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BERIBERI
VISIT US: DENTALTUTOR.IN
VITAM
IN
B1
(THIAM
INE) DEFICIENCY
VISIT US: DENTALTUTOR.IN
Beriberi is a disease caused by a vitamin B1 (thiamine) deficiency.
There are two types of the di...
WHAT CAUSES BERIBERI? WHO IS AT RISK?
The main cause of beriberi is a diet low in thiamine. The disease is very rare
in re...
WHAT ARE THE SYMPTOMS OF BERIBERI?
The symptoms of beriberi vary depending on the type (wet
or dry). The following are sym...
ETIOLOGY
Risk factors (non-modifiable)
 Female gender
 Increasing age
 Family history
 White or Asian ethnicity
 Smal...
ETIOLOGY
Risk factors (cont’d)
 Excess alcohol intake
 Cigarette smoking
 Anorexia
 Oophorectomy
 Sedentary lifestyle...
ETIOLOGY AND PATHOPHYSIOLOGY
Peak bone mass is achieved before
age 20

Bone loss after midlife is inevitable
but rate of ...
ETIOLOGY AND PATHOPHYSIOLOGY
Diseases associated with osteoporosis
Intestinal malabsorption
Kidney disease
Rheumatoid arth...
OSTEOPOROSIS
DIAGNOSTIC STUDIES
Clinical Manifestations
 Known as silent disease
Diagnosis
 Bone Mineral Density (BMD)
...
OSTEOPOROSIS
Can the disease be
prevented?
VISIT US: DENTALTUTOR.IN
TREATMENT AND NURSING CARE
Diet Therapy

Weight bearing Exercises

Decrease Risk Factors
 Quit smoking and decrease con...
DRUG TREATMENT OF
OSTEOPOROSISEstrogen Replacement Therapy
Calcium & Vitamin D supplements
Calcitonin
Biphosphonates (Fosa...
MEDICATIONS USED IN
TREATMENT OF
OSTEOPOROSISHormone Replacement Therapy – Estrogen
 Controversy over use. Should discuss...
MEDICATIONS USED IN
TREATMENT OF
OSTEOPOROSISCalcitonin
 If calcitonin inhibits bone resorption by opposing the effects o...
MEDICATIONS USED IN
TREATMENT OF
OSTEOPOROSISBisphosphenates – (Fosamax)
 Inhibit osteoclast-mediated bone resorption the...
MEDICATIONS USED IN
TREATMENT OF
OSTEOPOROSISSelective Estrogen Receptor
Modulators
 Mimic effect of estrogen on bone by ...
O
STEO
M
ALAC
IA
M
ETABOLIC
BONE
DISEASE
VISIT US: DENTALTUTOR.IN
OSTEOMALACIA
Decalcification and softening of the bone
Caused mainly by: vitamin D deficiency
**Vitamin D is required for ...
OSTEOMALACIA
SIGNS & SYMPTOMS
Most Common
 ____ ____
 Difficulty rising from a chair
 Difficulty walking
Additional Sig...
DIAGNOSIS
Blood work
 Decreased serum calcium or phosphorus
 Decreased serum 25-hydroxyvitamin D
 Elevated alkaline pho...
OSTEOMALACIA
TREATMENT AND NURSING CAREDrug Therapy


Diet Therapy
 Milk, yogurt, cheese
 Dark green leafy vegetables,...
PAG
ET’S
D
ISEASE
VISIT US: DENTALTUTOR.IN
PAGET’S DISEASE
Excessive bone resorption followed by
replacement of normal marrow by
vascular, fibrous connective tissue....
CLINICAL MANIFESTATIONS
In milder form, none
Common early symptom--
Fatigue
Waddling gait
Loss of height
Increased head si...
COMPLICATIONS
Pathological fractures (may be a first sign of disease)
Bone tumors
VISIT US: DENTALTUTOR.IN
PAGET’S DISEASE
Diagnosis
 Elevated serum alkaline phosphatase
 X-ray will show increase in bone size
 Bone scan shows ...
DRUG TREATMENT FOR PAGET’S
Drug Therapy
Calcitonin-salmon (Miacalcin)
Bone is in a constant state of remodeling, whereby ...
PAGET’S DISEASE
Other treatments and Nursing Care
 Back support by firm mattress
 Teaching about use of splints or brace...
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Beri beri

