Pyridoxine deficiency causes a wide range of symptoms, all due to derangements in pyridoxine-requiring metabolic processes.

Clinical features of vitamin B6 deficiency include peripheral neuropathy presenting as numbness, weakness, and dysesthesias in the limbs, glossitis, cheilitis, pellagra-like symptoms including seborrheic dermatitis and diarrhea, conjunctivitis, sideroblastic anemia, and neurological symptoms such as confusion, depression, insomnia, irritability, chronic fatigue, EEG abnormalities and convulsions, which are often tonic-clonic seizures.

Peripheral neuropathy presents as numbness, burning or tingling sensations in the feet which ascend to the legs and upper extremities. There is also a loss of sensation and reduced deep tendon reflexes in the lower limbs. Other neurological findings in vitamin B6 deficiency include areflexia and ataxia. In infants, there may be restlessness and irritability.

Studies have revealed an association between vitamin B6 deficiency and a high risk of rheumatoid arthritis and cardiac disease. Other studies have also shown a strong link between vitamin B6 deficiency and Alzheimer's disease, as well as other forms of dementia.

• Anemia

  Iron deficiency is the most common cause of anemia in pregnancy. Pregnant women with anemia are, in general, exclusively treated with iron supplementation. [ncbi.nlm.nih.gov]

  Abstract Iron deficiency is the most common cause of anemia in pregnancy. Pregnant women with anemia are, in general, exclusively treated with iron supplementation. [nature.com]

  Normocytic, microcytic, or sideroblastic anemia can also develop. [msdmanuals.com]

• Swelling

  Some contend that synovium swelling and inelasticity are caused by a B6 deficiency. Other doctors believe that vitamin B6 acts as a diuretic, helping the body to eliminate the excess fluid that may be making wrists swell. [prevention.com]

  Even the effects of premenstrual syndrome (PMS) may be reduced because pyridoxine acts as a mild diuretic to reduce swelling. [spineuniverse.com]

  Temporary inflammation, such as redness and swelling after an injury, is generally a sign that the immune system is actively fighting infection. [webmd.com]

  Vitamin B6 Deficiency Symptoms The deficiency symptoms of vitamin B6 are seen in the form of fatigue, loss of appetite, an emergence of dry skin, hair loss, the appearance of cracks around the lips, insomnia, and swelling of the mouth and tongue. [organicfacts.net]

• Malnutrition

  Malnutrition and risk of malnutrition were present in 11.5% and 61% respectively. Dietary intake of B6 (mg/day) in men and women were 1.60 (0.30) and 1.18 (0.31) (recommended 1.6 and 1.2 respectively), and 14 (23%) used B6 supplements. [ncbi.nlm.nih.gov]

  The nutritional state was unsatisfactory, malnutrition was present in 11.5% and only 27% were at no risk of malnutrition. [bmcgeriatr.biomedcentral.com]

  Because vitamin B6 is present in many foods, the deficiency rarely results from inadequate intake except in severe malnutrition. However, deficiency can also occur, because extensive processing can remove vitamin B6 from foods. [merckmanuals.com]

  Dietary deficiency of vitamin B6 may be more predominant in developing countries, where there are high incidence rates of chronic malnutrition. [symptoma.com]

• Anorexia

  During her early teens she had suffered with anorexia and today she remains calorie conscious. Paula is 5' 6" tall and weighed around 8 stone when I first saw her. [positivehealth.com]

  Glossitis, cheliosis, anorexia, diarrhea, constipation and weight loss have been associated with vitamin B-12 deficiency. Cardiovascular effects. [journalofethics.ama-assn.org]

  Vitamin syrups that fight anorexia and help you gain weight fast are vital to recovering from a severe loss of appetite or a serious medical condition that causes you to lose weight. [goedgeleven.co.za]

  Care must be exercised when evaluating patients on high‐flux HD, because vitamin B 6 resistance can contribute not only to PPN, but also to nausea, vomiting, anorexia, anaemia, and altered immune responses, which themselves can be misinterpreted as underdialysis [academic.oup.com]

