Beriberi is the vitamin B1 deficiency disorder specially thiamine deficiency, resulting in neurological disorders. Nervous system, cardiovascular system, and muscular systems are affected by beriberi or Vitamin b1 deficiency. Meaning of beriberi is  “I can’t, I can’t “. Beriberi is common in Southeast Asia where people uses rice with poor thiamine as staple food.

Types of Beriberi:-

Two main types of Beriberi are,

Wet Beriberi : Cardiovascular system is affected with wet beriberi and

Dry Beriberi : Nervous system is affected with dry beriberi.

Causes of beriberi :-

Vitamin B1 – thiamine deficiency is the main cause of Beriberi.

Beriberi is common in patients with  alcohol abuse, because excess alcohol consumption leads to poor  nutrition, and absorption of vitamins and minerals  is very less.

People who consumes diet with less with thiamine, i.e. Polished white rice will get beriberi.

Beriberi is common in people who eat white polished rice ( less in thiamine) as staple food.

Beriberi may also seen in patients after Gastric surgeries.

Genetic beriberi is rarely caused and is due to family history or genetic inheritance. Patients with genetic beriberi, intestines fails to absorb thiamine or vitamin B from foods ingested. The symptoms of Genetic beriberi are usually seen during adult age.

Babies who receive less thiamine containing milk from mother can also affected by Beriberi. Formula feeding infants with inadequate thiamine also can suffer from Beriberi.

Dialysis to treat other diseases, and Diuretics can increase the risk of Beriberi.

Symptoms of Beriberi:-

• Weight loss,
• Loss of appetite,
• Emotional disturbances
• General weakness,
• vomiting,

Dry beriberi Symptoms:-

• Nerve damage,
• Impaired sensory perception,
• Partial paralysis,
• Peripheral neural damage,
• Loss of sensation in feet and legs,
• Mental confusion,
• loss of muscle co-ordination,
• Pain in the limbs,
• Tingling,
• Difficulty in walking,
• Increased amount of lactic acid and pyruvic acid in blood,

Wet beriberi Symptoms:-

Cardiovascular abnormalities,

Cardiac failure,

Congestive cardiac failure, are main symptoms of wet beriberi.

Weakening of capillary walls,

Increased heart rate,

Shortness of breath,

Awakening at night with sweating,

Cardiac symptoms becomes fatal, if not treated,

If not treated beriberi may lead to death.

Treatment of Beriberi:-

Thiamine Hydrochloride in tablet form or in injection form is given to treat Beriberi. Even with an hour of treatment with thiamine hydrochloride itself the patient recovers from Beriberi symptoms.

• High doses of thiamine injection,
• Unrefined cereals,
• Fresh foods such as  meat, legumes,
• Green vegetables, fruits , and milk are provided to treat beriberi with rich thiamine supplement.

Anemia can be defined as medical condition in which decrease in the red blood cell or hemoglobin less than 13.5 gm% in males and 12 gm% in females.

Causes of anemia:-

* Anemia caused due to blood loss
* Anemia caused due to decreased or fault in the bone marrow
* Anemia caused due to abnormal destruction of red blood cells in the spleen and liver
* Anemia Caused due to Blood Loss
* When the blood loss occurs due to severe hemorrhage, there is loss of red blood cells leads to anemia.
* Alimentary canal conditions such as ulcers, files, gastritis (inflammation of the stomach) and cancer
* Prolonged Use of non steroidal anti-inflammatory drugs (NSAIDS) such as paracetamol, aspirin etc, causes anemia.
* Menstruation and during delivery, especially if menstrual bleeding is more than normal, antepartum hemorrhage. Postpartum hemorrhage and if there are multiple pregnancies also causes anemia.
* Severe blood loss in case of injury causes anemia.
* Anemia Caused due to fault in the bone marrow production of red blood cells

Anemia occurs due to following reasons:-

#  Sickle cell anemia is also called as hereditary anemia

#  Iron deficiency anemia due lack of iron in the food and lack of absorption in the gut

#  Vitamin deficiency such as vitamin c and vitamin B

#   Bone marrow and stem cell problems that is due to carcinoma

Anemia Symptoms:-

The symptoms of the anemia includes the following:-

* Fatigue
* Rapid heart rate
* Heart murmur
* Enlargement of the spleen
* Low blood pressure
* Abdominal pain
* Weakness Rapid breathing
* Maroon, or visibly bloody stools
* Trouble breathing
* Dizziness
* Pale or cold skin
* Tired
* Palpitations
* Hair loss,
* Malaise
* Worsening of heart problems

