KUPOSHANA JANYA

VYADHI
Malnutrition in relation to vitamin deficiency
 INTRODUCTION

• Nutrients play an important role in the human life.

• The nutritional requirements of growing children are more since their energy requirements is
high due to the fast tissue growth in early age.
• Lack of sufficient food intake leads to conditions like nutritional deficiency termed as
malnutrition (kuposhanajanya vyadhi).
• Malnutrition leads to growth retardation,.w resistance to infections and many other health
problems.
Kuposhana janya vyadhi dealt in Ayurvedic classics;
• Karshya
• Phakkaroga
• Parigarbhika
• Balshosha
 KARSHYA
• It is a condition of insufficient supply of nutrients in any stages of age.
• In Ayurveda karshya has been explained as clinical feature of a disease or as a complication of certain
diseases.
• Most of the diseases which are of acute nature causes karshyata in children due to their less tolerance to
diseases.
• It can also be correlated with under weight in children.
• Acharya dalhana explains that a person having a lean and thin body hut doesnot have any other compaints
is called krusha.
• Acharya charaka included it under astaunindhithya.
CAUSES:
• Ruksha annapana
• Upavasa
• Trushna
• Kshuth
• Vata dushita stanyapana
• Vatayja prakruti
• Chronic diseases
SYMPTOMS:
शुष्कस्फिगुदरग्रीवो धमनीजालसन्ततः।
त्वगस्थिशोषोतिकृ शः स्थूलपर्वा नरो मतः॥ (Ca.su-21/15)
Features of Atikrisha person or children;
• The flanks, abdomen and neck region will be dried up.
• There will be visible arteries over the body.
• It seems that there are only skin and bones are remaining and at the same time the joints will look
apparently larger in size.
CHIKITSA:
• karshya is a vata pradhana vyadhi, mainly occurring due to dhatu kshaya so vata prashamana upakrama should
be carried out.
The principle treatment are;
• Bruhmana chikitsa
• Nidan parivarjana
• Bruhmana therapy to the lactating mother
• Balanced diet to the children
• Balya jeevaniya bruhmaniya aharas should be given.
 PARIGARBHIKA

मातुः कु मारो गर्भिण्याःस्तन्यं प्रायः पिबन्नपि।

कायाग्निसाद वमथु तन्द्रा कार्श्य अरुचि भ्रमैः॥
युज्यते कोष्ठवृद्ध्या च तमाहुः पारिगर्भिकम्। (A.S.U-2/63-64)

• When a women becomes pregnant, while feeding the first child, the quantity of milk decreases in
her.
• Even though milk is produced it will be deficient in nutrients.
• Then the first child gets deficiency of nutrients and becomes lean.
• This is described as parigarbhika.
Symptoms:
• Agnisada(weak digestive power)
• Vamathu(vomiting)
Agnisada (weak digestive power)
Vamathu (nausea and vomiting)
• Tandra(drowsiness)
Tandra (drowsiness)
Karshya (emaciation)
• Karshya(emaciation)
Aruchi(poor appetite)
• Aruchi(anorexia)
Brama(vertigo)
Kostha vriddhi (distention of the abdomen)
• Brama(giddiness)
• Kosta vriddhi(distention of abdomen)
Treatment:
रोगं परिभवाख्यं च युञ्ज्यात् तत्र अग्निदीपनं। अ.स.उ-2/64
The principle treatment of parigarbhika includes;
* Agni deepana
उद्रिक्तं क्षुधं बालं परिभूतं तु लेपयेत्।
विदारीयवगोधूमकणाचूर्ण घृताप्लुतम्।।
पाययेत् तनु च क्षीरं शृतं स मधुशर्क रम्।। अ.स.उ-2/43
* Medicated ghrita with dravyas like vidari, yava, godhuma , pippali, pippalimula,
should be given.
* Anupana milk mixed with honey and sugar
vitamins
 INTRODUCTION
Vitamins are complex organic substances for the normal functioning and development of the
body.
Though they are needed in small quantity they carry out vital functions in the body, and so it
was named as vitamins.
They are not synthesised in our body , hence to be acquired from our diet.
 VITAMINS