• Burning Feet

  feet syndrome E53.9 Deficiency, deficient vitamin (multiple) E56.9 ICD-10-CM Diagnosis Code E56.9 Vitamin deficiency, unspecified 2016 2017 2018 2019 Billable/Specific Code B (complex) E53.9 group B E53.9 Encephalopathy (acute) G93.40 ICD-10-CM Diagnosis [icd10data.com]

  Associated with "burning feet" and impaired wound healing. [labtestsonline.org]

• Morning Sickness

  Pure Science Vitamin B6 (Pyridoxine Hydrochloride) 100mg - Reduces Pyridoxine Deficiency, Controls Cholesterol Levels, Relieves Pre Menstrual Syndrome, Alleviates Morning Sickness - 100 Vcaps This review is of Pure Science Vitamin B6 (Pyridoxine Hydrochloride [amazon.de]

  University of Michigan, Vitamin B6 for Morning Sickness https://www.uofmhealth.org/health-library/tn9126 [americanpregnancy.org]

  During pregnancy, vitamin B6 helps control morning sickness and nausea. Maternal B6 deficiency can increase the risk of autism. [paulaowens.com]

  In fact, it’s an ingredient in Diclegis, a medication commonly used to treat morning sickness (26). [healthline.com]

  Morning sickness Several studies have been conducted to prove that vitamin B6 deficiencies may cause morning sickness. Pregnant women who consumed 30 mg of vitamin B6 daily found that the effects of morning sickness decreased. [naturalremedies.org]

• Loss of Appetite

  Symptoms include loss of appetite, fatigue and insomnia, constipation, vomiting and intestinal distress. [betterhealth.vic.gov.au]

  The vitamin B6 deficiency symptoms in women include: Depression, Mood swings, Migraine, Hair loss, Irritability, Anemia, Loss of appetite, Dry skin, Cracks on tongue and lips, Weakness, Crying spells,inability to cope. [blissreturned.wordpress.com]

  High doses of B6 can also make you more vulnerable to direct sunlight, and lead to symptoms like vomiting, nausea, rashes, stomach pain, and loss of appetite. [stop-being-tired.com]

  Vitamin B6 Deficiency Symptoms The deficiency symptoms of vitamin B6 are seen in the form of fatigue, loss of appetite, an emergence of dry skin, hair loss, the appearance of cracks around the lips, insomnia, and swelling of the mouth and tongue. [organicfacts.net]

• Diarrhea

  Vitamin B12: Nerve damage and mental sluggishness, fatigue, diarrhea, depression and anemia. Why You Should Play It Safe All members of the vitamin B family are water-soluble. [vitamins.lovetoknow.com]

  When it does, it is usually associated with poor absorption of nutrients in the gastrointestinal tract (as in alcoholism, or with chronic diarrhea ), the taking of certain drugs (as isoniazid, hydrolazine, penicillamine) that inactivate the vitamin, with [medical-dictionary.thefreedictionary.com]

  Clinical features of vitamin B6 deficiency include peripheral neuropathy presenting as numbness, weakness, and dysesthesias in the limbs, glossitis, cheilitis, pellagra-like symptoms including seborrheic dermatitis and diarrhea, conjunctivitis, sideroblastic [symptoma.com]

  Insufficiency Symptoms At-risk patients Dietary sources A (retinol): Transcription regulation, vision 44% Blindness, decreased immunity, corneal and retinal damage Pregnant women, individuals with strict dietary restrictions, heavy alcohol use, chronic diarrhea [currentpsychiatry.com]

  They are also sometimes seen with other chronic diseases, with cancer and cancer treatment, with fad diets, and with prolonged diarrhea. [labtestsonline.org]

• Fracture

  Depending on severity and age of onset, features may include fractures, short stature, compressive neuropathies (pressure on the nerves), hypocalcemia with attendant tetanic seizures, and life-threatening pancytopenia. [rarediseases.info.nih.gov]

• Dermatitis

  Deficiency can cause peripheral neuropathy, seborrheic dermatitis, glossitis, and cheilosis, and, in adults, depression, confusion, and seizures. Suspect and diagnose based on clinical findings. [msdmanuals.com]

