Hypovitaminosis is a pathological condition of the human body that occurs when there is an imbalance between the processes of supplying the necessary amount of vitaminized substances and consuming them.
Of course, vitamins are not a vital structural unit, however, their inadequate content is reflected in the state health, and the adult, and the child, since representatives of a particular group of vitamins directly participate in the most important physiological reactions of the body. Many vitamin-like substances are included in the structure of vitally important enzymes and hormonal substances that have a regulating function in the physiological processes of the vital activity of the human body.
This pathology is dangerous because in most cases, the clinical signs of hypovitaminosis can simulate other diseases, but their treatment will not be effective until the diagnosis is established, which can be diagnosed only after using high-precision laboratory methods of investigation.
Causes of hypovitaminosis
The process of receipt, deposition and intensity of consumption of vitamins is influenced by a whole spectrum of etiopathogenetic factors, so the impact of each of them, individually or together, can provoke the manifestation of hypovitaminosis.
All variants of the etiological factors are somehow connected with the pathological processes taking place in the body, namely, insufficient intake of vitamins contained in food, impaired assimilation of vitaminized substances, poor development of normal flora in the intestines, which takes part in the synthesis of a number of vitamins and an increase needs of the human body in various kinds of vitamins.
Due to the fact that vitamins are a product of organic origin, and only a small group of vitamins can be synthesized in the body, the main reason for their insufficiency is a violation of the conditions of their intake with food. Alimentary deficiency of vitamins occurs in a situation where:
- The daily human food intake contains a small amount of vitaminized foods;
- Accelerated processes of vitamins destruction under the influence of improper processing and storage of food products (long shelf life or heat treatment using high temperatures);
- a person consumes a large number of products that have an antivitamin effect, for example, egg white interferes with the assimilation of biotin);
- there is insufficient intake of proteins of animal origin and complex carbohydrates.
Hypovitaminosis in children is most often provoked by nutritional causes if the conditions for correct introduction of the first complementary foods are not met, using unadapted mixtures for feeding a baby who is not breastfed.
Great importance in maintaining the normal balance of vitamins of different groups has a state of intestinal flora, as microorganisms in the intestine take a direct part in the synthesis of a number of vitamins and vitamin-like substances. In this regard, intestinal dysbiosis , resulting from the prolonged use of antibacterial drugs, is almost 100% of cases accompanied by the development of hypovitaminosis. Inhibitory effect on the intestinal microflora is also possessed by various drugs used as chemotherapy for oncological diseases and tuberculosis .
In a situation where a person consumes a sufficient amount of vitaminized foods, hypovitaminosis may also occur, since the processes of vitamin absorption may be disturbed in the human body due to endogenous and exogenous causes. So, the main cause of malabsorption of vitamins is a wide range of diseases of the intestine, especially its thin section of infectious and non-infectious chronic nature. In addition, the presence of even a small amount of pathogenic flora and parasitic invasion in the intestine has an extremely negative effect on the process of assimilation of vitamin-like substances.
A separate group of hypovitaminosis is "vitamin deficiency of consumption", which occurs in situations when the human body is exposed to unusual stressful influences ( pregnancy , lactation period, pubertal intensive growth phase, intense physical and psychoemotional activity).
Symptoms of hypovitaminosis
Despite the fact that vitamin deficiency in the body is accompanied by the emergence of general clinical symptoms in the form of reduced efficiency, severe weakness, recurrent episodes of dizziness, decreased mood and insomnia, all these manifestations are not specific and do not allow even an experienced doctor to suspect the presence of hypovitaminosis. However, a pronounced deficiency of one or another category of vitamins is accompanied by the appearance of typical signs, knowing which an experienced specialist will begin on time to examine and treat a patient with hypovitaminosis.
So, hypovitaminosis of group A, occurs with prolonged unbalanced nutrition of the patient with inadequate intake of food products of animal origin and carrots, since this vegetable contains carotene, which directly participates in the synthesis of vitamin A. In addition, the diseases accompanying the violation of the absorption capacity of thin intestines are also often accompanied by this type of hypovitaminosis.
The main organs in which vitamin A accumulates under normal conditions is the retina of the eye, the brain and the liver, which is why the deficiency of this vitamin affects the functioning of these particular structures of the human body. Occurrence of complaints of a visual impairment in a patient of any age, especially weakening of the so-called "twilight vision" should lead the therapist to think that a person has vitamin deficiency, since the organ of the target in hypovitaminosis A is precisely the organ of vision.
