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Treatment of bulimia nervosa and bulimarexia requires supportive care and psychotherapy Individual, group, family, and behavioral therapy have all been utilized Antidepressant medications may be helpful The best results have been with fluoxetine hydrochloride and other SSRIs Although death from bulimia is rare, the long-term psychiatric prognosis in severe bulimia is worse than that in anorexia nervosa
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American Dietetic Association Position of the American Dietetic Association: Nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and other eating disorders J Am Diet Assoc 2006 Dec;106(12):2073 82 [PMID: 17186637] Duncan AE et al Are there subgroups of bulimia nervosa based on comorbid psychiatric disorders Int J Eat Disord 2005 Jan; 37(1):19 25 [PMID: 15690461] Palmer R Bulimia nervosa: 25 years on Br J Psychiatry 2004 Dec;185:447 8 [PMID: 15572732] Walsh BT et al Treatment of bulimia nervosa in a primary care setting Am J Psychiatry 2004 Mar;161(3):556 61 [PMID: 14992983]
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A variety of biochemical tests are available to assess thiamine deficiency In most instances, however, the clinical response to empiric thiamine therapy is used to support a diagnosis of thiamine deficiency The most commonly used and widely available biochemical tests are measurement of erythrocyte transketolase activity and urinary thiamine excretion A transketolase activity coefficient greater than 15 20% suggests thiamine deficiency
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Friedli A et al Images in clinical medicine Oculo-orogenital syndrome a deficiency of vitamins B2 and B6 N Engl J Med 2004 Mar 11;350(11):1130 [PMID: 15014186] Said HM et al Intestinal absorption of water-soluble vitamins: an update Curr Opin Gastroenterol 2006 Mar;22(2):140 6 [PMID: 16462170]
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Thiamine deficiency is treated with large parenteral doses of thiamine Fifty to 100 mg/d is administered intravenously for the first few days, followed by daily oral doses of 5 10 mg/d All patients should simultaneously receive therapeutic doses of other water-soluble vitamins Although treatment results in complete resolution in half of patients (one-fourth immediately and another one-fourth over days), the other half obtain only partial resolution or no benefit
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NIACIN DEFICIENCY General Considerations
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Niacin is a generic term for nicotinic acid and other derivatives with similar nutritional activity Unlike most other vitamins, niacin can be synthesized from the amino acid tryptophan Niacin is an essential component of the coenzymes nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP), which are involved in many oxidation-reduction reactions The major food sources of niacin are protein foods containing tryptophan and numerous cereals, vegetables, and dairy products Niacin in the form of nicotinic acid is used therapeutically for the treatment of hypercholesterolemia and hypertriglyceridemia Daily doses of 3 6 g can result in significant reductions in levels of LDL and very-low-density lipoproteins (VLDL) and in elevation of HDL Niacinamide (the form of niacin usually used to treat niacin deficiency) does not exhibit the lipid-lowering effects of nicotinic acid Historically, niacin deficiency occurred when corn, which is relatively deficient in both tryptophan and niacin, was the major source of calories Currently, niacin deficiency is more commonly due to alcoholism and nutrient drug interactions Niacin deficiency can also occur in inborn errors of metabolism
THIAMINE TOXICITY
There is no known toxicity of thiamine
Clements RH et al Incidence of vitamin deficiency after laparoscopic Roux-en-Y gastric bypass in a university hospital setting Am Surg 2006 Dec;72(12):1196 202 [PMID: 17216818] Day E et al Thiamine for Wernicke-Korsakoff Syndrome in people at risk from alcohol abuse Cochrane Database Syst Rev 2004;(1):CD004033 [PMID: 14974055] Francini-Pesenti F et al Wernicke's encephalopathy during parenteral nutrition J Parenter Enteral Nutr 2007 Jan Feb; 31(1):69 71 [PMID: 17202444] Morcos Z et al Wernicke encephalopathy Arch Neurol 2004 May;61(5):775 6 [PMID: 15148159]
RIBOFLAVIN (B2) DEFICIENCY Clinical Findings
Riboflavin deficiency almost always occurs in combination with deficiencies of other vitamins Dietary inadequacy, interactions with a variety of medications, alcoholism, and other causes of protein calorie undernutrition are the most common causes of riboflavin deficiency Manifestations of riboflavin deficiency include cheilosis, angular stomatitis, glossitis, seborrheic dermatitis, weakness, corneal vascularization, and anemia
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