Vitamin B6 deficiency is a disease that develops with a deficiency of vitamin B6 in food, a violation of its absorption from the intestine or intensive destruction and excretion from the body. At the initial stage, the symptoms are nonspecific: fatigue, general weakness, distraction, lethargy. With persistent vitamin deficiency, signs of seborrheic dermatitis, stomatitis, glossitis, cheilosis, peripheral polyneuropathies and anemia are observed. Diagnosis is based on determining the content of pyridoxine in the blood. Treatment includes a diet high in vitamins, the use of pyridoxine preparations parenterally or orally, the elimination of gastrointestinal diseases.
ICD 10
E53.1 Pyridoxine deficiency
Meaning
Vitamin B6 is represented by a group of biologically active compounds – pyridoxine, pyridoxal, pyridoxamine and phosphates, in particular pyridoxal phosphate. The terms “pyridoxine” and “adermine” are used as synonymous names of the vitamin. A synonym for vitamin B6 deficiency is vitamin deficiency B6. According to statistical studies, in Russia, insufficient supply of pyridoxine exists in 60-80% of the population. In most people, vitamin deficiency is at an early stage, does not manifest itself with specific symptoms and often remains undiagnosed. Severe forms of the disease with a detailed clinical picture are more often found in infants, young children and elderly patients. The peak incidence occurs in the winter-spring period.
Causes of vitamin B6 deficiency
Vitamin B6 is water-soluble, found in products of plant and animal origin: cereals, legumes, bananas, meat, fish, liver, yeast. It is partially produced by the microflora in the intestine. The following factors contribute to the development of vitamin deficiency:
- Poor nutrition. Insufficient intake of pyridoxine with food may be due to strict diets or fasting. With artificial feeding of infants, the risk of vitamin deficiency increases due to the use of mixtures in which the vitamin was destroyed during heat treatment.
- Increased need for vitamin. The metabolism of the compound increases in cold climates, with intense physical exertion and neuropsychiatric stress, during pregnancy. With its usual amount in the diet, vitamin deficiency develops.
- Diseases of the digestive system. In intestinal diseases, the absorption of vitamin and its production by microflora decreases. The most common causes are malabsorption syndrome, celiac disease, Crohn’s disease and ulcerative colitis.
- Long-term medication. Antibacterial drugs suppress the intestinal microflora synthesizing vitamins. The direct antagonists of pyridoxine are cycloserine, ethionamide, isonicotinic acid hydrazide, hydrolysin, penicillamine, glucocorticoids, estrogens.
Pathogenesis
Vitamin B6 participates in enzyme reactions of protein metabolism. It is a coenzyme of enzymes that ensure the production of amino acids, the processes of transamination, deamination, decarboxylation and methylation. With a lack of pyridoxine, there is a deficiency of amino acids necessary for protein synthesis. This affects the work of many internal organs: liver functions are disrupted, the level of albumins, transferrin (an iron-carrying protein) and hemoglobin decreases.
Prolonged vitamin deficiency leads to myocardial dystrophy, a reduction in the production of red blood cells, a violation of the structure and functions of the skin, mucous membranes. Clinically, this is manifested by anemia, dermatitis, glossitis, cheilosis. Pyridoxine ensures the normal course of decarboxylation of glutamic acid, a mediator of central nervous system excitation. As a result of the reaction, it turns into gamma-aminobutyric acid – a mediator of inhibition. With vitamin B6 deficiency, the concentration of excitation mediators increases, which is manifested by convulsions, irritability, insomnia.
Symptoms of vitamin B6 deficiency
The stage of prehypovitaminosis is accompanied by nonspecific symptoms. Patients experience weakness, fatigue, apathy, get tired quickly, do not feel rested after a night’s sleep. With the development of vitamin deficiency, increased irritability occurs, disinhibition in behavior is often observed in children, they become hot-tempered, aggressive and disobedient. In the severe stage, depression, inhibition and confusion of consciousness, deterioration of memory, attention, thinking are formed. Sensitivity to light and sounds increases, sleep worsens. Convulsions are noted at night. Weakened immunity contributes to frequent infectious diseases, especially in the cold season.
In patients of all ages, appetite decreases, nausea appears. Dermatitis develops, characterized by damage to the nasolabial fold, brows, ocular zones, scalp and neck. Seborrhea is possible. Cheilitis is detected – “congestion” in the corners of the mouth, vertical cracks on the lips; glossitis – redness and swelling of the tongue; conjunctivitis – inflammation of the mucous membrane of the eye. Polyneuritis of the lower and upper extremities is more often manifested by a violation of sensitivity, a feeling of “goosebumps”, tingling. Elderly people, pregnant women and children have hypochromic anemia with characteristic symptoms: weakness, dizziness, muscle hypotension, dry and pale skin, brittle nails and hair, increased cheilitis, glossitis.
Complications
Without timely treatment, mucosal and skin lesions are complicated by the development of bacterial and fungal infections. The slow renewal of the lining layer of the digestive tract contributes to the occurrence of gastritis, colitis and other inflammatory diseases. In the elderly, a complication of vitamin deficiency may be sclerotic changes in the vessels and tissues of the heart, increasing the risk of atherosclerosis and cardiosclerosis. In childhood, vitamin B6 deficiency can lead to severe seizures, similar to epileptic seizures, delayed physical and mental development, mental instability, B6-dependent anxiety.
Diagnostics
The primary determination of vitamin B6 deficiency is carried out on the basis of anamnesis and clinical picture. The diagnosis is carried out by a pediatrician, therapist, dermatologist. The specialist finds out the peculiarities of the patient’s diet, the presence of gastrointestinal diseases, the use of pyridoxine antagonist drugs and antibiotics. Characteristic symptoms – cheilosis, glossitis, dermatitis, conjunctivitis – are not highly specific signs of vitamin B6 deficiency, as they can be observed with insufficiency of other vitamins, for example, riboflavin. A number of laboratory tests are prescribed for differential diagnosis:
- Urine analysis. A study of daily urine for the content of the metabolite pyridoxine – 4-pyridoxic acid is performed. In the state of vitamin deficiency , the final indicator is below 0.5 mg. The lack of pyridoxine increases the excretion of xanthurenic acid in the urine, therefore, its content in a single portion of urine after taking tryptophan is being investigated. Vitamin deficiency is confirmed by values of more than 50 mg.
- Blood plasma analysis. Sometimes laboratory conditions allow you to study blood plasma, and not whole blood. The level of pyridoxine is being studied. With its deficiency, the final values are less than 20 nmol/l.
Treatment for vitamin B6 deficiency
Therapy is determined by the causes that led to the disease. For patients whose vitamin deficiency is caused by fasting, diet therapy is indicated, a diet is prepared that includes fresh fruits and vegetables, eggs, dairy and meat products, cereals and legumes. Additionally, oral administration of pyridoxine (tablets, capsules) is prescribed. In the presence of diseases of the gastrointestinal tract that prevent the absorption of vitamins, their treatment is carried out. At the same time, parenteral administration of vitamin B6 begins. If vitamin deficiency is provoked by prolonged medication, the main treatment is corrected with the cancellation or reduction of the dose of the drug.
Prognosis and prevention
Vitamin B6 deficiency is successfully treatable, in most cases vitamin deficiency and its clinical manifestations can be eliminated in 2-3 months of therapy. Preventive measures include the rejection of strict diets and fasting, the use of infant formula enriched with vitamins, the treatment of intestinal diseases. Additional intake of pyridoxine dosage forms is necessary for pregnant women, women during lactation, patients taking antibiotics, sulfonamide and anti-tuberculosis drugs, oral contraceptives.
