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Vitamin Deficiency - B1, B12, Folate, C, D

B1 (Thiamine) Deficiency

Vitamin B1 helps turn food into energy to keep the nervous system healthy. Our bodies can’t make it so we source it from the food we eat.


A deficiency of this vitamin is associated with Chronic alcohol use and Malabsorption.


It can present as:

  • Wet beriberi – High output heart failure

  • Dry beriberi – Peripheral neuropathy (Paraesthesia, Hyporeflexia, Weakness, Wasting)

  • Wernicke’s Encephalopathy – Confusion, Ataxia, Ophthalmoplegia


  • Korsakoff Syndrome if very severe, which involves brain damage, causing symptoms of Confabulation and Hallucinations



B12 and Folate Deficiency

These vitamins are crucial in the production and repair of DNA, and in the production of RBCs.


A deficiency of this vitamin leads to Macrocytic Anaemia.


It can presents with Anaemia symptoms, Neuropathy (Paraesthesia, Blurred vision), Fatigue, Mouth ulcers, Muscle weakness, Memory loss.


A potential complication of Vit B12 deficency is SACD (Subacute Combined Degeneration of the Spinal Cord). This is where a patient has a mix of UMN + LMN features, as well as Sensory ataxia (Romberg’s +ve). This is more likely to occur in Pernicious anaemia.


C Deficiency

A deficiency of this vitamin can lead to Scurvy, which presents with Fatigue, Easy bruising, Myalgia, Mouth ulcers, and Teeth loss.


There's a high risk of intracerebral/endocardial haemorrhage if left untreated.

This patient presented with a “scorbutic tongue” due to what proved to be a vitamin C deficiency. The condition referred to as “scorbutic tongue”, i.e., related to scurvy, involves inflammation of the tongue, or glossitis, which includes areas of erythema and petechial submucosal hemorrhages. - Centers for Disease Control and Prevention (https://commons.wikimedia.org/wiki/File:Scorbutic_tongue_(cropped).jpg) Scorbutic gums due to a vitamin C deficiency, a symptom of scurvy - Centers for Disease Control and Prevention (https://en.wikipedia.org/wiki/File:Scorbutic_gums.jpg)

D Deficiency

A deficiency of this vitamin can lead to Rickets in children and Osteomalacia in adults.

“Anteroposterior (AP) view of the legs in a 2 year old child with rickets.” © Michael L. Richardson CC BY-SA 1.0 (https://creativecommons.org/licenses/by-sa/1.0/) “The so called incurable cases” © Umeedhom CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/)

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