Diagnosis of Anemia:-

* Complete blood count (CBC)
* Red blood count
* Hemoglobin
* Hematocrit
* White blood count
* Platelet count
* Differential count
* Means corpuscular volume
* Stool guaiac – Tests for blood in stool
* Peripheral blood smear – Looks at the red blood cells under a microscope
* Transferring level – Looks at a protein that carries iron around the body
* Reticulocyte count
* Bone marrow biopsy
* These are the tests done for diagnosis of anemia.

Anemia Treatment:-

Care at Home:
1. Anemia can be treated at home by providing iron rich diet, adequate bed rest and by taking iron and folic acid tablets etc.
2. If the patient is having stomach ulcer he or she as to stop taking aspirin and medications such as ibuprofen etc.

Medical Treatment of anemia:

Oral therapy for anemia:-  The medical treatment includes iron and folic acid tablets, oral solutions like ferrous fumarate and ferrous gluconate etc.

Parenteral therapy for anemia:

Intravenous injections: -  It includes administration of the iron injections through intravenously for sudden onset of action, and used to treat severe anemia.

Intramuscular injections: – Here injections are given in a Z track method and it is effective but having more side effects.

Blood transfusion for anemia : – In case of severe anemia the packed cell are transfused.

Oxygen – To ensure that each red blood cell can deliver the maximum oxygen to body tissues

Fluids – To help to elevate blood pressure when blood loss causes blood pressure to drop

Platelets – Replaces missing platelets when bleeding is severe Antibiotics are given to treat infections.

Erythropoietin is given to improve the red blood cell production. Surgery for anemia treatment includes Hysterectomy that is removal of the uterus will help to prevent the loss of the bleeding after the delivery and due to any carcinoma.

Follow-up care in anemia

Follow up care in anemia is very essential to prevent further occurrence of the anemia, it includes the regular check up, and continuation of the medications.

Prevention of anemia:-

Prevention of anemia can be achieved by regular check up and by early detection of the anemia and treatment. And taking iron rich diets like drumstick, green leafy vegetables, papaya, cereals and milk and milk products helps in preventing anemia.

Complications of anemia : Complications of the anemia includes the hypoxia, cardiac problems like cardiac failure, tissue hypoxia and brain anoxia.

Main sources of vitamin D:-

Natural sunlight : Exposure of skin to sunlight helps in the synthesis of Vitamin D by converting inactive form into active form.

Fortification of dietary foods : Adding vitamin D rich foods in the diet is known as fortification of dietary foods.

Oily fish : Fish and fish oil are the richest sources or vitamin D.

Mushrooms are also rich in vitamin D.

sources of Vitamin D :-

* Cod Liver Oil
* liver and beef,
* boiled egg
* meat and animal origin food
* cheese, butter
* Salmon,
* Mackerel,
* Margarine fortified,
* Sardines, canned in oil,
* reduced fat milk
* Cereal grain bars,
* Pudding,
* dried cereals
only dietary foods don’t fulfill the vitamin D requirement of the body. Exposure to sunlight is the best source of vitamin D.

Vitamin D supplementation for different groups

individuals with less sunlight exposure – 400 to 1000 units/day.

Old age, or after 65 years – 800 to 1000 units/day

Patients with cystic fibrosis – 800 to 1000 units/day

Active metabolites of Vitamin D are administered for patients with kidney disease.

Deficiency disorders of vitamin D:-

* Nearly 40% US people are suffering from vitamin D deficiency.
* Osteoporosis is caused due to poor absorption of calcium, as the deficiency of vitamin D. Osteoporosis is characterized by weak bones, increased bone fragility, etc.
* Osteomalacia is seen in adults is characterized by weak bones prone to get fracture.
* Rickets in children : Children between the age group of infancy to 2 years are at risk of rickets. The symptoms of rickets are retarded growth, bone deformity, tetany, muscular hypotonia, and convulsions.
* vitamin D deficiency leads to poor absorption of other vitamins and minerals and leads to vitamin and mineral deficiency in the human body.
* fractures may occur due to vitamin D deficiency.