  Inflammation of the skin, called dermatitis, is another common feature of vitamin B6 deficiency, presenting as flaking and discoloration of the skin. [symptoma.com]

• Ulcer

  Application(s): anti-ulcer drug One of various classes of drugs with different action mechanisms used to treat or ameliorate peptic ulcer or irritation of the gastrointestinal tract. anticonvulsant A drug used to prevent seizures or reduce their severity [ebi.ac.uk]

  K12.1 ICD-10-CM Diagnosis Code K12.1 Other forms of stomatitis 2016 2017 2018 2019 Billable/Specific Code Applicable To Stomatitis NOS Denture stomatitis Ulcerative stomatitis Vesicular stomatitis Type 1 Excludes acute necrotizing ulcerative stomatitis [icd10data.com]

  Sores or ulcers around the corners of the mouth are another sign, particularly of vitamin B6 deficiency. A lack of vitamin B6 may also cause dermatitis. [livestrong.com]

  Examples of autoimmune disorders include rheumatoid arthritis, inflammatory bowel disease, celiac disease, Crohn’s disease, ulcerative colitis, and other malabsorption issues. [curejoy.com]

• Intertrigo

  Intertrigo Intertrigo describes the rash or inflammation that occurs where the body folds. Areas such as, under the arms, under the breast and other places are affected. Vitamin B6 deficiencies may lead to this condition. [naturalremedies.org]

  Eating just two to three servings of store-bought baked goods every day helps North Americans avoid the deficiency that can cause oily skin acne, seborrhea, dandruff, intertrigo (rashes in the folds of the skin), chapped lips, and conjunctivitis (itching [facingacne.com]

  If you eat three servings of mass-produced baked goods a day, you get enough vitamin B6 to prevent deficiency diseases, such as seborrhea (oily skin), intertrigo (rashes and ulcers in folds of skin), conjunctivitis (inflammation under the eye lids), chapped [healthifybody.com]

  The classic clinical syndrome for B6 deficiency is a seborrheic dermatitis-like eruption, atrophic glossitis with ulceration, angular cheilitis, conjunctivitis, intertrigo, and neurologic symptoms of somnolence, confusion, and neuropathy (James et al. [newworldencyclopedia.org]

• Skin Rash

  One reason B6 deficiency may result in skin rashes is that the vitamin helps synthesize collagen, which is needed for healthy skin. In these cases, consuming B6 may clear up the rash quickly (10, 11). [healthline.com]

  But be on alert: too much B6 has been linked to serious nervous disorders as well as to oversensitivity to sunlight, which can produce skin rashes and numbness. Amounts above 100 mg should only be taken under the supervision of your doctor. [prevention.com]

  Signs of deficiency can include skin rashes, depression, nausea, convulsions and confusion. What happens if you get too much? No adverse effects have been associated with high intakes of vitamin B6 from foods. [eatingwell.com]

  Symptoms include an inflamed tongue (painful, smooth, purple-red tongue), cracks and redness in the tongue and corners of the mouth, anxiety, inflamed eyelids and sensitivity to light, hair loss, reddening of the cornea and skin rash. [betterhealth.vic.gov.au]

• Eruptions

  The classic clinical syndrome for B6 deficiency is a seborrheic dermatitis-like eruption, atrophic glossitis with ulceration, angular cheilitis, conjunctivitis, intertrigo, and neurologic symptoms of somnolence, confusion, and neuropathy (James et al. [newworldencyclopedia.org]

  Acneiform eruption due to "megadose" vitamins B6 and B12. Cutis. 1991;48:119-120. 47. Braun-Falco O, Lincke H. The problem of vitamin B6/B12 acne. A contribution on acne medicamentosa [in German]. MMWMunch Med Wochenschr. 1976;118:155-160. 48. [health.cvs.com]

  Vitamin B 6 pyridoxine, pyridoxal, pyridoxamine Main article: Vitamin B6 § Deficiency Deficiency causes seborrhoeic dermatitis-like eruptions, pink eye and neurological symptoms (e.g. epilepsy ) Vitamin B 7 biotin Deficiency does not typically cause symptoms [en.wikipedia.org]

