Preventing iron deficiency through a healthy diet is harm reduction in pregnant women

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The terms iron deficiency and anemia cannot be used interchangeably and are different

New Delhi, 22nd February 2019: As per a recent study, fortification coupled with supplementation may expose varying but significant proportions of women in 24 states or union territories to the risk of an excessive iron intake. The tolerable upper limit for women of reproductive age is 45 mg per day. Prolonged exposure to iron above this limit could put women at risk of experiencing symptoms such as gastric acidity, constipation, oxidative (physiological) stress or changes in their gut bacterial profile.

Iron deficiency (depleted iron stores in the body) and anemia, on the other hand, are often perceived as interchangeable terms. While iron deficiency is the most common cause of anemia, but the two are different. Deficiency of iron without anemia is much more prevalent than is detected. A person may have iron deficiency even if the hemoglobin is normal. The majority are unaware of their iron deficient state.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Iron deficiency anemia is the most common type of anemia, and occurs when the body doesn’t have enough of this mineral. In the absence of enough iron in the blood stream, the rest of your body cannot get the amount of oxygen it needs. What exacerbates this condition is that many people are unaware that they have iron deficiency anemia. At times, one may experience the symptoms for years without knowing what they are due to. A poor diet or certain intestinal diseases that affect iron absorption can also lead to this condition. This deficiency is usually treated with iron supplements or changes to diet.”

Some symptoms of moderate-to-severe iron deficiency anemia include general fatigue, weakness, pale skin, shortness of breath, dizziness, cravings for things such as dirt, a tingling or crawling feeling in the legs, soreness or swelling in the tongue, cold hands and feet, fast or irregular heartbeat, brittle nails, and headaches.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “Mostly, iron deficiency anemia is mild, and does not lead to any further complications, and can be corrected easily. However, if left untreated for a long time, it can cause other health problems. In pregnant women, this can lead to the birth of a premature or low-birth-weight baby. Consuming a healthy diet rich in all the essential nutrients is thus a way of reducing harm.”

Some tips from HCFI

• Eat foods rich in iron such as green and leafy vegetables, red meat, lentils, beans, and iron-fortified cereals and breads.

• Include vitamin C-rich foods and drinks in your diet as it will help the body in absorbing iron.

• Avoid drinking tea or coffee with meals, as this affects the absorption of iron.

• Include enough sources of vitamin B12 and folic acid in your diet.

A case of thyroid storm precipitated by H1N1

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Rajesh, aged 40 years, one of my employees with confirmed H1N1 flu developed persistent tachycardia, hypotension, restlessness and air hunger. He was managed conservatively in the ICU. Tachycardia was controlled with Ivabradine. But, tachycardia was persisting even after discharge.

We investigated him further. Thyroid profile revealed TSH to be 0.004 suggestive of acute thyroid storm, which was quite possibly precipitated by H1N1 flu.

We carried out a literature search for evidence showing an association between the two. Much to our surprise, there was evidence-based data supporting this association. Cases have been reported of thyroid storm triggered by H1N1 infection.

A case of 31-year-old female with H1N1 precipitating thyroid storm was published by Salim Alawi Baharoon in April 2010 issue of the Annals of Thoracic Medicine. The patient presented with history of high-grade fever, vomiting, productive cough and increasing shortness of breath. She was given empiric antibiotics and oseltamivir along with other treatment. Unexplained tachycardia prompted thyroid function tests, which were suggestive of a diagnosis of thyroid storm (Ann Thorac Med. 2010 Apr;5(2):110-2).

A similar case of H1N1 infection accompanied by thyroid storm was published by Oguz et al in 2010 in Endocrine Abstracts (Endocrine Abstracts. 2010;22:194).

A thyroid storm is a rare life-threatening exacerbation of thyrotoxicosis, and is usually characterized by hyperthermia, tachycardia, severe agitation and altered mental status. It is a medical emergency and carries a mortality of 10%.

Thyroid storm is often precipitated by interruption of thyroid medicine use, acute medical illness, trauma or surgery. Systemic infections such as respiratory infections, endocarditis and urinary tract infections have been known to precipitate a crisis.

The diagnosis of thyroid storm mainly depends on the clinical presentation and results of thyroid function tests. The thyroid stimulating hormone (TSH) level will be abnormally low or even undetectable, and the levels of T3 and T4 will be elevated.

Diagnosis may be delayed due to the nonspecific clinical presentation.

Patients who have survived thyroid storm should receive definite therapy for their underlying hyperthyroidism to avoid any recurrence of this potentially fatal condition.

Although literature does not conclusively establish a cause and effect association between H1N1 flu and thyroid storm, it is still important to know the clinical signs and symptoms of thyroid storm and the condition should be kept in mind as differential diagnosis in patients with unexplained tachyarrhythmia, alterations of consciousness or hypermetabolic status.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA