welcome back to learn with Med nuggets in this video we will discuss everything you need to know about vitamin B including signs and symptoms that can be caused by different types of vitamin B deficiencies and some mnemonics to help you easily remember them there are eight types of vitamin B vitamin B1 also known as thymine B2 also called riboflavin B3 niacin B5 pantothenic acid B6 pyridoxine B7 biotin B9 folic acid and B12 cobalamine all B vitamins help our body convert carbohydrates to glucose for energy they also help to metabolize fats and proteins B complex vitamins are required for a healthy skin hair eyes liver and also for good brain and nervous system functioning now let's move on to the courses and signs and symptoms of the different types of vitamin B deficiencies vitamin B1 deficiency can be caused by heavy drinking research over the past 30 years has identified that this might be due to inadequate nutritional intake in Alcoholics and due to alcohol's effect on thymine uptake and function malabsorption syndromes diarrhea prolonged vomiting commonly seen in patients with anorexia nervosa or hyperemesis gravidarum and bariatric surgery because the duodenum which is the place at which vitamin B1 absorption takes place is bypassed in the new root of the GI tract created by bariatric surgery therefore this will lead to lack of absorption of vitamin B1 an important clinical and board exam point you must remember is that in malnourished or alcohol dependent patients you must always give thiamine before dextrose to prevent the patient from developing Wernicke encephalopathy remember B1 before dextrose vitamin B1 deficiency can lead to two very important conditions called beriberi and Wernicke encephalopathy berry berry comes in two forms called wet berry berry and dry berry berry dry berry berry can lead to a symmetrical peripheral neuropathy wet beriberi can lead to the development of high output heart failure an easy way to remember this is heart pumps blood right and blood is wet so wet berry berry will cause heart problems Wernicke encephalopathy presents with the classic Triad of confusion Ataxia and ophthalmoplegia at least for your board exams in real life all three features are only present in one third of patients syndrome is a severe and late Neuropsychiatric manifestation of Wernicke encephalopathy korsakov syndrome presents with personality changes retrograde and anterogrid Amnesia and confabulations now let's move on to vitamin B2 deficiency vitamin B2 is also known as riboflavin when I was studying for my board exams I always found it difficult to remember the names of different vitamin B types I remembered vitamin B2 is riboflavin by the word Flavin which reminded me of flavors whenever I think of flavors two flavors come to my mind that is chocolate and vanilla cereboflavin is two flavors and that is B2 vitamin B2 deficiency can cause chelitis and corneal vascularization which can be remembered by the pneumonic the two C's of B2 now let's move on to vitamin B3 also called niacin vitamin B3 deficiency can be caused by heavy drinking conditions associated with tryptophan deficiency such as harden up disease and carcinoid syndrome as tryptophan is used by our body to synthesize niacin tryptophan can be converted into two different derivatives in our body one is niacin and the other one is serotonin heart knob disease is caused by decreased reabsorption of tryptophan and this tryptophan deficiency can lead to Nicene deficiency in carcinoid syndrome there's an excessive production of Serotonin and this uses up all the tryptophan that is required for the production of niacin therefore carcinoid syndrome can also lead to niacin deficiency vitamin B6 is a cofactor that is required to produce niacin from tryptophan therefore conditions causing vitamin B6 deficiency such as the drug isoniacin can also lead to vitamin B3 deficiency vitamin B3 deficiency can cause three important clinical features that can be remembered with the simple mnemonic the 3DS of B3 which stands for diarrhea dementia and dermatitis moving on to vitamin B5 pantothenic acid you can remember that pantothenic acid refers to vitamin B5 using the image of a pentagon as a pentagon has five sides Pentagon pantothenic five sides B5 vitamin B5 deficiency is rare however a deficiency in this vitamin can cause things like adrenal insufficiency enteritis alopecia and dermatitis vitamin B6 pyridoxine a deficiency in vitamin B6 can be caused by drugs like iosen acid and oral contraceptives vitamin B6 deficiency can lead to cideroblastic anemia as B6 is a cofactor in the heme synthesis pathway that produces hemoglobin in red blood cells vitamin B6 deficiency can also cause peripheral neuropathy which can be irreversible sometimes an important clinical and board exam point you must remember is that whenever you give ice and acid to treat tuberculosis make sure to give paridoxine as well to prevent ionizing induced peripheral neuropathy which can be caused by B6 deficiency vitamin B7 biotin biting deficiency is extremely rare it can be caused by excessive consumption of raw egg whites as they contain a protein called avidine which can bind to Biotin and prevent its absorption at the intestinal lumen biotin deficiency can also be caused by the prolonged use of antibiotics which can destroy gut Flora that produce biotin biting deficiency can lead to a bunch of signs and symptoms that you don't really have to know for your exams [Music] vitamin B9 folate vitamin B9 or folate is commonly found in things that you don't like to eat such as leafy green vegetables and fruits therefore malnutrition is one of the most common causes of vitamin B9 deficiency folate deficiency can also be caused by malabsorption syndromes affecting the jejunum such as celiac disease tropical sprue and inflammatory bowel disease and small bowel resection as folate is absorbed in the jejunum it's very important to remember for your boats that drugs such as Methotrexate phenytoin trimethoprim and sulfonamides can also cause benign deficiency vitamin B9 plays a very important role in DNA synthesis therefore benign deficiency can lead to megaloblastic anemia and maternal folate deficiency can cause neural tube defects in babies such as spina bifida and anencephaly now let's move to the last type of vitamin B vitamin B12 also known as cobalamine vitamin B12 is found almost exclusively in animal products therefore vegetarians are more susceptible to vitamin B12 deficiency vitamin B12 plays an important role in enzymatic reactions required for the myelination of the nervous system and the formation of red blood cells therefore a deficiency in B12 can lead to megaloblastic anemia and a neurologic condition called Subacute combined degeneration Subacute combine degeneration is a condition that leads to symmetrical demyelination of spinal cord tracts such as the corticospinal tracts and the dorsal columns therefore patients can present with parisis impaired proprioception loss of joint posture and sense and vibrations vitamin B12 deficiency can be caused by mild absorption malnutrition or increased demand malabsorption of vitamin B12 can be caused by conditions such as pernicious anemia pernicious anemia is an autoimmune condition characterized by the absence of intrinsic factor A protein that is crucial for the absorption of vitamin B12 gastrectomy as our stomach is the place that produces intrinsic factor and by diseases involving the terminal ileum where vitamin B12 absorption takes place such as Crohn's disease celiac disease pancreatic insufficiency resection of the ilium and tapeworm infection malnutrition from strict vegan diets and anorexia nervosa can also cause B12 deficiency conditions that can lead to an increased demand of vitamin B12 such as pregnancy lactation and even leukemia can lead to vitamin B12 deficiency another very important point you need to remember is that drugs such as metformin can also lead to the development of B12 deficiency since B12 and B9 deficiency can both present with megaloblastic anemia you must remember how to differentiate these two conditions for your boards remember B9 deficiency is not associated with neurologic symptoms like B12 deficiency and the methylmalonic acid level is normal in B9 deficiency unlike in B12 deficiency where the methyl malonic acid levels are very high the reason behind this is B12 is a cofactor that is required for the conversion of methyl malonic acid to success so a B12 deficiency can lead to high levels of methyl malonic acid another important point to remember is that vitamin B12 deficiency takes a long time around ears and ears to develop than a B9 deficiency as our bodies have a very large number of vitamin B12 stores in comparison to vitamin B9 and this brings us to the end of our vitamin B video thank you for listening have a great day