Pyridoxine Deficiency Clinical Presentation

Updated: Apr 19, 2021
  • Author: Richard E Frye, MD, PhD; Chief Editor: George T Griffing, MD  more...
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Presentation

History

Contributing factors

Several factors contribute to an increased risk for pyridoxine deficiency, [15] as follows:

  • Advanced age

  • Medical conditions that may increase the risk for pyridoxine deficiency include the following:

  • Medical procedures that may increase the risk for pyridoxine deficiency include the following:

    • Hemodialysis

    • Peritoneal dialysis

    • Phototherapy for hyperbilirubinemia

  • Medications that may increase the risk for pyridoxine deficiency include the following:

    • Cycloserine

    • Hydralazine

    • Isoniazid

    • D-penicillamine

    • Pyrazinamide

  • Social-behavioral conditions that may increase the risk for pyridoxine deficiency include the following:

    • Excessive alcohol ingestion (except for pyridoxine-supplemented beer)

    • Tobacco smoking

    • Severe malnutrition

  • Other risk factors that may increase the risk for pyridoxine deficiency include the following:

    • Poisoning, such as Gyromitra mushroom poisoning

    • Perinatal factors, such as a pyridoxine-deficient mother

    • Inherited conditions, such as pyridoxine-dependent neonatal seizures [12, 13, 14]

Other patient history

A patient's medical history may include the following:

  • Sideroblastic anemia

  • Pregnancy - Pregnancy can cause a pyridoxine-deficient state; however, a change in the ratio of plasma PLP to pyridoxal does occur, thereby falsely suggesting a deficiency state if only serum PLP is measured.

  • Physical exercise - This may transiently increase plasma PLP levels.

Symptoms and conditions associated with low pyridoxine levels

Symptoms and conditions associated with low pyridoxine levels include the following:

  • General

    • Weakness

    • Dizziness

    • Inflammation [10, 11]

  • Cardiovascular

    • Atherosclerosis

    • Early myocardial infarction

    • Early stroke [11]

    • Recurrent venous thromboembolism

  • Hematologic - Fatigue resulting from anemia is an example.

  • Peripheral nervous system

    • Bilateral, distal limb numbness (appears early)

    • Bilateral, distal limb burning paresthesia (replaces numbness later in the course)

    • Distal limb weakness (rare)

  • Central nervous system (CNS)

    • Depression

    • Irritability

    • Confusion

    • Generalized seizures

    • White matter lesions

  • Gastrointestinal

    • Anorexia

    • Vomiting

Symptoms and conditions associated with secondary niacin deficiency (ie, pellagra)

Symptoms and conditions associated with secondary niacin deficiency (ie, pellagra) include the following:

  • Skin

    • Erythematous itching and burning

    • Blisters and vesicles

    • Hyperpigmentation and thickening

  • CNS

    • Depression

    • Anxiety

    • Irritability

    • Disorientation

    • Stupor

    • Coma

  • Gastrointestinal

    • Anorexia

    • Nausea

    • Abdominal discomfort and pain

    • Glossitis

    • Diarrhea

Next:

Physical Examination

Physical examination findings may include the following:

  • Oral

    • Glossitis

    • Cheilosis

  • Dermatologic - Seborrheic dermatitis is an example.

  • Adult, neurologic

    • Distal limb numbness and weakness

    • Impaired vibration and proprioception

    • Preserved pain and temperature

    • Sensory ataxia

    • Generalized seizures

  • Neonatal and young infant, neurologic

    • Hypotonia

    • Irritability

    • Restlessness

    • Focal, bilateral motor, or myoclonic seizures

    • Infantile spasms

  • Secondary niacin deficiency

    • Skin - Dermatitis over sun-exposed areas; blisters and vesicles; beefy red, raw tongue

    • CNS - Confusion, dementia, disorientation, rigid tone, primitive reflexes

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