Hypovitaminosis B2 is a disease caused by a deficiency of vitamin B2 in the diet, its insufficient absorption from the intestines or intensive destruction and excretion from the body. It manifests itself as seborrheic dermatitis, rough scaly skin, swelling and soreness of the tongue, conjunctivitis, lacrimation, photophobia, redness and swelling of the lips, their peeling. With a prolonged vitamin deficiency, paresthesia, muscle weakness, burning muscle pains, cramps and normocytic anemia develop . Urine and blood tests for vitamin B2 are performed to confirm the diagnosis. Treatment involves the use of riboflavin preparations, diet correction, and therapy for concomitant diseases.
General information
The term ” hypovitaminosis ” comes from the Greek language, in translation means “reduction of vitamins.” The synonymous name for hypovitaminosis B2 is hyporiboflavinosis , vitamin deficiency B2. To date, in developed countries, the prevalence of severe riboflavin hypovitaminosis is extremely low, however, according to laboratory studies, the epidemiology of mild forms of the disease, without symptoms, remains high. In almost all regions of Russia, insufficient vitamin supply is found in 60-80% of the population. This indicator does not depend on the socio-economic level of a person, his age and gender. Mild hypovitaminosis B2 does not manifest itself clinically, but contributes to the development of other diseases.
Causes
In order for the body to be fully provided with riboflavin, its sufficient presence in the daily diet, active absorption from the small intestine, and preservation in the bloodstream before participating in biochemical processes are necessary . The reasons for the development of hypovitaminosis are adverse factors that act at a certain stage of vitamin intake and assimilation. These include:
- Unbalanced diet. Hypovitaminosis is most susceptible to people who adhere to strict diets with a strict restriction of nutrients, patients with anorexia . Vegetarians are at risk because the main sources of riboflavin are dairy products, eggs, and animal liver.
- Taking medication. Long-term treatment with drugs that reduce the level of vitamin, provokes the development of its deficiency, and then persistent insufficiency. The main antagonists of riboflavin are tricyclic antidepressants and barbiturates.
- Diseases of the digestive tract. Hypovitaminosis occurs with digestive disorders, absorption of nutrients from the stomach and intestines, and a deficiency of liver transport proteins. The causes are malabsorption syndrome , inflammatory processes in the intestine, and liver failure .
- Increased Vitamin Consumption. The need for vitamins increases with regular intense physical exertion and some metabolic pathologies, for example, with thyrotoxicosis . The high-risk group includes patients with acute diseases, pregnant women, children and the elderly.
- Inherited diseases. There are inherited and congenital forms of impaired vitamin metabolism. With these diseases, the full delivery of riboflavin to tissues is impossible, the course of biochemical processes with its participation.
Pathogenesis
Vitamin B2 is present in the composition of flavoproteins – enzymes that participate in the transfer of hydrogen, provide tissue respiration, synthesis of structural and enzymatic proteins. With hypovitaminosis B2, tissue hypoxia develops, the production of hemoglobin and erythropoietin is disrupted , the secretory function of the stomach is reduced due to the impossibility of the formation of some components of hydrochloric acid, and the process of bile secretion and absorption of carbohydrates slows down. Dysbacteriosis is formed in patients, because riboflavin is necessary to maintain the activity of E. coli.
A change in metabolic processes, in particular, a decrease in the production of structural proteins, is manifested by inflammation, peeling, cracks, erosion on the skin and mucous membranes. Dermatitis, cheilitis , glossitis develops . Hypovitaminosis leads to dysfunction of the nervous system, which is characterized by increased sensitivity to intense stimuli (light, sound), rapid fatigue. Riboflavin is part of visual purpura, protects the retina from exposure to ultraviolet rays. With its insufficiency, visual function deteriorates.