FAT SOLUBLE WATER SOLUBLE

Vitamin-A B Complex vitamins
Vitamin-D * Thiamine(B1)
Vitamin-E * Riboflavin(B2)
Vitamin-K * Niacin(B3)
* Pantothenic acid(B5)
* Pyridoxine(B6)
* Biotin(B7)
* Folic acid(B9)
* Cyanocobalamin(B12)
Fat soluble Water soluble
vitamins vitamins

Absorbed with help of Dissolved in water and

fat molecules absorbed by tissues

Since water soluble

Excess amount is Stored excess amount is
in liver excreted in urine

Toxicity from excess

Excess intake may leads intake is rare
to toxicity
 VITAMIN - A
This occurs in two forms, as retinol in animal foods and as beta-carotene in plant
foods.
 Carotene is converted into retinol in the intestine, which is then absorbed and
stored in the liver as retinol-palmitate.
The daily requirement of vitamin - A for children is 300IU.
FUNCTIONS:
Retinol, a derivative of vitamin-A helps for our vision in dim light
It is essential for the maintenance of mucus secreting epithelium
Participates in the hormonal regulation of cell growth i.e,epithelial cell
differentiation
Acts as an anti-oxidant , hence prevents oxidant induced mutagenic effect
It has anti-carcinogenic effect through epithelial regulatory function
Immunity enhancing functions.
Wald’s visual cycle:
 sources
• Sources of vitamin – A includes;
liver
fish
eggs
milk
butter
yellow and green leafy
vegetables(carrot, sweet potato,
pumpkins ,Mangoes and spinach
 Deficiency
Night blindness - This is because of failure in the dark adoptation because of decreased synthesis
of rhodopsin in the retina.
Xeropthalmia(dry eye)
Bitot’s spot - : These are triangular, foamy, pearly-white or yellowish spots on the bulbar
conjunctiva, usually lateral to cornea and often bilateral.
Keratomalacia - As the deficiency of vitamin A continues, the entire cornea or a part of it
becomes soft and later it is liquefied.it was a medical emergency because, the soft cornea may
burst open, leading on to prolapse of iris. If the eye collapses, vision is lost.
Squamous metaplasia of columnar epithelium lining respiratory, urinary system and glandular
ducts
Secondary pulmonary infections
Urinary lithiasis
Follicular papillary dermatosis
Immune deficiency
 VITAMIN - D

• It is also known as sun shine vitamin

• There are two forms namely vitamin D2 (calciferol) and D3 (cholecalciferol). Chemically, these
are steroids.
• D2 is formed by the irradiation of ergosterol in the plants and is not obtained.
• D3 is the naturally occurring vitamin D, obtained from animal fats and fish liver oils.
• It is also naturally synthesized in the body, on exposure of 7-dehydrocholesterol (present as
provitamin D under the skin) to ultraviolet rays of sun.
• It is then stored in the liver and fat depots
• Children requires 600 IUof vitamin – D per day.
FUNCTIONS:
Vitamin D promotes the absorption of calcium and
phosphorus in the intestine.
It helps in the mineralization, i.e. calcification of bones and
their hardening
SOURCES:
exposure to sunlight,
fish liver oil.
egg yolk,
fish like herring, tuna and sardines
 DEFICIENCY
Deficiency leads to inadequate absorption of calcium and phosphors and further faculty mineralization of
bone and tooth structure
Deficiency of vitamin – D leads to;
Rickets in growing children
Osteomalacia in adults
Hypocalcemic tetany
 The required amount of vitamin D3 is obtained from exposure to sunlight. Therefore, rickets is rare in India.
 Dietary Vitamin D is essential only when exposure is inadequate.
 VITAMIN - E

