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Beriberi

Beriberi is a medical condition characterized by the deficiency of thiamine pyrophosphate, the active form of thiamine (vitamin B1). Thiamine phyrophosphate serves as a coenzyme in the metabolism of carbohydrates and also plays a very important role in energy production by acting as a coenzyme for transketolase to produce glucose. Individuals suffering from thiamine deficiency may be resulted from insufficient dietary intake of vitamin B1 or excessive consumption which may occur from certain conditions such as fever, lactation, pregnancy and hyperthyroidism. Chronic diarrhea may also cause thiamine deficiency as it impairs the body’s ability to absorb vitamin B1. 

Pathophysiology

Individuals who inadequately consume thiamine would usually deplete their vitamin stores within a month causing them to experience weakness, decreased deep tendon reflexes and resting tachycardia. Some would even develop peripheral neuropathy.

Dry Berberi

When the nervous system is affected, the condition is known as dry beriberi. This is characterized by symmetric motor, sensory and reflex function impairment most especially in the distal lower extremities. Another neurological presentation of the sickness is the Wernicke encephalopathy. Symptoms include:

Horizontal nystagmus

Ataxia

Fever

Palsies of the eye movements

Progressive mental impairment which may lead to Korsakoff syndrome

Unless the affected individual is in frank Korsakoff syndrome, the neurological symptoms can be improved by early treatment of thiamine.

Wet Beriberi

Wet beriberi on the other hand is thiamine deficiency with cardiovascular involvement characterized by:

peripheral vasodilation

high cardiac output

salt and water retention

edema on dependent extremities

Symptoms may include:

edema

tachycardia

high venous and arterial pressures

chest pain due to myocardial injury

Shoshin Beriberi

This is also known as the acute fulminant cardiovascular beriberi – a more rapid form of wet beriberi.  It predominantly injures the heart causing rapid deterioration which in turn leads to the inability of the cardiac muscles to function well. In this case, edema may not be present. Patients may experience cyanosis in their hands and feet, anxiety, restlessness, distended neck veins and tachycardia.

 

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