Beriberi

Causes and Risks:
Beriberi has become almost nonexistent in the United States since the discovery of its cause, thiamine deficiency. Most foods are vitamin enriched and a normal diet contains adequate amounts of thiamine .

Beriberi can appear, however, in breast-fed infants when the mother has an inadequate intake of thiamine or among people whose diet includes certain types of fish that produce an enzyme which inactivates thiamine.

Early symptoms of beriberi are nonspecific and include fatigue , irritability, restlessness , loss of appetite , and vague abdominal discomfort .

As the disease progresses, patients develop burning sensations, tingling in the extremities, and changes in sensation such as numbness . Patients may develop psychosis . Heart manifestations are caused by degeneration of the heart muscle and include heart failure with shortness of breath ( dyspnea ) and cyanosis (bluish tinged skin). Neurologic symptoms are caused by degeneration of the nerve fiber and its insulation ( myelin ). Death is generally a result of heart failure.

Prevention:
Adequate intake of thiamine will prevent beriberi. Nursing mothers should insure that their diet is adequate in all vitamins .

Symptoms:
Early symptoms:

Later symptoms:



Signs and Tests:
Physical examination may show signs of congestive heart failure , including difficulty breathing , bluish skin ( cyanosis ), and others. The person with late-stage beriberi may be confused or psychotic . Neurological examination shows a loss of vibratory sensation (the person is less able to sense vibration), loss of coordination , gait changes ( ataxia ), and other changes. The liver may be enlarged ( hepatomegaly ).

Tests include:

  • ECG (to rule out other causes of seizures and neurologic changes)
  • clinical response to administered thiamine (symptoms improve after the person is given thiamine supplements)



Treatment:
Administration of thiamine reverses the deficiency and symptoms improve rapidly.

Prognosis:
Cardiac damage is reversible and is not permanent. Full recovery is expected after treatment. Untreated, beriberi is often fatal.

Complications:



Call Your Healthcare Provider:
Beriberi is extremely rare in the United States. However, if you feel your family's diet is inadequate or poorly balanced and you or your children have any of the described symptoms, call your health care provider.