/ [Accessed 6 Dec. 2019].

Anon, (2019). Alpha-ketoglutarate dehydrogenase. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1569585/ [Accessed 16 Nov. 2019].

Biocyc.org. (2019). MetaCyc 2-ketoglutarate dehydrogenase complex. [online] Available at: https://biocyc.org/META/new-image?object=CPLX66-42 [Accessed 20 Nov. 2019].

Medscape.com. (2019). What is included in the treatment of beriberi (thiamine deficiency)?. [online] Available at: https://www.medscape.com/answers/116930-91240/what-is-included-in-the-treatment-of-beriberi-thiamine-deficiency [Accessed 13 Nov. 2019].

Kenneth Osiezagha, R. (2019). Thiamine Deficiency and Delirium. [online] PubMed Central (PMC). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659035/ [Accessed 8 Dec. 2019].

Emedicine.medscape.com. (2019). Wernicke Encephalopathy: Practice Essentials, Etiology, Epidemiology. [online] Available at: https://emedicine.medscape.com/article/794583-overview [Accessed 18 Nov. 2019].

Medical News Today. (2019). Wernicke-Korsakoff syndrome: Symptoms, causes, and treatment. [online] Available at: https://www.medicalnewstoday.com/articles/220007.php#treatment [Accessed 30 Nov. 2019].

Linus Pauling Institute. (2019). Thiamin. [online] Available at: https://lpi.oregonstate.edu/mic/vitamins/thiamin [Accessed 2 Dec. 2019].

Pubs.niaaa.nih.gov. (2019). The Role of Thiamine Deficiency in Alcoholic Brain Disease. [online] Available at: https://pubs.niaaa.nih.gov/publications/arh27-2/134-142.htm [Accessed 8 Dec. 2019].

Healthline. (2019). Wernicke-Korsakoff Syndrome: Risks, Causes, Symptoms, and More. [online] Available at: https://www.healthline.com/health/wernicke-korsakoff-syndrome#outlook [Accessed 13 Nov. 2019].

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