In addition, people with hypovitaminosis A most often suffer from inflammatory changes in the conjunctival mucosa that are bilateral in nature and manifest as a burning sensation, itching, lacrimation and the appearance of a purulent discharge in the inner corner of the eye.
Due to the fact that hypovitaminosis A is accompanied by systemic damage to the mucous membranes, changes occur in all organs in the form of a tendency to excessive dryness and peeling of the skin, the appearance of dry cough and signs of erosive gastritis . In childhood, the primary manifestations of this pathology is the tendency to the appearance of atopic dermatitis , stomatitis and candidiasis of the oral cavity. Persons suffering from hypovitaminosis A are most often prone to long-term infections of the respiratory tract, the organs of the genitourinary and digestive system. It should be borne in mind that the appearance of the above symptoms can be observed only when the level of the deposited vitamin A level is reduced, which is extremely rare, because to cover all costs the body needs daily intake of only 5000 IU of carotene, and during pregnancy this need is increased by 30%.
The second most frequent occurrence of vitamin deficiency is hypovitaminosis of group B1. This category of hypovitaminosis should not be referred to the category of alimentary deficiency as hypovitaminosis A, for example, since thiamine is found in a wide range of foods that are included in the daily diet of each person (vegetables, all sorts of meat, eggs and yeast). This pathology should be referred to the category of increased consumption and a violation of the absorption of vitamin B1.
So, a woman during pregnancy needs more thiamine, and patients who suffer from a chronic form of enteritis and colitis in a hypermotonic type, simply do not absorb this vitamin. The debut of clinical manifestations of hypovitaminosis B1, as a rule, is sluggish and is accompanied by the appearance of nonspecific symptoms in the form of increased irritability, sleep disorders, impaired ability to work. Adherence to the above symptoms of a sense of aversion to food, memory impairment, emotional instability, flatulence and a tendency to constipation indicates a progression of the disease.
With severe hypovitaminosis B1, the patient has violations of skin sensitivity and progressive muscle weakness, which has reflections in the external appearance of the patient in the form of asymmetric muscular atrophy.
Hypovitaminosis of the B2 group develops with a chronic pathology of the gastrointestinal tract in which the riboflavin is absorbed under normal conditions. To a greater extent, the deficiency of this group of vitamins affects the mucous membranes of the mouth and conjunctiva of the eyes. The lips of the patient have numerous microdamages, of which the blood periodically appears, deep fissures are also noted at the corners of the lips, accompanied by a pronounced pain syndrome with a wide opening of the mouth. The main specific symptom of vitamin B2 hypovitaminosis is a lesion of the mucous membrane of the oral cavity, which acquires a gray tinge, against which the red-crimson smooth surface of the tongue stands out. The defeat of the organs of vision is photophobia, reduced visual acuity and frequent episodes of purulent conjunctivitis .
Hypovitaminosis of group B6 is a rare pathology and is more common in pediatric practice in violation of the conditions of breastfeeding and the introduction of complementary foods and is manifested in some lag in physical development, increased convulsive activity and anemia of the child's body.
In patients of adult age, hypovitaminosis B6 affects the structures of the nervous system and skin, and the first manifestations of this pathology are polyneuritis and pustular lesions of the skin. Seizures are observed only with severe vitamin deficiency in people with alcoholism.
Hypovitaminosis group B12 in hematology stands out as a separate nosological form, called "pernicious anemia." In the clinical symptom complex of this pathology, there are three main syndromes: anemic, neurological and gastroenterocolytic. The anemic syndrome manifests itself in the form of circulatory disturbances in the distal parts of the limbs, headaches and weakness due to hypoxic damage to the structures of the brain. Neurological lesions are the violation of all types of sensitivity and suppression of tendon reflexes. Symptoms that testify to the development of gastroenterocolitis syndrome are: perversion of taste preferences, nausea, aching pain in the upper half of the abdomen, not having a clear localization, alternating constipation and episodes of loosening the stool.
Gipovitaminoz group C belongs to the category of alimentary deficiency of ascorbic acid and is observed among people who do not consume fruits and vegetables in an unprocessed form, since mainly vitamin C is found in citrus fruits, sauerkraut and berry crops.
Insufficient content of ascorbic acid in the child's body causes the development of a whole range of clinical symptoms in the form of lagging not only physical, but also mental development, the development of bone deformations of different localization, aversion to food. In adults, hypovitaminosis C is manifested by the appearance of multiple subcutaneous hemorrhages, gingival hemorrhage, intermittent fever, hemodynamic and respiratory disorders of varying intensity.
