Beriberi is a severe and chronic form of thiamine deficiency
The two main types in adults are wet beriberi, and dry beriberi.
Wet beriberi affects the cardiovascular system.
Wet beriberi results in a fast heart rate, shortness of breath, and leg swelling.
Dry beriberi affects the nervous system and is associated with numbness of the hands and feet, confusion, trouble moving the legs, and pain.
A gastrointestinal form exists with loss of appetite and constipation.
Acute beriberi, is found mostly in babies and presents with loss of appetite, vomiting, lactic acidosis, changes in heart rate, and enlargement of the heart.
Causes of beriberi is deficient thiamine.
Predisposing risk factors:
Diet of mostly white rice
alcoholism
dialysis
chronic diarrhea
diuretics
diseases or operations on the digestive tract
genetic deficiencies
Prevention is by good fortification.
Treatment with thiamine supplementation.
Rarely it may be due to a genetic condition which results in difficulties absorbing thiamine in food.
Wernicke encephalopathy and Korsakoff syndrome are forms of dry beriberi.
Diagnosis of beriberi is based on symptoms, low levels of thiamine in the urine, high blood lactate, and improvement with thiamine treatment.
Treatment is with thiamine either by mouth or by injection.
With treatment symptoms of beriberi resolve in a couple of weeks.
It is prevented through the fortification of food.
Beriberi symptoms include: weight loss, emotional disturbances, impaired sensory perception, weakness and pain in the limbs, and periods of irregular heart rate.
Edema is common finding.
It may increase the amount of lactic acid and pyruvic acid in the blood, and may cause high-output cardiac failure and death.
Symptoms may occur concurrently Wernicke’s encephalopathy.
Dry beriberi specially affects the peripheral nervous system.
Wet beriberi specially affects the cardiovascular system and other bodily systems.
Infantile beriberi affects the babies of malnourished mothers.
Gastrointestinal beriberi affects the digestive system and other bodily systems.
Dry beriberi is associated with wasting and partial paralysis resulting from damaged peripheral nerves.
Dry beriberi manifested by difficulty in walking, tingling or loss of sensation in hands and feet, loss of tendon reflexes, loss of muscle function or paralysis of the lower legs, mental confusion/speech difficulties, pain, nystagmus, and vomiting.
Impairment of the large proprioceptive sensory fibers without can lead to a loss of balance and coordination.
Thiamine and its phosphphosphorylated derivatives, can be measured in whole blood, tissues, foods, and pharmaceutical preparations following the conversion of thiamine to fluorescent thiochrome derivatives.
Capillary electrophoresis and in-capillary enzyme reaction methods have emerged as techniques in quantifying and monitoring thiamine levels.
The normal thiamine concentration in EDTA-blood is about 20-100 µg/l.
Treatment of beriberi with thiamine intravenously, and later orally, provides rapid recovery that can occur within hours.
Thiamine supplements will lead to recovery, at a much slower rate.
Generally, with treatment, rapid improvement occurs, within 24 hours, but improvements of peripheral neuropathy may require several months of treatment.
Historically, beriberi was associated with a diet based on white rice.
Beriberi caused by inadequate nutritional intake of thiamine is rare today, because of quality of food and the fact that many foods are fortified with vitamins.