Vitamin E or tocopheral is a kind of anti oxidant

As an anti-oxidant, it is used as a free radical scavenger.
A normal Child requires about 400-600IU of vitamin E per day.
FUNCTIONS:
The principal role of vitamin E is as an antioxidant, it intercepts free radicals and prevents
destruction of cell membrane by modulation of lipid per oxidation.
 Regulation of immune response through cell mediated immunity.
Participates in the maintenance of nervous system
 Protects from various diseases like cancer, arthritis and ischemic heart disease by preventing
peroxidation and maintaining integrity of cellular membrane.
 It inhibits platelet aggregation and enhances vasodilation.
 SOURCES
The sources of vitamin – E includes;
• vegetable oil,
• almonds
• sunflower oil,
• peanuts
• soybean, corn-oil,
• green leafy vegetables,
• egg-yolk
• butter
 DEFICIENCY
 Its role in human beings is not understood completely. But in experimental animals, its
deficiency has been shown to be associated with miscarriage and sterility.
Patient develops spinocerebellar syndrome, characterized by neurological symptoms which
includes impaired coordination and muscle weakness due to degenerations of axons in posterior
columns.
There is increased risk of cardio vascular diseases in adults and hemolytic anemia (premature
destruction of RBC) in children
 VITAMIN - K
It occurs in two forms vitamin K1 and K2.
 Vitamin K1 is found in our dietary source and Vitamin K2 is synthesized by the bacterial flora
in the human gut.
Vitamin K is stored in the liver.
 Daily requirement is about 55 micrograms for children.
FUNCTION:
 It plays an important role in the formation of prothrombin, a coagulation factor
 Vitamin K is a cofactor for hepatic carboxylation of prothrombin, factor VII, IX and X
SOURCES:
40-50% from gut bacteria
Dietary sources includes;
* vegetables
* almonds
* peanuts
* spinach
* broccoli…
 DEFICIENCY

Vitamin K deficiency leads to haemorrhage,

It was rare in adults, except those with severe liver diseases and in cases of intake of oral
anti coagulants.
The deficiency occurs exclusively in breastfed and premature babies, because human milk is
low in vitamin – K and their gut is not yet colonized with bacteria
 VITAMIN – B1

 Thiamine is lost during cooking, because it is present in the outer pericarp of the cereal and it
leaches into the water while cooking. Hence food should be cooked in minimal water to conserve
its thiamine content.
 It is less in the milled rice than in the raw, home pounded rice, because vitamin B1 is lost during
milling and polishing. During milling, outer pericarp and germ of the rice is lost, which is rich in
vitamin B1. It is further lost, if cooked with baking soda.
The dietary requirement of vitamin – B1 ranges from 1 - 2 mg/day
FUNCTIONS:
In the brain and liver, thiamine gets converted to its active form thiamine pyrophosphate,
which helps in maintaining the nervous system
 This is essential for the carbohydrate metabolism.
 It helps in the complete oxidation of pyruvic and lactic acids.
Clinically thiamine is used for treatment of congestive heart failure and Alzheimer’s
disease as well as cancer prevention
SOURCES:
 Thiamine is obtained from unmilled cereals, pulses and groundnuts, dry beans, peas,
soybeans etc.. and it is very low in meat, fish and eggs.
 Milk is an important source of thiamine for infants and if mothers are deficient in
thiamine, the infants are at risk of thiamine deficiency.
 DEFICIENCY
 vitamin – B1 deficiency was most often associated with severe malnutrition and alcoholism.
Deficiency of this vitamin leads to the following conditions;
* Beri beri(dry & wet)
* Wernicke – Korsakoff syndrome
Nowadays the incidence of beriberi is reduced because of the changes in the food habits and
improvement in the socioeconomic conditions
DRY BERI BERI:
 In this type, there is involvement of the nervous system.
 It is characterized by polyneuropathy. The calf muscles become tender, progressively become
weak and wasted.
The tendon reflexes are sluggish. The child finds it difficult to stand from sitting position.
 All these are due to accumulation of pyruvic acid and lactic acid in the muscles.
Other symptoms includes, the child will also have anorexia, dyspepsia, constipation, slow growth
and emaciation.
WET BERI BERI:
 In this type, there is involvement of mainly cardiovascular system.
 It is characterized by palpitation, tachycardia, dyspnea and edema feet.
It may cause congestive heart failure associated with dilated cardiomyopathy
Congestive heart failure occurs due to peripheral dilation of arterioles and capillaries
Wericke’s encephalopathy
* It is common in Europe and North America and also among alcoholics.
* It is characterized by bilaterally symmetrical ophthalmoplegia, nystagmus and ataxia.
* Later the state of confusion progresses to stupor and coma.
 Korsakoff’s psychosis
* It is characterized by memory defects and disorientation.
 VITAMIN – B2
It is an odorless, orange yellow, bitter tasting compound, sparingly soluble in water.
 It is resistant to heat, oxidizing agents and acids.
 It is sensitive to light, and so it decomposes when exposed to visible light especially in
newborns treated with phototherapy
Riboflavin acts as a cofactor in several enzymes concerned with cellular oxidation and cellular
growth.
 Daily requirement is about 1 - 2.3 mg.
SOURCES:
Rich sources are ;
 milk
 liver
 green leafy vegetables
 Fair sources are cereals and pulses.
 Germination of pulses increases the riboflavin content.
 DEFICIENCY
Deficiency of vitamin – B2 leads to a condition called d ‘Ariboflavinosis’.
It is characterized by the following symptoms;
* angular stomatitis,
* glossitis (sore, red, glazed, smooth tongue),
* cheilosis (cracking at the angle of the mouth),
* nasolabial dyssebacia (scaly desquamation at nasolabial folds),
* scrotal dermatitis
* vascularization of cornea and keratitis, resulting in watering of eyes, photophobia, and blurring
of vision.
 VITAMIN – B3