Gipovitaminoz group D belongs to the category of pathologies of the pediatric profile, because among the adult population the insufficiency of this vitamin does not practically occur. Feature of vitamin D is that to maintain a normal level in the body, it not only comes with food, but is also self-synthesized under the influence of ultraviolet rays.
Children suffering from rickets, or hypovitaminosis group D, can be easily distinguished from peers, as they have characteristic phenotypic manifestations (deformation of the brain and facial parts of the skull, keeled deformation of the thorax, curvature of the limbs). In the situation, the code lacks vitamin D in an adult, there are signs of osteoporosis in the form of a decrease in bone mineral density and a predisposition to the appearance of pathological fractures.
There may be a congenital form of hypovitaminosis D, which is a consequence of the vitamin D deficiency in the mother during pregnancy and the manifestation of which are gross anomalies of bone formation. In addition to violating the regime of outdoor walks, congenital rickets can be triggered by a severe form of toxicosis in the third trimester of pregnancy and chronic extragenital pathologies.
Hypovitaminosis of the PP group is a rare pathology and is observed in people engaged in extreme starvation as a method of losing weight, as well as in children suffering from long-term diarrhea of infectious nature.
Manifestations of vitamin deficiency in this category are progressive cognitive impairment, trophic damage to the skin and symptoms of enterocolitis, which in itself contributes to the progression of hypovitaminosis. A patient with hypovitaminosis RR constantly senses weakness, irritability and a sleep disorder.
Hypovitaminosis of group E is manifested by progressive muscular dystrophy and infertility , in connection with which it is necessary for women to consume a sufficient amount of vegetable fats (corn, sea buckthorn oil).
Hypovitaminosis of group K is accompanied by a violation of the formation of prothrombin in the liver, which takes a direct part in the processes of blood clotting. The result of insufficient content of vikasol in the body is a tendency to hemorrhagic phenomena, which are difficult enough to eliminate. The most common source of bleeding is the nasal and oral cavity, but with a pronounced vitamin K deficiency, a generalized petechial rash appears throughout the skin and even the phenomenon of intracranial hemorrhage.
Treatment of hypovitaminosis
Among the therapeutic measures for the treatment of hypovitaminosis, the most effective is substitution therapy with the use of vitaminized preparations, as well as sufficient intake of foods containing the maximum concentration of a vitamin. The key to successful therapy of hypovitaminosis is the correction of eating behavior, since when using a balanced diet, not only vitamins in the pure form but also substances participating in their synthesis are supplied to the human body.
Various pharmaceutical companies offer a wide range of medicines containing one or a group of vitamins. With hypovitaminosis, most specialists recommend the use of multivitamin medicines containing several vitamin components in therapeutic proportions. The advantages of using multivitamin preparations in comparison with monotherapy are that the insufficient content of one group of vitamins can have a negative effect on the balance of other vitamins, and that vitamin deficiency in most patients is accompanied by a deficiency of several vitamins.
When appointing a patient with hypovitaminosis of a particular multivitamin drug should take into account that each drug has a different ratio of components and their doses. Elderly people with a wide range of chronic pathologies, as well as patients in the stage of reconvalescence of severe infectious and inflammatory diseases are recommended to use Undevite orally 2 tablets 3 r / day for a course of at least 1 month. In a situation where a person is in the period of acclimatization to new conditions, as well as in conditions of increased mental and physical activity, it is advisable to use Aerovit for 1 tablet 1 p / day. Patients in the rehabilitation period after a severe cardiac, neurologic pathology and surgical treatment suffered a multidrug treatment with decamevit 1 tablet 2 pills per day for 20 days. Patients with group A hypovitaminosis and B group vitamins in a moderate form are advisable using Hexavit 1 dragee 2 pills a day.
The use of specific medications in injection or oral form, containing a high saturating concentration of a vitamin, is shown only after the laboratory examination of blood and confirmation of hypovitaminosis of a certain group of vitamin.
Indication for the use of vitamin A is the presence of specific clinical manifestations, as well as a reduced level of retinol in the serum of less than 0.4 μmol / l. Treatment consists in the application of diet therapy enriched with food products containing a large amount of vitamin A (egg yolk, liver of marine fish, carrots, sea buckthorn). Scheme of drug therapy is the use of Vitamin A in a dose of 10000ME intramuscularly in combination with 20 mg Riboflavin 3 weeks.
Treatment of hypovitaminosis D should be started immediately with the first signs of rickets in children, as well as radiologic confirmation of osteoporotic bone reconstruction in patients of adult age. Dietotherapy is to saturate the diet of an adult with a sufficient amount of fish oil and butter, and infants are recommended early introduction of the first complementary foods. Drug replacement therapy is carried out with an aqueous or alcoholic solution of vitamin D in a therapeutic saturating daily dose of 3000 IU with a course of 45 days. Then the dose of the drug is recommended to be reduced to 400 IU and applied daily during the year. In order to eliminate signs of muscular atrophy, patients with hypovitaminosis D show the use of exercise therapy and massage. If there is an individual intolerance to the synthetic vitamin D preparation, the patient should be given a physiotherapy treatment using ultraviolet irradiation sessions for two months.
Treatment of hypovitaminosis group E is recommended to be used only when the level of tocopherol in the blood serum is reduced to 0.8 mg. Drug treatment is the use of Tocopherol acetate in a daily dose of 30 mg for a month, followed by a prophylactic dose of 8 mg.
Treatment of hypovitaminosis group C is better to start with diabetotherapy, since synthetic preparations of vitamin C have a wide range of contraindications to use (pregnancy, diabetes , nephropathy). To this end, the patient is recommended to introduce fresh berry crops and citrus fruits into the daily diet. Drug therapy for hypovitaminosis of this type is carried out by oral intake of vitamin C in a daily dose of 100 mg.
As a rule, hypovitaminosis of group K is accompanied by marked clinical manifestations, therefore treatment of patients of any age category should be performed in a hospital in order to avoid possible complications in the form of massive bleeding. Drug therapy should be carried out under the control of the basic indicators of the coagulogram. With a small deficit of vicasol, you should use the oral form of the drug at 30 mg per day. The expressed deficiency of vitamin K is subject to correction by Fitamadion in a daily dose of 20 mg subcutaneously.
Treatment of hypovitaminosis group B consists in the administration of oral medications at an average therapeutic dosage (Vitamin B1 at a dose of 10 mg, vitamin B6 at 50 mg, vitamin B9 at a dose of 1 mg / day).
Isolated vitamin deficiency of the PP group is subject to drug correction with the application of Routine to 0.02 g three times a day for at least 6 weeks.
Prevention of hypovitaminosis
Preventative measures for hypovitaminosis of various types are combined into a single concept of "vitaminization of the body" and the period of their recommended use is considered spring and autumn seasons. During these periods, people are encouraged to eat plenty of greens, vegetables and fruits.
It is also necessary to produce additional vitaminization of ready meals just before they are consumed. For example, in a ready-made compote, you can add concentrated rose hip syrup.
Preventive measures to prevent hypovitaminosis should be considered elimination of the causes of vitamin deficiency, namely: timely dehelminthization of the intestine, prevention of dysbacteriosis with antibacterial drugs, timely treatment of chronic diseases of the intestine and stomach.
Medication prophylaxis is used in case of reliably transferred hypovitaminosis of one or another type in an anamnesis and consists in the use of medicines in preventive dosage even under condition of complete absence of clinical manifestations of vitamin deficiency. So, the transferred xerophthalmia and a hemorrhagia in the anamnesis which were display of a hypovitaminosis And, is the indication for application of a course of vitamin A in preventive dosage 3300 IU a course 1 month twice a year.
Preventive measures to prevent hypovitaminosis D are most often used in the neonatal and infancy of a child and consist of daily insolation, the promotion of natural breastfeeding and the daily intake of an aqueous solution of vitamin D (Aquadetrim at a dose of 400 IU for a year). An adult category of people, as a rule, is not subject to preventive intake of a drug of vitamin D, except for pregnant women, who have a third trimester for the winter period. This category of pregnant women should take vitamin D at a dose of 400 IU before delivery as a prophylaxis of the congenital form of rickets in a newborn baby.
Prevention of hypovitaminosis K is used in pediatrics only in the situation when the woman giving birth during pregnancy took Diphenin. In this case, the prophylactic dose of Fitamadione is 0.5 mg intramuscularly 1 time immediately after birth and after 6 hours as a prophylaxis for the development of hemorrhagic complications in the child. Preventive intake of vitamin K preparations for women during pregnancy is not applied, as these drugs have extremely negative toxic effects on the developing fetus.
Prevention of hypovitaminosis in group B is the timely diagnosis and treatment of chronic pathologies of the gastrointestinal tract and preventive intake of oral multivitamin complexes containing all groups of vitamins in preventive dosage (Neurovitan 1 tablet 2 pills per day for 2 weeks).