Avitaminosis is a chronic pathological condition that occurs with an acute deficit of a vitamin, as a consequence of a violation of the correct diet or the manifestation of any chronic pathological process.
It is necessary to distinguish such forms of this condition as " hypovitaminosis ", in which there is an increased consumption of various categories of vitamins, and "avitaminosis", which is a consequence of the complete absence of intake and absorption of vitamins in the body.
In a situation where the patient has symptoms of a deficiency of one type of vitamin, it is a question of monoavitaminosis, if in the patient's body there is a deficiency of vitamins belonging to different categories of vitamin-like substances, then treatment of polyvitaminosis should be started.
Causes of vitamin deficiency
Depending on the causes of vitamin deficiency, there are two main categories of vitamin deficiency: external and internal. Exogenous type of vitamin deficiency is observed in the complete absence of the fact of the receipt of vitally important vitamins and other nutrients with vitaminized foods, therefore this pathology is more often considered as "spring avitaminosis".
Endogenous form of avitaminosis arises as a result of human chronic pathologies of the upper part of the digestive tract, accompanied by a violation not so much of absorption, as the synthesis of a whole group of vitamins and vitamin-like substances. The autumn season is accompanied by a recurrence of gastroenterological diseases, so the endogenous form of vitamin deficiency can be considered as "autumn avitaminosis." Most often, a violation of the absorption capacity of the small intestine is observed in the aggressive course of dysbiosis, the occurrence of which is most often promoted by the uncontrolled long-term use of antibacterial drugs.
In addition to nutritional reasons, the occurrence of avitaminosis can be triggered by the receipt of a wide range of "antivitamin substances", whose activity is aimed at stopping the absorption and splitting of vitamins. Thus, even with the intake of vitamins of various categories in the body in sufficient quantity, the patient has symptoms of vitamin deficiency.
Fortunately, recently the incidence of avitaminosis has significantly decreased, although in some episodes conditions are created for the emergence of a complete deficiency of a vitamin-like substance.
Symptoms and signs of vitamin deficiency
Due to the fact that avitaminosis is a chronic pathology and has a long period of latency in relation to the increase of the clinical symptomatology, called hypovitaminosis, early diagnosis of this condition is extremely difficult. During the period of hypovitaminosis, the product of laboratory methods for the analysis of blood and urine for determining the level of saturation of blood plasma with one or another form of vitamin is the diagnostic plan. An additional method of examination, which allows to indirectly judge the presence of vitamin deficiency is the analysis of urine to determine the level of concentration of the products of the splitting of vitamins.
With the development of vitamin deficiency, nonspecific symptoms primarily arise in the form of recurring weakness, decreased ability to work, increased irritability and manifestation of the so-called " chronic fatigue syndrome ". In this latent period, some patients note pathological changes from the condition of the skin, hair and nails, namely the appearance of areas of excessive peeling, a tendency to rash, delamination of the nail plates, and the intensity of these manifestations gradually increases.
Skin covers of patients suffering from beriberi have a pale-gray hue and a common acne not only on the face, but also other parts of the body.
Vitamin A vitamin deficiency
The manifestation of pronounced avitaminosis of group A is represented by a separate nosological form of "follicular hyperkeratosis ", which represents a significant decrease in the turgor of skin and underlying soft tissue structures.
Avitaminosis of fat-soluble categories of vitamins has the features of manifestations in the form of the appearance of areas of hyperpigmentation on the skin, prone to rapid growth and fusion, as these vitamins have a pronounced antioxidant effect.
Vitamin B2 vitamin deficiency
Avitaminosis of group B2 is manifested by increased secretion of sebaceous and sweat glands, a recurring course of herpes, as well as nervous disorders, depressive conditions and impaired functions of the digestive tract.
In addition to the general nonspecific manifestations of avitaminosis, which are observed in all forms of this pathology, it is necessary to distinguish typical signs of vitamin deficiency of each individual vitamin.
Vitamin C vitamin deficiency
So, vitamin deficiency of group C is represented by a nosological unit called "scurvy". The basis of all manifestations of scurvy is a significant disruption of the synthesis of collagen, which is involved in the formation of most structures of the human body. Since collagen is part of the structure of the connective tissue of the vascular walls, disruption of its production leads to damage to the walls of vessels of different calibers and concomitant bleeding of varying degrees of intensity, from small hemorrhages on the gums to bleeding into the meninges.
The visual manifestations of this pathology consist in the appearance of a large number of subcutaneous hematomas of different localization and prevalence with the complete absence of the fact of traumatization. In pediatrics, scurvy manifests itself as a marked disruption in the development of cartilaginous structures, as a result of which there is a lag in growth in patients with childhood with this pathology.
