Introduction:
Cirrhosis is irreversible scarring of the liver related to chronic liver disease. The liver carries out several essential functions, including the detoxification of harmful substances in the body. It also purifies the blood and manufactures vital nutrients. Common causes of cirrhosis are hepatitis B or C infection, fatty liver disease and alcohol abuse. Cirrhosis is a progressive disease, developing slowly over many years, until eventually it can stop liver function (liver failure). Research shows that vitamin deficiency is present in many people suffering from cirrhosis.
Cirrhosis patients and vitamin deficiency:
Thiamine deficiency in cirrosis:
Lévy S, et al found that alcoholics as well as patients with cirrhosis had a high incidence of thiamine deficiency. Therefore thiamine was recommended by the authors to give a thiamine supplement to both alcoholic patients and those with cirrhosis related to any cause. (1)
In a report by Baines, M. et al oral thiamine at a dose of 250mg for 5 days was as effective as IV thiamine in restoring thiamine levels in alcoholic patients without encephalopathy (2).
Other vitamin deficiencies in cirrosis
Peres WA, et al found a high prevalence of vitamin A deficiency (3), and Lim, LY and Chalasani, N. et al found that a large number of cirrhosis patients were vitamin D deficient (4). Saja MF documented that vitamin K is often administered in an attempt to correct coagulopathy, but did not result in significant correction of coagulation factors (5). Muro, N et al showed that Vitamin B12 was often high in cirrhosis patients, and that plasma folic acid levels were shown to be low in cirrhosis patients and even lower if cirrhosis was related to alcohol compared to controls (6).
Assessment and Plan: Cirrhosis and Vitamin deficiency
- Lévy S, et al found that alcoholics as well as patients with cirrhosis had a high incidence of thiamine deficiency recommended by the authors to give a thiamine supplement to both alcoholic patients and those with cirrhosis related to any cause (1).
- In a report by Baines, M. et al oral thiamine at a dose of 250mg for 5 days was as effective as IV thiamine in restoring thiamine levels in alcoholic patients without encephalopathy (2).
- Peres WA, et al found a high prevalence of vitamin A deficiency (3), and Lim, LY and Chalasani, N. et al found that a large number of cirrhosis patients were vitamin D deficient (4).
- Saja MF documented that vitamin K is often administered in an attempt to correct coagulopathy, but did not result in significant correction of coagulation factors (5).
- Muro, N et al showed that Vitamin B12 was often high in cirrhosis patients, and that plasma folic acid levels were shown to be low in cirrhosis patients and even lower if cirrhosis was related to alcohol compared to controls (6).
References:
1.Lévy S, Hervé C, Delacoux E, Erlinger S. Thiamine deficiency in hepatitis C virus and alcohol-related liver diseases. Dig Dis Sci. 2002 Mar;47(3):543-8. http://www.ncbi.nlm.nih.gov/pubmed/11911339
2.Baines M, Bligh JG, Madden JS. Tissue thiamin levels of hospitalised alcoholics before and after oral or parenteral vitamins. Alcohol. 1988;23(1):49-52. http://www.ncbi.nlm.nih.gov/pubmed/3358822
3.Peres WA, Chaves GV, Gonçalves JC, Ramalho A, Coelho HS. Vitamin A deficiency in patients with hepatitis C virus-related chronic liver disease. Br J Nutr. 2011 Dec;106(11):1724-31. http://www.ncbi.nlm.nih.gov/pubmed/21736776
4.Lim LY, Chalasani N. Vitamin d deficiency in patients with chronic liver disease and cirrhosis. Curr Gastroenterol Rep. 2012 Feb;14(1):67-73. http://www.ncbi.nlm.nih.gov/pubmed/22113744
5.Saja MF, Abdo AA, Sanai FM, Shaikh SA, Gader AG. The coagulopathy of liver disease: does vitamin K help? Blood Coagul Fibrinolysis. 2013 Jan;24(1):10-7. http://www.ncbi.nlm.nih.gov/pubmed/23080365
6.Muro N, Bujanda L, Sarasqueta C, Gil I, Hijona E, Cosme A, Arenas J Jr, Elosegui ME, Sarasola M, Calpasoro J, Arenas JI. [Plasma levels of folate and vitamin B(12) in patients with chronic liver disease]. [Article in Spanish] Gastroenterol Hepatol. 2010 Apr;33(4):280-7. http://www.ncbi.nlm.nih.gov/pubmed/20206409