• Withdrawn

  Do you find yourself socially withdrawn and dependent fairly strongly on one person? If you answer yes to 12 or more of these questions, then you may have pyroluria and should consider getting a urine test done. [changinghabits.com.au]

  Vitamin B 6 was originally included in the medication Bendectin, which was prescribed for NVP treatment and later withdrawn from the market due to unproven concerns that it increased the risk for birth defects. [lpi.oregonstate.edu]

• Kidney Failure

  In certain long-term conditions like kidney failure, as little as 5 mg a day is enough. Most conditions require 100 to 200 mg a day until a second urine test shows vitamin B6 levels have been built back up. [healthifybody.com]

  Olavs Hospital which performed the analyses), homocysteine (Hcy, 90 mL/min; severe reduction (kidney failure) < 15 mL/min. [bmcgeriatr.biomedcentral.com]

  A marginal deficiency sometimes occurs in alcoholics, patients with kidney failure, and women using oral contraceptives. Some doctors believe that most diets do not provide optimal amounts of this vitamin. [wa.kaiserpermanente.org]

• Renal Insufficiency

  End-stage renal diseases, chronic renal insufficiency, and other kidney diseases can cause vitamin B6 deficiency [3]. [ods.od.nih.gov]

• Irritability

  In infants, there may be restlessness and irritability. Studies have revealed an association between vitamin B6 deficiency and a high risk of rheumatoid arthritis and cardiac disease. [symptoma.com]

  @article{Anbardan2012GenderRI, title={Gender Role in Irritable Bowel Syndrome: A Comparison of Irritable Bowel Syndrome Module (ROME III) Between Male and Female Patients}, author={Sanam Javid Anbardan and Nasser Ebrahimi Daryani and Seyed-Mohammad Fereshtehnejad [semanticscholar.org]

  Moderate and severe deficiency leads to the following symptoms: nervousness depression memory loss muscle weakness difficulty in concentration irritability Other serious complications of vitamin B6 lead to: occurrence of microcytic anaemia dermatitis [medasq.com]

  Not having enough B6 can cause confusion, depression, irritability, and mouth/tongue sores. Low levels of vitamin B6 have been linked to chronic inflammation in the body. At home, check your mouth in a mirror. [sharecare.com]

  * This consisted of increased irritability, gastrointestinal distress, aggravated startle response, and convulsive seizures. The symptoms were shown to respond to pyridoxine therapy with both clinical and electroencephalographic improvement. [jamanetwork.com]

• Convulsions

  —B 6 requirements in relation to convulsive seizures in infants. A.M.A. Amer. J. Dis. Child., 88 : 623, 1954. Google Scholar 2. Bhandari, N. R. —Etiological aspects of convulsions in infancy and childhood. Thesis for M. D. (paed.) [link.springer.com]

  The convulsions are most commonly seen in newborns and infants. [symptoma.com]

  They are characterized by untreatable convulsions during childhood. [ncbi.nlm.nih.gov]

• Peripheral Neuropathy

  We describe two patients who developed subacute axonal peripheral neuropathy under duodopa treatment. [ncbi.nlm.nih.gov]

  Symptoms can include peripheral neuropathy, a pellagra-like syndrome, anemia, and seizures, which, particularly in infants, may not resolve when treated with antiseizure drugs. [msdmanuals.com]

  Symptoms of vitamin B6 deficiency include neurological sequelae such as paresthesias (due to peripheral neuropathy), generalized convulsions, depression, irritability, glossitis and dermatitis. [symptoma.com]

• Tingling

  Vitamin B6 supplements in doses higher than 200 mg/day may cause nausea, vomiting, stomach pain, loss of appetite, headache, pains, photosensitivity (burns after exposure to moderate sunlight), numbness or tingling in the arms and legs, clumsiness (unstable [nutrientsreview.com]

  Signs and symptoms of vitamin B6 deficiency include: Peripheral neuropathy with tingling, numbness, and pain in the hands and feet Anemia Seizures Depression Confusion Weakened immune system It can lead to a pellagra-like syndrome, with seborrheic dermatitis [medicalnewstoday.com]