Vitamin B1 vitamin deficiency
B1 avitaminosis has the classic name "beriberi" and negatively affects the function of all the internal organs of the human body, and more on the structures of the nervous system. In addition to the development of polyneuropathies of various localizations, which significantly worsen the quality of life of the patient, prolonged vitamin B1 damage causes damage to brain structures, manifested by general cerebral and focal symptoms.
Vitamin PP vitamin deficiency
The main manifestations of the PP vitamin deficiency is the defeat of the skin, which becomes very dry and becomes covered with large pits of ulceration.
In addition to the external signs of pellagra, there is a negative effect on the structure of the central nervous system, which initially has a latent flow, and can subsequently cause depressive, hallucinogenic conditions and even progressive dementia.
Vitamin K vitamin deficiency
Avitaminosis of group K is accompanied by the development of a massive hemorrhagic syndrome, which is manifested by the appearance of a large number of sources of bleeding and hemorrhage. The pathogenesis of the onset of these changes is based on the violation of blood clotting processes, and not on the pathological changes of the vessels, as in scurvy. Avitaminosis K is an urgent condition and requires the use of emergency medication correction with the use of substitution therapy.
A dangerous condition for a person's life is megaloblastic anemia, which is nothing more than a manifestation of vitamin B12 avitaminosis, which is characterized by an aggressive progressive course and can lead to death if there is no timely medical assistance.
The main sphere of influence of vitamin A is the organ of vision, therefore, avitaminosis of this type manifests itself as a significant violation of visual function until the development of complete blindness.
Aviaminoz group D in the adult category of patients is almost not found, and in pediatrics is a frequent pathology and is manifested by all signs of severe rickets.
Avitaminosis in children
The children's organism is also prone to the development of vitamin deficiencies of various vitamin groups, as the child has not yet sufficiently formed the mechanisms of absorption, cleavage and excretion of the products of metabolism of vitamins and other nutrients supplied with food. The initial manifestations of vitamin deficiency in the child is low-activity behavior, lack of appetite and impaired immunity. With prolonged avitaminosis, with complete absence of drug correction, there is a sharp lag in the physical and even mental development of the child.
The risk group for the appearance of signs of vitamin deficiency is children born before the term, because in the process of fetal development there is insufficient replenishment of vitamin stores from the mother, since the deposition of vitamins and important nutrients in the child's body occurs in the third trimester of pregnancy.
In the child's infancy, beriberi can occur due to increased intake of vitamins, since it is during this period that rapid growth and development of all structures of the child's body is noted.
The classical type of vitamin deficiency is present in pediatric practice very rarely, only in the case of prolonged alimentary dystrophy, which is a defect in elementary conditions for caring for the baby or the presence in the child of congenital forms of fermentopathy and congenital diseases of the digestive system with malabsorption syndrome.
In turn, the insufficient content of essential vitamins in the child's body can be facilitated by a prolonged course of parenteral nutrition, inappropriate use of chemotherapy drugs and chronic intoxication syndrome that arise in malignant tumors.
In childhood, avitaminosis is characterized by a slow flow with a long latent period, at which the level of vitamins in the body is reduced, but all groups of vitamins are present in their entirety. In this period, the use of such nonspecific measures as long daily walks in the fresh air, a full night's rest and adherence to the diet can prevent further development of vitamin deficiency.
In early childhood, the cause of vitamin deficiency can be non-compliance with the diet and rest of the mother during pregnancy and lactation, in this connection, the child can develop gross malformations. Thus, congenital avitaminosis of group A, is accompanied by the appearance of a fetal disruption of the bookmark of the optic nerve in the period of embryogenesis, therefore at birth the child has blindness and congenital cataract.
B group avitaminosis is accompanied by the development of severe neurologic changes. Children suffering from this pathology are characterized by increased irritability, lack of congenital reflexes, muscular stiffness, as well as an imbalance in the activity of internal organs, caused by a violation of their innervation.
The most severe form of avitaminosis for a child's health is rickets, that is, a deficiency of vitamin D. The debut of the disease is considered the infant's age, but in pediatric practice there are episodes of congenital vitamin D deficiency. Children suffering from this pathology have distinctive phenotypic signs allowing an experienced pediatrician without conducting laboratory tests correctly to establish the diagnosis.
Avitaminosis D is accompanied by gross deformations of all the bony structures of the child's body, as well as increased fragility of bones, which causes frequent pathological fractures with the slightest traumatic effect. In addition to bone manifestations, avitaminosis D is manifested by severe neurologic symptoms, which inhibits the psychomotor development of the child. Due to the fact that this pathology can have serious negative consequences for the child's health, the World Association of Pediatricians and Neonatologists has developed a unified scheme for the prevention of rickets, which is recommended for all infants, even if they have no symptoms of vitamin deficiency.
