Constellation of neuropathy, muscle weakness and wasting, cardiomegaly, edema, phthalmoplegia, confabulation strongly suggest -
Deficiency - beri-beri In the developed world, thiamin deficiency is mainly encountered in chronic alcoholics. Poor diet, impaired absorption, storage and phosphorylation of thiamin in the liver, and the increased requirements for thiamin to metabolise ethanol all contribute. In the developing world, deficiency usually arises as a consequence of a diet based on polished rice. The body has very limited stores of thiamin, so deficiency is manifest after only 1 month on a thiamine-free diet. There are two forms of the disease in adults: * Dry (or neurological) beri-beri manifests with chronic peripheral neuropathy and with wrist and/or foot drop, and may cause Korsakoff's psychosis and Wernicke's encephalopathy Wet (or cardiac) beri-beri causes generalised oedema due to biventricular hea failure with pulmonary congestion. In dry beri-beri, response to thiamin administration is not uniformly good. Multivitamin therapy seems to produce some improvement, however, suggesting that other vitamin deficiencies may be involved. Wernicke's encephalopathy and wet beri-beri should be treated without delay with intravenous vitamin B and C mixture . Korsakoff's psychosis is irreversible and does not respond to thiamin treatment. Ref Harrison 20th edition pg 66
Cobalamine deficiency
Thiamine deficiency
Niacin deficiency
Riboflavin deficiency
Nutrition