View source for Beriberi

==Background==
*Dry Beriberi: neuro symptoms caused by thiamine deficiency<ref>Pereira AG, et al. An Overview of Beriberi. Med Princ Pract. 2026;35(1):18-24. PMID 40753975</ref>
*Wet Beriberi: cardiac symptoms caused by thiamine deficiency
*Infantile Beriberi: neuro/cardiac symptoms caused by thiamine deficiency in <1 year old infant

===Causes===
*Anything that causes [[thiamine deficiency|thiamine (vitamin B1) deficiency]]: poor dietary intake, malabsorption, increased metabolic requirement
**Chronic [[alcoholism]], dieting/fasting/starvation, [[anorexia nervosa|anorexia]], [[vomiting]]/[[diarrhea]], unbalanced TPN, GI surgery, malignancy, [[dialysis complications|dialysis]], [[AIDS]], [[IBD]], [[pancreatitis]], liver disease, [[thyrotoxicosis]]

===Pathophysiology===
*Thiamine is a cofactor for enzymes required in:
**Krebs cycle
**Pentose phosphate pathway
**Alpha-ketoglutarate dehydrogenase
**Pyruvate dehydrogenase.
*Because thiamine is an important cofactor in critical pathways for energy production, deficiency results in lactic acidosis and alteration of brain metabolism.
*Thiamine is also important for lipid metabolism and may affect myelin sheath formation. This may explain peripheral neuropathy symptoms in dry beriberi.

{{Thiamine deficiency types}}

==Clinical Features==
[[File:Beriberi USNLM.jpg|thumb|Dry Beriberi with symmetric peripheral neuropathy.]]
[[File:PMC3237207 JFCM-18-162-g001.png|thumb|Bariatric beriberi with bilateral wrist drop and peripheral neuropathy after bariatric surgery for morbid obesity.]]
===Dry Beriberi===
*Symmetrical peripheral neuropathy ([[weakness|motor]] and [[numbness|sensory]]) mostly distal extremities

===Wet Beriberi===
*[[CHF]], [[high output heart failure]], cardiomegaly, peripheral edema, [[tachycardia]], [[SOB|DOE/PND/orthopnea]]
*Can include neuropathy seen in Dry Beriberi

===Infantile Beriberi===
*[[CHF]], cardiomegaly, [[tachycardia]], [[hypoxia|cyanosis]], [[shortness of breath (peds)|dyspnea]], [[failure to thrive (peds)|weight loss]], marasmus, [[nausea and vomiting (peds)|vomiting]], loud cry, [[nystagmus]], [[seizure (peds)|seizure]]

===Bariatric Beriberi===
*Occurs 1-3 months post-[[weight loss surgery complications|bariatric surgery]]
*Causes are multifactorial, including low nutritional intake, poor baseline [[malnutrition|nutrition]], persistent [[vomiting]], malabsorption

==Differential Diagnosis==
{{Vitamin deficiencies DDX}}

===[[High-output heart failure]]===
{{Template:High-output heart failure DDX}}

==Evaluation==
[[File:PMC3772304 kcj-43-569-g002.png|thumb|Chest x-ray showing cardiomegaly with mild pulmonary congestion and pleural effusion in a patient with wet beriberi.]]
*Clinical diagnosis

==Management==
''If you suspect Beriberi then treat it! Diagnosis is clinical and difficult to confirm, treatment is simple/inexpensive/effective, there is little risk to treatment, and the risk of morbidity/mortality from not treating is high''
#[[Thiamine]] 50-100mg IV/IM q day x 7-14 days, then 10mg PO q day until complete recovery
#[[Magnesium]]; hypomagnesemic state may be resistant to thiamine administration
#Multivitamin (at risk for other vitamin deficiencies)
*Give thiamine BEFORE glucose in patients requiring glucose who are at risk for thiamine deficiency; glucose without thiamine can precipitate/worsen WE by driving thiamine intracellularly

==Disposition==

==Prevention==
{{Vitamin prophylaxis for ETOH}}

==Medication Dosing==
{{MedicationDose
| drug = Thiamine
| dose = 50-100mg IV/IM daily x 7-14 days, then 10mg PO daily until recovery
| route = IV/IM
| context = Thiamine replacement
| indication = Beriberi
| population = Adult
}}

==See Also==
*[[Thiamine]]
*[[Thiamine deficiency]]

==References==
#Donnino, Michael, et al. “Myths and misconceptions of wernicke’s encephalopathy: what every emergency physician should know.” Annals of emergency medicine.  2007. Vol 50, no 6. Pages 715-721.
#Sechi, GianPietro; Serra, Alessandro.  “Wernicke’s encephalopathy: new clnical settings and recent advances in diagnosis and management.” Neurology. Vol 6, May 2007.  Pages 442-455
<references/>
[[Category:Neurology]]
[[Category:Cardiology]]