Avitaminosis on the hands
Avitaminosis on the hands is most often manifested in patients who constantly follow strict dietary recommendations and have bad habits in the form of alcohol and smoking. In this category of patients, the association of dieticians recommends year round use of vitamins in sufficient quantities, thereby normalizing metabolic processes in the body, stimulating the renewal and restoration of structures at the cellular level. The preferred method of replenishing the vitamin balance in the body is the correction of eating behavior, rather than the use of pharmaceutical synthetic multivitamin complexes.
In addition, in the diet of a patient with beriberi on hand, a sufficient number of different types of sea fish should be included, which contains a large number of nutrients that help restore skin cells.
The defeat of the skin in the form of a decrease in turgor, increased dryness and a tendency to peeling may be observed in any type of polyvitaminosis, however, to a greater extent, the avitaminosis of group A and B reflects on the skin of the palmar and dorsal surfaces of the hands. In this situation, not only a decrease in the turgor and elasticity of the skin, but also a violation of its integrity in the form of the appearance of cracks, ulcers and areas of lichenification.
Due to the fact that vitamin deficiency negatively affects the functioning of the immune system, there is a total lesion of not only the skin but also skin rudiments (tarnishing, dry hair, dandruff, fragility of nail plates, increased sensitivity of tooth enamel). In addition, the skin condition on the hands is affected by the inadequate content of vitamin D in the human body and the products of its metabolism.
The appearance of microdamages on the skin of the palmar and dorsal surfaces of the hands is accompanied by pronounced itching, and the cracks are rapidly inflated and differ by a long period of healing. Some patients with beriberi make complaints about slushing the outer layer of the skin, which is accompanied by discomfort and even pain. The appearance of wrinkles on the hands indicates that the patient has hypervitaminosis E.
Treatment of vitamin deficiency
Due to the fact that avitaminosis is a chronic pathology with a long course and gradual formation of a clinical picture, treatment of this pathology must be pathogenetically grounded, individual and complex.
The primary therapeutic measure for vitamin deficiency is the determination of the degree of vitamin deficiency with the help of laboratory tests of blood and urine plasma, as well as diagnosis of the underlying disease and pathological condition, which was the primary cause of vitamin deficiency. Only if etiopathogenetic therapy is carried out can we expect a positive result from the treatment of vitamin deficiency.
The therapeutic measures of the etiologic orientation are the timely elimination of signs of dysbacteriosis (Latsidofil 2 capsules three times a day for 20 days), timely treatment of colitis of infectious and organic nature, and preventive de-worming (Mebendazole 100 mg once).
After finding out the type of vitamin deficiency according to the data of the laboratory study, it is necessary to immediately begin substitution therapy with the use of synthetic pharmacological vitamin preparations with the preferred parenteral type of administration. Dietary recommendations in the case of the development of a complete clinical and laboratory symptom complex are of secondary importance and are used only as additional measures.
The appointment of vitamin A as a therapy for vitamin deficiency requires an individual approach to the choice of the required dose of the drug, which largely depends on the degree of vitamin deficiency and the severity of clinical manifestations. Thus, the average daily therapeutic dose of vitamin A is 50 000 IU, and in a situation where there are no cutaneous manifestations of avitaminosis, 25 000 IU is considered a sufficient dosage. Xerophthalmia, which is one of the manifestations of avitaminosis A, is well amenable to correction due to the use of 100 000 IU of vitamin A intramuscularly. The use of vitamin A in a therapeutic dose in combination with 20 mg of riboflavin is justified only in the presence of signs of pigment retinitis. It should be taken into account that synthetic vitamin A is absolutely contraindicated for women in the first trimester of pregnancy, as well as for people suffering from chronic cardiac and renal insufficiency.
Treatment of vitamin B vitamin deficiency should be performed in a hospital setting of the neurological profile by the method of parenteral administration of vitamin B1 in a daily dosage of 100 mg, and parenteral forms of other vitamins should not be administered in parallel, since in this situation there is a high risk of developing a severe allergic reaction.
In case of severe vitamin B2 deficiency, it is recommended to use intramuscular injection of Riboflavin in a daily dose of 20 mg for 2 weeks, after which to switch to an oral dose of a maintenance dose of 2 mg / day until the clinical and laboratory signs of beriberi are completely eliminated.
The purpose of pyridoxine, as the main treatment for vitamin B6 avitaminosis, requires a careful approach to determining the optimal dosage of the drug. The average daily therapeutic dosage of the drug for the adult category of patients is 600 mg, and in pediatrics optimal appointment of Pyridoxine at a dose of 10 mg by intramuscular injection.