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Beri beri

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Beri beri

  1. 1. BERIBERI VISIT US: DENTALTUTOR.IN VITAM IN B1 (THIAM INE) DEFICIENCY
  2. 2. VISIT US: DENTALTUTOR.IN Beriberi is a disease caused by a vitamin B1 (thiamine) deficiency. There are two types of the disease: wet beriberi and dry beriberi. Wet beriberi affects the heart and circulatory system. In extreme cases, wet beriberi can cause heart failure. Dry beriberi damages the nerves and can lead to a loss of muscle strength and eventually, muscle paralysis. Beriberi can be life-threatening if it isn’t treated. If you have access to foods rich in thiamine, such as beans, vegetables, meat, and whole grains, your chances of developing beriberi are low. Today, beriberi mostly occurs in people with an alcohol use disorder (alcoholism) WHAT IS BERIBERI?
  3. 3. WHAT CAUSES BERIBERI? WHO IS AT RISK? The main cause of beriberi is a diet low in thiamine. The disease is very rare in regions with access to vitamin-enriched foods (e.g., breakfast cereals and breads). Beriberi is most common in regions of the world where the diet includes a lot of unenriched white rice, which only has a tenth of the amount of thiamine as brown rice. • Alcohol abuse can make it hard for your body to absorb and store thiamine. • Genetic beriberi is a rare condition that prevents the body from absorbing thiamine. • Pregnant women, breast-feeding mothers, and anyone with hyperthyroidism (over-active thyroid gland) need extra thiamine. • Prolonged diarrhea or use of diuretics (medication that makes you urinate more) can lead to depletion of thiamine. • Infants drinking breast milk or formula low in thiamine are at risk for thiamine deficiency. • Kidney dialysis can increase your risk of beriberi by depleting your body’s stores of thiamine more quickly. VISIT US: DENTALTUTOR.IN
  4. 4. WHAT ARE THE SYMPTOMS OF BERIBERI? The symptoms of beriberi vary depending on the type (wet or dry). The following are symptoms of wet beriberi: •shortness of breath during physical activity •waking up short of breath •rapid heart rate •swollen lower legs The symptoms of dry beriberi include: •decreased muscle function, particularly in the lower legs •tingling or loss of feeling in the feet and hands •pain •mental confusion •difficulty speaking •vomiting •involuntary eye movement •paralysis VISIT US: DENTALTUTOR.IN
  5. 5. ETIOLOGY Risk factors (non-modifiable)  Female gender  Increasing age  Family history  White or Asian ethnicity  Small stature  Early menopause VISIT US: DENTALTUTOR.IN
  6. 6. ETIOLOGY Risk factors (cont’d)  Excess alcohol intake  Cigarette smoking  Anorexia  Oophorectomy  Sedentary lifestyle  Insufficient calcium intake  Low testosterone levels (hypogonadism in men) VISIT US: DENTALTUTOR.IN
  7. 7. ETIOLOGY AND PATHOPHYSIOLOGY Peak bone mass is achieved before age 20  Bone loss after midlife is inevitable but rate of loss is variable Bone resorption exceeds bone deposition Bones become weakened and prone to fracture, loss of height, and kyphosis. VISIT US: DENTALTUTOR.IN
  8. 8. ETIOLOGY AND PATHOPHYSIOLOGY Diseases associated with osteoporosis Intestinal malabsorption Kidney disease Rheumatoid arthritis Hyperthyroidism Chronic alcoholism Cirrhosis of the liver Hypergonadism Diabetes mellitus VISIT US: DENTALTUTOR.IN
  9. 9. OSTEOPOROSIS DIAGNOSTIC STUDIES Clinical Manifestations  Known as silent disease Diagnosis  Bone Mineral Density (BMD)  Dual-energy x-ray absorptiometry (DEXA)  History and physical  Quantitative ultrasound VISIT US: DENTALTUTOR.IN
  10. 10. OSTEOPOROSIS Can the disease be prevented? VISIT US: DENTALTUTOR.IN
  11. 11. TREATMENT AND NURSING CARE Diet Therapy  Weight bearing Exercises  Decrease Risk Factors  Quit smoking and decrease consumption of alcohol VISIT US: DENTALTUTOR.IN
  12. 12. DRUG TREATMENT OF OSTEOPOROSISEstrogen Replacement Therapy Calcium & Vitamin D supplements Calcitonin Biphosphonates (Fosamax, Didronel, Actonel, Boniva, Aredia, Bonefos, Skelid) Selective Estrogen receptor modulator – Evista Teriparatide (Forteo)  Portion of parathyroid hormone First drug to stimulate new bone formation VISIT US: DENTALTUTOR.IN
