Beriberi

Background

• Dry Beriberi: neuro sx caused by thiamine deficiency
• Wet Beriberi: cardiac sx caused by thiamine deficiency
• Infantile Beriberi: neuro/cardiac sx caused by thiamine deficiency in <1 year old infant

Causes

• Anything that causes thiamine (vitamin B1) deficiency: poor dietary intake, malabsorption, increased metabolic requirement
  • Chronic alcoholism, dieting/fasting/starvation, anorexia, vomiting/diarrhea, unbalanced TPN, GI surgery, malignancy, 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.

Clinical Features

Dry Beriberi

• Symmetrical peripheral neuropathy (motor and sensory) mostly distal extremities

Wet Beriberi

• CHF, high output heart failure, cardiomegaly, peripheral edema, tachycardia, DOE/PND/orthopnea
• Can include neuropathy seen in Dry Beriberi

Infantile Beriberi

• CHF, cardiomegaly, tachycardia, cyanosis, dyspnea, weight loss, marasmus, vomiting, loud cry, nystagmus, seizure

Differential Diagnosis

Thiamine deficiency types

• Wernicke-Korsakoff syndrome
• Beriberi

Diagnosis

• Clinical diagnosis

Treatment

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

1. Thiamine 50-100 mg IV/IM q day x 7-14 days, then 10 mg PO q day until complete recovery
2. Magnesium; hypomagnesemic state may be resistant to thiamine administration
3. Multivitamin (at risk for other vitamin deficiencies)

• For chronic alcoholics consider banana bag: thiamine 100 mg + magnesium 2-4 g + folate 1 mg + multivitamin; all in 1L NS or D5W
• 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

See Also

• Thiamine deficiency

References

1. 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.
2. 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