  Other symptoms of vitamin B6 deficiency in adults is ADD (attention deficit disorder), heart palpitations, loss of libido (in men), indigestion and tingling sensation in the arms and legs etc. [blissreturned.wordpress.com]

  Studies have shown taking large amounts of vitamin B6 (more than 500 mg a day) can cause nerve damage, difficulty walking, or tingling. "Some is good. More is not better," says Salge Blake. "Just having a well-balanced diet will meet your needs." [webmd.com]

• Paresthesia

  In general, symptoms related to vitamin B6 deficiency are peripheral neuropathies, such as paresthesia, burning and painful dysesthesias, and thermal sensations. These symptoms were reported and assigned one of five grade scores. [ncbi.nlm.nih.gov]

  Key Words: Paresthesia, Polyneuropathies, Pyridoxine, Vitamins 피리독신(pyridoxine)은 탈카복시화(decarboxylation)와 아미노기전달(transamination) 반응에서 보조효소로 기능하는 필수 수용성 비타민이다. [jkna.org]

  Adverse Effects: Nausea, headache, paresthesia, somnolence and low serum folic acid concentrations have been reported. Sensory neuropathy can occur following long-term administration of large doses (2 g or more daily for 2 months or longer). [rxmed.com]

  Symptoms of vitamin B6 deficiency include neurological sequelae such as paresthesias (due to peripheral neuropathy), generalized convulsions, depression, irritability, glossitis and dermatitis. [symptoma.com]

  Symptoms such as numbness and paresthesias in the extremities, loss of position and vibratory sensation, difficulty walking, depression and irritability, diminished cognitive function (including memory impairment), and psychosis may be observed even in [journalofethics.ama-assn.org]

Vitamin B6 deficiency should be a strong differential in any infant with seizures, patients with seizures unresolved by appropriate anticonvulsant therapy and in individuals with other B vitamin deficiencies.

Although there is no single accepted or standard diagnostic test for vitamin B6 deficiency, serum pyridoxal phosphate and urine/serum vitamin B6 assays provide an approximate measurement of vitamin B6 status.

Serum PLP level is the most reliable indicator of the body's vitamin B6 status. However, PLP levels should be measured with albumin levels to get correct values, as PLP levels depend on serum albumin levels [13]. Urine 4-pyridoxic acid also reflects the body's vitamin B6 status and can be used in the diagnosis of vitamin B6 deficiency. 4-pyridoxic acid is the main inactive metabolite of vitamin B6 and is excreted in the urine [14].

Nerve conduction tests and nerve biopsy (sural nerve) may be necessary to investigate neuronal function and pathologic changes. Nerve biopsy notably reveals axonal degeneration and demyelination of the nerves. EEG findings in infants with seizures induced by pyridoxine deficiency reveal high voltage, generalized and synchronous spikes of 1-4 Hz and sharp waves.

Treatment of vitamin B6 deficiency begins with identifying and correcting the underlying cause: pyridoxine should be co-administered with the inciting medications in patients receiving the latter, malabsorptive syndromes and chronic alcoholism should be well managed and dietary adjustments should be made.

Deficiencies due to high metabolic demand and inborn errors of metabolism of vitamin B6 require doses larger than the daily recommended ones. Treatment of the underlying diseases should be accompanied by concurrent pyridoxine therapy at a dose of 50-100mg PO daily. 30 - 50 mg pyridoxine should be prescribed for those receiving isoniazid.

Treatment should be administered with caution, however, because pyridoxine supplementation may cause toxic side effects including peripheral neuropathy. Toxicity is most common at high doses of the supplements. Lactating mothers and infants receiving pyridoxine supplements should particularly have their doses well monitored to prevent side effects.

Vitamin B6 deficiency responds well to treatment with little or no complications; however, the neonatal and infantile seizures may be unresponsive to anticonvulsant therapy.

The causes of vitamin B6 deficiency can be categorized into 4 groups for descriptive purposes. These include inadequate dietary intake, conditions which interfere with the absorption of vitamin B6, diseases which cause increased loss of vitamin B6 and conditions or drugs which reduce the availability of the vitamin.

Dietary causes of vitamin B6 deficiency are rare because the vitamin is present in most foods, however, foods rich in vitamin B6 include fish, chicken, eggs, vegetables especially beans, fruits including avocados and oranges, and grains. Dietary deficiency of vitamin B6 may be more predominant in developing countries, where there are high incidence rates of chronic malnutrition. There's a daily recommended minimal requirement of vitamin B6 of 1.5 mg, although the US National research council recommends a minimal daily intake of 2.0 mg for adults and 0.3 mg for infants. Intake of processed foods, however, may cause vitamin B6 deficiency because food processing is associated with vitamin-depleting activities. For example, heat-treated foods contain an enzyme with anti-vitamin activity.

Malabsorption of vitamin B6 occurs in chronic alcoholism, protein-losing enteropathies, inflammatory bowel diseases, gastrointestinal surgeries and other malabsorption syndromes such as Celiac's disease [2] [3] [4].

The functions of vitamin B6 may be inhibited by medications which inhibit its actions. These drugs include isoniazid, cycloserine, hydralazine, corticosteroids, anticonvulsants and penicillamine. These drugs form complexes with the active form of vitamin B6 which impede its actions and also displace the active form of the vitamin from its binding site, rendering the vitamin functionally unavailable [5] [6] [7] [8]. Excessive loss of vitamin B6 is seen in individuals undergoing chronic dialysis and in liver diseases such as hepatitis, which increase the clearance rate of the vitamin [9]. Some medications also speed up the metabolism of vitamin B6.

Vitamin B6 deficiency can also be caused by conditions associated with a high metabolic rate such as pregnancy, lactation, and hyperthyroidism; however these causes are rare. Inborn errors of metabolism may also impede function and availability of the vitamin, causing symptoms due to pyridoxine deficiency.

Generally, it is rare to exhibit isolated vitamin B6 deficiency. B-vitamin deficiencies, especially caused by malabsorption, dietary insufficiency and increase loss all occur together.

Pyridoxine deficiency can occur at any age without sexual predilection. However, the elderly are most at risk of developing the condition [10] [11]. This could be because of a higher daily requirement than can be met by one's diet, as the daily requirement of vitamin B6 increases with age. Seizures complicating pyridoxine deficiency are mostly seen in infants less than 3 months old, particularly neonates [8] [9].

Pyridoxine, pyridoxal and pyridoxamine, which are forms of vitamin B6, are transported by facilitated diffusion into the hepatocytes after absorption. Pyridoxine and pyridoxamine are subsequently phosphorylated by pyridoxal kinase and converted to pyridoxal 5' phosphate (PLP) by a flavin-dependent enzyme.

PLP is an essential cofactor of a number of metabolic processes including decarboxylation, transamination, and pathways for lipid, amino acid, neurotransmitter, and carbohydrate synthesis. PLP is also an important coenzyme involved in amino acid metabolism, involving the production of tryptophan, methionine, and gamma aminobutyric acid (GABA). Therefore, a deficiency of vitamin B6 would cause symptoms related to the deficiency of these amino acids and to derangements in all metabolic pathways requiring pyridoxine.

Methionine deficiency results in the accumulation of S-adenosylmethionine, which inhibits myelin and sphingolipid synthesis. Tryptophan deficiency sequel to vitamin B6 deficiency may cause pellagra-like symptoms because of an impaired synthesis of niacin (tryptophan is an essential substrate for the production of niacin). With PLP being a cofactor for glutamic acid decarboxylase, its unavailability due to pyridoxine deficiency causes a reduced synthesis of GABA, eventually causing uninhibited neural firing, which is the basis of seizures in this condition [12].

Vitamin B6 may be administered prophylactically to patients on medications which cause pyridoxine deficiency. Individuals who are on other medications which also interfere indirectly with pyridoxine-dependent processes should also receive pyridoxine; an example of this latter medication is estrogen, which interferes with tryptophan metabolism.

Daily doses of 10mg to 50 mg of pyridoxine are recommended for patients undergoing hemodialysis [15]. Patients on penicillamine should likewise receive 100mg PO of pyridoxine daily, and those on estrogen therapy should also ingest 20-25mg pyridoxine daily per os.