Niacin can be synthesized from the essential amino acid tryptophan with the help of
pyridoxine.
Niacin is present in two forms- nicotinic acid and its amide nicotinamide (niacinamide).
These are water soluble and resistant to acids, bases, light or heat
Daily requirement is about 15 mg.
FUNCTION:
It is a component of the NAD and NADP , which is essential for glycolysis, citric acid cycle, and
other oxidative metabolic processes.
 It is required for conversion of phenylalanine to tyrosine.
 provided at required level , the helps to combat cardiovascular disease, diabetes, osteoarthritis,
neurological problems and skin diseases
SOURCES:
* beef liver or chicken liver
* tuna fish
* peanuts
* brown rice
* green peas
* mushrooms
* sweet potatoes
 DEFICIENCY
Persons with severe niacin deficiency develops pellagra , which is characterized by 3D’s 0;
* Dementia
* Dermatitis(keratotic scaly leisons on exposed area such as face , neck, dorsum of
hands and feet)
* Diarrhoea
There is presence of red ulcerated oral mucosa, thickening of colon wall with atrophy of
crypts.
 VITAMIN – B5
Vitamin – B5 also called as pantothenic acid.
Its name originates from a Greek word ‘pantos’ which means everywhere, as it can be found
throughout all living cells.
It is absorbed in the gastrointestinal tract by intestinal cells and enters the circulation.
It is part of two important coenzymes- Co A (coenzymes A) and ACP (Acyl carrier protein)
which are part of the carbohydrate and fat metabolism.
The daily intake of this vitamin ranges from 3 – 12mg for adults.
 SOURCES
The richest sources of vitamin B5 are;
 yeast
 eggs
 milk
 vegetables
 legumes
 whole grain cereals
 DEFICIENCY
Since, vitamin B5 occurs to some extent in all foods , its deficiency is extremely rare
People who are alcoholic, women on oral contraceptives, insufficient food intake and impaired
absorption are at the risk of deficiency
Some of the vitamin B5 deficiency incudes;
* fatigue * insomnia
* depression * irritability
* vomiting * stomach pain
* burning feet * muscle cramos
 VITAMIN B6
 There are 3 different natural forms of vitamin B6 : pyridoxine, pyridoxamine and pyridoxal
which are normally present in food.
An average dietary recommendation for adults is 1.5mg/day
It is required for the synthesis of neurotransmitters serotonin and norepinephrine and also for
myelin formation.
In adults its deficiency affects the PNS , skin, mucous membrane and the blood cell system, and
in children the CNS is also affected.
 SOURCES
Major sources of vitamin B6 includes;
* milk
* cereal grains
* legumes
* vegetables(carrots, spinach, peas)
* cheese
* fish
* meat
* flour
 DEFICIENCY
A deficiency of vitamin B6 alone is rare and is usually associated with the deficit of other B
complex vitamins(especially with vit B 2)
Peoples who are at the risk of deficiency are;
* chronic alcoholics * pregnant and breast feeding women
* women who takes oral contraceptives * elderly peoples
* underweight peoples * liver diseases
* genetic disorders * renal dialysis
• Symptoms of vitamin B6 deficiency includes;
* cheilosis
* glossitis
* dermatitis
* microcytic hypochromic anemia
* convulsions in infants
* neurologic dysfunction
 VITAMIN B7

Biotin is a cofactor in several carboxylation reactions

 It is usually combined with proteins in the food and in tissue.
The dietary vitamin is absorbed by the intestinal cells. In addition, intestinal bacteria produce
biotin in the gastrointestinal tract.
The estimated intake for adults is 100-200mg/day.
 SOURCES
The richest sources of biotin includes;
* egg yolk
* soya bean
* nuts
* liver
* cereals
* yeast
 DEFICIENCY

