Question:
A patient on a maize diet presented with diarrhea, dementia and dysentry. Which vitamin deficiency is responsible for the features?
A patient on a maize diet presented with diarrhea, dementia and dysentry. Which vitamin deficiency is responsible for the features?
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Remember the classic 4 Ds of the deficiency disease associated with a maize-heavy diet and think which B vitamin is derived from tryptophan.
Updated On: Jun 23, 2026
- Niacin
- Thiamine
- Riboflavin
- Pyridoxine
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The Correct Option is A
Solution and Explanation
Step 1: Identify the clinical triad.
The patient presents with diarrhea, dementia, and dysentery. This clinical triad -- along with dermatitis -- constitutes the classic presentation of Pellagra, caused by Niacin (Vitamin B3) deficiency. Pellagra is remembered by the mnemonic: 4 Ds -- Diarrhea, Dermatitis, Dementia, and Death.
Step 2: Explain why a maize diet causes Niacin deficiency.
Niacin (Vitamin B3) can be obtained directly from the diet or synthesized endogenously from the essential amino acid Tryptophan (60 mg of tryptophan yields approximately 1 mg of niacin). Maize (corn) is deficient in tryptophan, and the niacin present in maize is in a bound, biologically unavailable form (niacytin). A diet consisting predominantly of maize therefore leads to niacin deficiency.
Step 3: Exclude other options.
- Thiamine (B1) deficiency: Beriberi (wet/dry) or Wernicke-Korsakoff syndrome.
- Riboflavin (B2) deficiency: Cheilosis, glossitis, angular stomatitis, corneal vascularization.
- Pyridoxine (B6) deficiency: Peripheral neuropathy, sideroblastic anemia, convulsions in neonates.
Conclusion: Niacin (Vitamin B3) deficiency (Pellagra) is responsible for diarrhea, dementia, and dysentery in a maize-diet patient.
The patient presents with diarrhea, dementia, and dysentery. This clinical triad -- along with dermatitis -- constitutes the classic presentation of Pellagra, caused by Niacin (Vitamin B3) deficiency. Pellagra is remembered by the mnemonic: 4 Ds -- Diarrhea, Dermatitis, Dementia, and Death.
Step 2: Explain why a maize diet causes Niacin deficiency.
Niacin (Vitamin B3) can be obtained directly from the diet or synthesized endogenously from the essential amino acid Tryptophan (60 mg of tryptophan yields approximately 1 mg of niacin). Maize (corn) is deficient in tryptophan, and the niacin present in maize is in a bound, biologically unavailable form (niacytin). A diet consisting predominantly of maize therefore leads to niacin deficiency.
Step 3: Exclude other options.
- Thiamine (B1) deficiency: Beriberi (wet/dry) or Wernicke-Korsakoff syndrome.
- Riboflavin (B2) deficiency: Cheilosis, glossitis, angular stomatitis, corneal vascularization.
- Pyridoxine (B6) deficiency: Peripheral neuropathy, sideroblastic anemia, convulsions in neonates.
Conclusion: Niacin (Vitamin B3) deficiency (Pellagra) is responsible for diarrhea, dementia, and dysentery in a maize-diet patient.
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