Generally, pyridoxine supplements should be administered in conditions which constitute risk factors for the development of pyridoxine deficiency.

Vitamin B6 is involved in a number of metabolic pathways including those for heme, nucleic acid, and neurotransmitter synthesis. Pathways for carbohydrate, lipid, and amino acid metabolism are also dependent on vitamin B6. Given the fact that it is an essential component for metabolic reactions, a deficiency of vitamin B6 also results in a lot of symptoms, cutting across various pathways and organ systems.

Vitamin B6 deficiency may result from poor dietary intake, poor absorption, functional unavailability or increased clearance of the vitamin. Conditions which are associated with a high metabolic rate also cause vitamin B6 deficiency. However, vitamin B6 deficiency usually occurs in combination with a deficiency of other B-vitamins.

Symptoms of vitamin B6 deficiency include neurological sequelae such as paresthesias (due to peripheral neuropathy), generalized convulsions, depression, irritability, glossitis and dermatitis [1].

Treatment involves the elimination of the underlying cause and administration of vitamin B supplements. Supplements are also co-administered with high-risk medications to prevent pyridoxine deficiency.

Vitamin B6 (pyridoxine) is a key factor involved in a number of processes in the body. It is required in order to process sugars, fats and amino acids in the body as well as for the proper function of the brain and nerve cells. It is also essential for the production of red blood cells which help carry oxygen in the blood.

Vitamin B6 deficiency often results from 4 groups of conditions including inadequate dietary intake of vitamin B rich foods, conditions which cause poor absorption of the vitamin in the gut, conditions which place a high demand on nutrients in the body, an example of which is breastfeeding and pregnancy, and conditions or drugs which increase the breakdown and excretion of the vitamin.

Dietary deficiency of vitamin B6 is quite rare because almost all foods contain Vitamin B6, and especially fruits, vegetables especially tomatoes and beans, and protein-rich foods such as fish and meat. There is a daily requirement of vitamin B6 of 1.5 mg every day, below which the body may show signs of deficiency, hence chronic malnutrition is a common cause of vitamin B6 deficiency.

Absorption of vitamin B6 can be tampered with by chronic alcohol consumption and diseases which destroy the gut's absorptive capacity. Examples of such diseases include inflammatory bowel diseases.

Medications which render vitamin B6 inactive in the body include steroids, anticonvulsants, isoniazid, a drug used for treating tuberculosis and hydralazine, an antihypertensive drug. These drugs affect the ability of the vitamin to function in the body.

Some genetic problems involving certain metabolic processes requiring pyridoxine may also cause abnormal functioning of vitamin B6. Usually, it is rare to have an isolated deficiency of vitamin B6. The other B-vitamins are usually also deficient at the same time, as some of the causes of vitamin B6 deficiency affect them as well.

The disease can occur at any age, however, the elderly are at a higher risk of developing vitamin B6 deficiency. It impairs a lot of processes in the body, particularly in the brain, causing convulsions, confusion, depression, irritability, pins and needles with numbness of the hands and feet. It can also cause anemia or shortage of red blood cells. The convulsions are most commonly seen in newborns and infants. Other prominent features are inflammation of the tongue (glossitis), which presents as soreness and redness of the tongue, and angular cheilitis which presents as cracks at the angles of the mouth.

Inflammation of the skin, called dermatitis, is another common feature of vitamin B6 deficiency, presenting as flaking and discoloration of the skin.

In the laboratory, although there is no standard test, there are some substances in the blood and urine which are products of vitamin B6 that can be measured to make a diagnosis of this condition. The nerves may also be analyzed by biopsy to evaluate specific changes which characterize this condition. Treatment involves eliminating or correcting the underlying cause and administering vitamin B6 supplements. The offending drug may not be changed, if there are no alternatives to it. In such cases, such individuals would also receive vitamin B supplements.

Patients receiving drugs that can cause vitamin B6 deficiency should also receive vitamin B6 supplements. Dietary adjustments should also be made to ensure they consume more foods rich in vitamin B6. Conditions or physiologic states which pose a risk of developing a deficiency of vitamin B6 should also be managed with vitamin B supplements to prevent the condition.

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