Its deficiency is extremely very rare, which is probably due to the fact that biotin is synthesized
by beneficial bacteria in human digestive tract.
People at the risk of deficiency are;
* patients who are maintained under intravenous nutrition
* haemodialysis patients
* diabetes mellitus
* impaired uptake of vitamins
• Symptoms of deficiency includes;
* hair loss
* dry or scaly skin ,
* cracking in the corners of the mouth,
* swollen and painful tongue,
* dry eyes,
* loss of appetite,
* fatigue,
* insomnia,
* depression.
 VITAMIN B9

Vitamin B9 also called folate.

The name comes from a Latin word folium, which means leaves, because folates were first
isolated from spinach.
Vitamin B9 can occur in two different forms; folate and folic acid.
Daily requirement for adults is 100 µg.
FUNCTION:
 Folic acid is necessary for the synthesis of DNA in the rapidly multiplying cells
like RBCs.
 It is also necessary for the maturation of normoblasts to RBCs.
SOURCES:
Liver
soybean
dark green leafy vegetables
beans
egg yolk
milk and dairy products
orange..
 DEFICIENCY

Deficiency impairs the synthesis of DNA in the cells resulting in abnormal cell division.
 Tissues with rapidly dividing cells such as intestinal mucosa and bone-marrow are affected in
folic acid deficiency. Therefore, megaloblastic anemia and diarrhea are predominant symptoms
and it is more commonly observed in children and pregnant mothers.
Folic acid deficiency in pregnant women leads to neural tube defect in the new borns
 VITAMIN B12

It is also known as cobalamine.

 It is a red crystalline substance containing cobalt atom.
It plays a key role in the normal functioning of the brain, nervous system and for the formation
of blood.
Vitamin B12, is absorbed in the small intestine with the help of an intrinsic factor secreted by
the stomach and is transported in blood circulation bound to a protein
FUNCTION:
It forms part of coenzymes of some important metabolic reactions like synthesis of
DNA, methionine and choline.
 For the metabolism of folic acid.
 Along with folate and iron, required for formation of red blood cells.
 Involved in formation of mylelin sheath surrounding the nerve fiber
 SOURCES

• Beef liver
• Fish
• meat
• poultry
• eggs
• milk, and other dairy products
• cereals
• nutritional yeasts
 DEFICIENCY

• Deficiency of vitamin B12 leads to pernicious anemia. The mature red blood cells (RBC) are not
produced by the bone marrow and thus the capacity to carry oxygen by the hemoglobin is
reduced
• Other symptoms of vitamin B12 includes;
* palpitation of the heart
* pale skin
* nervous problems like numbness, muscle weakness and mobility problems
* mental problems like memory loss, depression or behavioural changes.
 VITAMIN C