Symptoms of hypovitaminosis B2
At the stage of prehypovitaminosis , a non-specific deterioration in the general condition develops: weakness, increased fatigue, drowsiness appear. Twilight vision is impaired ( hemeralopia develops ). With persistent hypovitaminosis, the eyes and oral cavity are primarily affected. The mucous membranes become inflamed, the lips become dry and become covered with cracks, their surface peels off. Later erosion occurs, with infection with a fungal infection – seizures in the corners of the mouth. The tongue is edematous, bright red, shiny. The oral cavity is covered with ulceration, the use of acidic, spicy and hot food causes pain. On the mucous membrane of the eyes, inflammation is accompanied by redness, lacrimation, and the appearance of a vascular pattern on proteins. Visual acuity decreases.
On the surface of the skin rashes form in the form of red peeling spots. Outwardly, they resemble seborrheic dermatitis . Pathological foci of inflammation are located on the scalp, in the nasolabial triangle, around the eyes and auricles. In men, the skin of the scrotum is affected, in women, the outer part of the vagina. Sometimes the nail rolls become inflamed in patients. With prolonged hypovitaminosis, the central nervous system functions pathologically change: paresthesia and convulsions, ataxia develop , tendon reflexes increase. In childhood, riboflavin deficiency is manifested by stunted growth, weight loss, and anemia .
Complications
In severe untreated B2 hypovitaminosis, structural and functional changes in the adrenal cortex are formed, hematopoiesis , gluconeogenesis and iron metabolism are disrupted . The risk of developing adrenal insufficiency and hypochromic anemia is increased . In most patients, natural immunity is reduced, which contributes to frequent relapses of infections, including fungal infections of the mucous membranes. During pregnancy, the main complication is miscarriage and abnormalities in the development of the skeletal system of the fetus.
Diagnostics
Suspicion of hypovitaminosis B2 appears in the presence of characteristic symptoms, chronic diseases of the digestive tract, prolonged use of drugs that reduce the level of riboflavin. The examination is carried out by a gastroenterologist with the participation of a dermatologist and an ophthalmologist. Differential diagnosis involves the exclusion of seborrheic dermatitis, conjunctivitis and visual disturbances that are not associated with vitamin deficiency. The following diagnostic procedures are applied:
- Clinical Survey. During the initial conversation, the doctor clarifies the symptoms, the presence of thyrotoxicosis, diseases of the gastrointestinal tract, liver and kidneys, taking barbiturates and antidepressants. The composition of the patient’s diet, his adherence to diets, and vegetarianism are clarified.
- Inspection Inflammation and cracks in the lips, infection of the corners of the lips, ulceration in the oral cavity, redness of the tongue and mucous membranes of the eye, and lacrimation are determined. In open areas of the skin, peeling and erythema are detected . The characteristic places of the foci are the scalp, nasolabial triangle, the area near the eyes and ears.
- Analysis of blood, urine. The content of riboflavin in the blood plasma and in the sample of daily urine is studied . Hypovitaminosis is confirmed at a vitamin level of less than 137 ng / ml (mcg / l). Urine analysis allows to evaluate the process of excretion per day in normal urine released about 9% ribo flavin present in the blood.
Treatment of hypovitaminosis B2
To meet the body’s need for vitamin B2, riboflavin preparations are prescribed to patients. The course of administration is 1-2 months. Along with drug treatment, a diet containing a sufficient amount of vitamin is selected. Its sources are milk products, liver, meat, brewer’s yeast and fortified bread. The menu is designed in such a way that the daily intake of riboflavin with food is in the range from 1.5 to 2.1 mg (for adult non-pregnant patients). In parallel with the main treatment, the treatment of diseases of the liver, kidneys, intestines and stomach is carried out.
Forecast and Prevention
Hypovitaminosis B2 is amenable to therapy. In the absence of diseases that interfere with the absorption and assimilation of the vitamin, the prognosis is favorable, riboflavin deficiency is eliminated within 1-3 months after the start of treatment. Preventive measures include a balanced diet high in animal products, avoiding strict diets and vegetarianism, timely treatment of diseases of the gastrointestinal tract, kidneys and liver, periodic monitoring of vitamin levels with long-term use of antagonist drugs.