  13. 13. MEDICATIONS USED IN TREATMENT OF OSTEOPOROSISHormone Replacement Therapy – Estrogen  Controversy over use. Should discuss with health care provider Calcium There are a variety of calcium supplements available (See Table 64-16, p. 1689). They should be taken with _______ _ to aid in absorption. Also if taking large doses i.e. 1000 mg. / day – take in divided doses of 500mg BID for better absorption VISIT US: DENTALTUTOR.IN
  14. 14. MEDICATIONS USED IN TREATMENT OF OSTEOPOROSISCalcitonin  If calcitonin inhibits bone resorption by opposing the effects of parathyroid hormone, how does that affect serum calcium levels?  What is needed to counter that effect? VISIT US: DENTALTUTOR.IN
  15. 15. MEDICATIONS USED IN TREATMENT OF OSTEOPOROSISBisphosphenates – (Fosamax)  Inhibit osteoclast-mediated bone resorption thereby increasing BMD and total bone mass.  Side effects – anorexia, weight loss, gastritis  Patient Teaching VISIT US: DENTALTUTOR.IN
  16. 16. MEDICATIONS USED IN TREATMENT OF OSTEOPOROSISSelective Estrogen Receptor Modulators  Mimic effect of estrogen on bone by reducing bone resorption without stimulating the breasts or uterus.  Side effects Leg cramps Hot flashes VISIT US: DENTALTUTOR.IN
  17. 17. O STEO M ALAC IA M ETABOLIC BONE DISEASE VISIT US: DENTALTUTOR.IN
  18. 18. OSTEOMALACIA Decalcification and softening of the bone Caused mainly by: vitamin D deficiency **Vitamin D is required for the absorption of calcium from the intestine and calcium is responsible for mineralization of bone Etiology  Lack of exposure to __________ ____  GI malabsorption, extensive burns, chronic diarrhea, pregnancy, drugs such as Dilantin. VISIT US: DENTALTUTOR.IN
  19. 19. OSTEOMALACIA SIGNS & SYMPTOMS Most Common  ____ ____  Difficulty rising from a chair  Difficulty walking Additional Signs and Symptoms  Low back pain, muscle weakness  Weight loss, progressive deformities VISIT US: DENTALTUTOR.IN
  20. 20. DIAGNOSIS Blood work  Decreased serum calcium or phosphorus  Decreased serum 25-hydroxyvitamin D  Elevated alkaline phosphatase X-Rays  Show loose’rs transformation zone – ribbons of decalcification in bone VISIT US: DENTALTUTOR.IN
  21. 21. OSTEOMALACIA TREATMENT AND NURSING CAREDrug Therapy   Diet Therapy  Milk, yogurt, cheese  Dark green leafy vegetables, okra, broccoli  Fish and seafood  Almonds VISIT US: DENTALTUTOR.IN
  22. 22. PAG ET’S D ISEASE VISIT US: DENTALTUTOR.IN
  23. 23. PAGET’S DISEASE Excessive bone resorption followed by replacement of normal marrow by vascular, fibrous connective tissue. The new bone is ______, ____________, ___ ______ Most often affect the pelvis, long bones, spine, ribs, sternum, and cranium VISIT US: DENTALTUTOR.IN
  24. 24. CLINICAL MANIFESTATIONS In milder form, none Common early symptom-- Fatigue Waddling gait Loss of height Increased head size VISIT US: DENTALTUTOR.IN
  25. 25. COMPLICATIONS Pathological fractures (may be a first sign of disease) Bone tumors VISIT US: DENTALTUTOR.IN
  26. 26. PAGET’S DISEASE Diagnosis  Elevated serum alkaline phosphatase  X-ray will show increase in bone size  Bone scan shows increased uptake in affected bones VISIT US: DENTALTUTOR.IN
  27. 27. DRUG TREATMENT FOR PAGET’S Drug Therapy Calcitonin-salmon (Miacalcin) Bone is in a constant state of remodeling, whereby old bone is removed by osteoclasts, and new bone is laid down by osteoblasts. Calcitonin inhibits bone removal by osteoclasts, and promotes bone formation by osteoblasts. NSAIDS Bisphosphonates VISIT US: DENTALTUTOR.IN
  28. 28. PAGET’S DISEASE Other treatments and Nursing Care  Back support by firm mattress  Teaching about use of splints or braces to support bones and joints and help prevent weakened bones - skin care, circulation, etc.  Teach how to correctly use canes or walkers  Physical therapy  Diet high in…what? VISIT US: DENTALTUTOR.IN

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