Vitamin C is a water-soluble vitamin that is necessary for normal growth and development.
 vitamin C is an antioxidant, which can help to neutralize free radicals in the body.
Daily allowance of 40 mg is recommended for adults
FUNCTION:
Ascorbic acid is easily oxidized. It is able to protect other substances from oxidation; acting as an
antioxidant.
 In body tissues, ascorbic acid protects the easily oxidizable nutrients.
It is effective in ‘mopping up’ free radicals and it has a preventive function for diseases in which free
radicals are involved.
 It helps in absorption of dietary iron.
It is involved in collagen (intercellular connecting protein) synthesis, formation of bone and teeth
calcification
 SOURCES
• Dietary Sources of Ascorbic acid occurs in mainly in foods of plant origin, especially fruits and
vegetables.
* vegetables like cabbage, lettuce, spinach, amaranth and cucumber contain this vitamin.
* The citrus fruits (lemons and oranges), berries and melons are particularly rich in the
vitamin.
* Gooseberry (Amla) is one of the richest sources of this vitamin.
 DEFICIENCY
• Vitamin C deficiency results in a condition called scurvy-characterized by weakness, bleeding
gums and defective bone growth.
• Other symptoms includes;
* slow wound healing
* Poor immunity, leads to the risk of infections
* muscle and joint pain
* easy bruising
 HYPERVITAMINOSIS
• Hypervitaminosis is the condition which occurs due to excess amount of vitamin intake than the normal
level.
• It may be acute and chronic with very specific and general clinical symptoms.
• Water-soluble and fat-soluble vitamin toxicity has their own specific effects on the body leading to
intoxication syndrome.
• Certain symptoms of intoxication syndrome are common to all the forms of hypervitaminosis like
headache, severe weakness, dizziness, inability to exercise, inability to perform daily routine, nausea,
sensations of internal tremor, constipation or diarrhoea.
• Hypervitaminosis due to fat soluble vitamin groups have a more pronounced course as these get
accumulated in the body tissues and cause severe intoxication. Hypervitaminosis due to water-soluble
vitamins has a less pronounced course and does not impose a threat to the life of a person. Therefore, it
can be normalized by increasing the urinary output and restricting the intake of such type of supplements.
 HYPERVITAMINOSIS – A
It occurs due to prolonged uncontrolled ingestion of too much of preformed vitamin A
from foods and supplements.
The chronic hypervitaminosis A is associated with the symptoms like;
* dry patchy skin * dry fissured lips
* hair loss and brittle nails. * hepatomegaly
* baldness * weight loss
* low grade fever * papilloedema (optic disc swelling
caused by increased intracranial pressure due to any cause),
 HYPERVITAMINOSIS D
• The chronic toxic dose in adults is higher than 50,000 IU/day. In infants younger than 6 months, 1000
IU/day may be considered unsafe.
• Toxicity is much more likely to occur from high intakes of dietary supplements containing vitamin D
• Hypervitaminosis D results in;
* muscle weakness,
* frequent and rapid fatigue,
* functional dyspepsia (indigestion),
* sub febrile type of fever,
* progressive weight loss,
* constant headaches without clear localization,
 HYPERVITAMINOSIS E

• The side effects are observed when the doses are above 1g/kg.
• High doses of alpha tocopherol supplements can affect blood clotting by inhibiting vitamin K-
dependent carboxylase and thus leads to increased bleeding.
• Management is by discontinuing the supplements and treats the cause.
 HYPERVITAMINOSIS K

• High doses of vitamin K can worsen the clotting problems caused by severe liver disease.
• Vitamin K toxicity can occur only with type K3 that leads to haemolytic anemia by inhibiting the
glutathione function
• This may cause rupture of RBC membrane due to oxidative stress and thus lead to haemolytic
anemia, jaundice and liver damage.
• This is rarely observed in adults and is mostly seen in infants.
 HYPERVITAMINOSIS C
• The chronic toxic dose is more than 2 g/day.
• The symptoms of hypervitaminosis C manifested in general as ;

* feeling of weakness,
* dizziness,
* diarrhoea,
* nausea and vomiting,
* insomnia,
* strong headache,
* allergic reactions to skin,
* heartburn and stomach ache
 HYPERVITAMINOSIS B
• Hypervitaminosis of B- complex are very rare because the excess amount is excreted through urine.
• Hypervitaminosis of vitamin B complex has combined characters and the symptoms appear in the form of ;

* generalized hyperemia and

* hypersensitivity of skin,
* headache of varying degrees of intensity without limited localization,
* intestinal ulcers,
* occurrence of sleep disorders,

* fatty liver,
* hyperglycemia,
* nausea and indigestion are found.
• Hypervitaminosis B12 may lead to various types of allergic reactions, congestive heart failure,
pulmonary oedema, reduction in the size of vascular controlled reflexes, palpitation, tingling
sensation and numbness of limbs.
• Hypervitaminosis B9 (folic acid) are specified by tonic convulsions in the gastrocnemius
muscles that may occur at any time of the day and inhibition of the function of hepatic alcohol
dehydrogenase. Sleep, stomach and skin problems are also associated with overdose.
• Hypervitaminosis B5 (Pantothenic acid) may cause diarrhoea, gastrointestinal problems, and
water retention leading to oedema.
• Hypervitaminosis B2 (Riboflavin) may result in liver dysfunction, photophobia, zaeda in the
corners of mouth and cardiomyopathies, vomiting, itching, numbness, burning or prickling
sensation, hypotension, fatigue and production of bright yellow urine.
• Overdose of Thiamine (B1) blocks nerve transmission, cause paralysis, restlessness, convulsions,
respiratory paralysis and cardiac failure.