Treatment of megaloblastic anemia or vitamin B12 avitaminosis is carried out according to the following scheme: the first week after diagnosis, the daily dose of Cyanocobalamin is 100 mcg by subcutaneous injection, then in the same dosage the drug is administered 4 times a month at a frequency of 1 week, followed by lifelong drug 1 once a month.
Avitaminosis of group D may have different degrees of severity, therefore, when determining the necessary individual treatment regimen, the degree of vitamin deficiency should be considered. Thus, a mild degree of rickets implies the use of 1500 IU per day of an aqueous solution of vitamin D orally, while a severe degree is treated with the same drug in an average daily dose of 5000 IU. The course of vitamin D deficiency therapy is at least 1 month, regardless of the severity of the course of the disease.
Avitaminosis of group E extremely rarely has severe clinical manifestations, therefore, for the treatment of this pathology, it is sufficient to administer oral Tocopherol acetate at a dose of 100 mg per day. Only with the available signs of malabsorption is the use of the parenteral form of vitamin E in a daily dose of 30 mg.
Treatment of vitamin K deficiency consists in carrying out urgent measures with the use of intramuscular injection of 10 mg of Fitamadion, followed by a transition to oral intake in an average daily dose of 20 mg. The duration of therapy depends on the severity of the vitamin deficiency and continues until the main coagulogram parameters are normalized.
Treatment of pellagra is carried out only in a hospital and implies the use of nicotinamide in a daily dosage of 1000 mg orally, and in the case of a patient with chronic gastrointestinal diseases, it is advisable to use the parenteral type of administration of nicotinic acid in a dose of 50 mg 3 times a day. As additional components in the therapy of PP vitamin deficiency, Thiamine and Pyridoxine in a dose of 5 mg are used.
Avitaminosis of group C is treated by outpatient treatment with oral intake of ascorbic acid in a daily dose of 500 mg and only a severe degree of vitamin deficiency is to be treated with parenteral forms of this drug at the same daily average dosage.
Prevention of vitamin deficiency
The manifestation of avitaminosis is much easier to avoid than to treat, so every person who wants to prevent the development of this pathology should follow simple recommendations of the World Association of Dieticians, according to which the most effective method of preventing vitamin deficiency is the balance of eating behavior and additional vitaminization of the diet.
In addition to adhering to the main recommendations for vitaminized nutrition, certain categories of people (sportsmen, adolescents during pubertal period, convalescent after a disease or surgical treatment), that is, people who are in a stressful situation, it is recommended to take multivitamin synthetic complexes as preventive measures whose composition the necessary groups of vitamins are not contained in the curative, but in the preventive dose.
Do not be afraid of taking pharmaceutical synthetic multivitamin complexes, based on the risk of allergic reaction, as modern pharmacological technologies allow the synthesis of drugs of the last generation, which are devoid of even adverse reactions inherent in herbal medicines.
All chemical vitamin-containing preparations are produced preferably in capsular form, because when using such complexes, the capsule shell slowly dissolves in the intestine and gradual accumulation in the blood plasma of each separate group of vitamins, which allows the best way to achieve the necessary level of saturation of the body with vitamins and vitamin-like substances.
With the purpose of rational selection of a multivitamin complex, it is better to consult a dietician or gastroenterologist, and only after carrying out a laboratory blood test for the level of saturation of the body with vitamins of various categories, the expert will recommend an individual scheme for the prevention of avitaminosis. These studies are conducted to avoid the opposite effect, called " hypervitaminosis ", which can have serious consequences.
Of great importance is compliance with the conditions for the correct intake of vitaminized drug. So, most synthetic drugs are recommended to take during the greatest activity of the body, that is, in the morning. Better digestion of the chemical is facilitated by its use during meals, but do not chew the capsule or tablet. There are products that interfere with the normal absorption of vitamins, which include all carbonated drinks, coffee and milk, and therefore, when taking a multivitamin complex should be excluded from the diet of the above products.
Natural and more organic in relation to the influence on the human body of the method of preventing avitaminosis, is the process of additional vitaminization of food products, which are daily included in the human diet. So, it is enough to prepare an infusion of rose hips and add it to compotes, jelly, and the prevention of vitamin C avitaminosis will be provided in full.
It should be borne in mind that the use of a sufficient number of fruits and vegetables can not always be regarded as an effective prevention of vitamin deficiency, since the quality of the food product and its processing is of great importance. Thus, most vitamins break down with long-term storage of food and non-compliance with the rules for their culinary processing.