Beriberi

Definition

Beriberi is a vitamin deficiency disease in which the body does not have enough thiamine (vitamin B1).

Alternative Names

Causes

There are two major types of beriberi:

• Wet beriberi affects the cardiovascular system.
• Dry beriberi and Wernicke-Korsakoff syndrome affect the nervous system.

Beriberi is now rare in the United States because most foods are now vitamin-enriched, which means that if you eat a normal, healthy diet you get enough thiamine. Today, beriberi occurs mostly in patients who abuse alcohol, because drinking heavily can lead to bad nutrition and makes it harder for the body to absorb and store thiamine.

There is a rare condition known as genetic beriberi. This condition is inherited (passed down through families). People with genetic beriberi lose the ability to absorb thiamine from foods. This can happen slowly over time and symptoms occur when the person is an adult. However, since beriberi may not be considered in non-alcoholics, this diagnosis is often missed.

Beriberi can also occur in breast-fed infants when the mother's body is lacking in thiamine. The condition can also affect infants who are fed unusual formulas with inadequate thiamine supplements.

Dialysis and high doses of diuretics raise your risk of beriberi.

Symptoms

Symptoms of dry beriberi include:

• Pain
• Tingling
• Loss of feeling (sensation) in hands and feet
• Muscle damage with loss of muscle function or paralysis of the lower legs
• Vomiting
• Strange eye movements (nystagmus)
• Mental confusion/speech difficulties
• Difficulty walking
• Coma
• Death

Symptoms of wet beriberi include:

• Swelling of the lower legs
• Increased heart rate
• Lung congestion
• Enlarged heart related to congestive heart failure
• Shortness of breath with activity
• Awakening at night short of breath

Exams and Tests

A physical examination may show signs of congestive heart failure

A person with late-stage beriberi may be confused or have memory loss and delusions. The person may be less able to sense vibration. A neurological exam may show signs of decreased reflexes, changes in the person's walk, coordination problems, drooping of the eyelids, and other changes.

The following tests may be done:

• Blood tests to measure the amount of thiamine in the blood
• Urine tests to see if thiamine is passing through urine

Treatment

The goal of treatment is to replace the thiamine that the person's body is lacking. This is done with thiamine supplements. Thiamine supplements are given through a shot (injection) or taken by mouth.

Other types of vitamins may also be recommended.

Blood tests may be done after the person is given thiamine supplements to see how well they are responding to the medicine.

Outlook (Prognosis)

Untreated, beriberi is often deadly. With treatment, symptoms usually improve rapidly.

Heart damage is usually reversible and is not permanent. Full recovery is expected. However, if acute heart failure has already occurred, the person's outlook is poor.

Nervous system damage is also reversible, if caught early. If not, some symptoms (such as memory loss) may remain even with treatment.

If a patient with Wernicke's encephalopathy receives thiamine replacement, language problems, unusual eye movements, and walking difficulties may go away. However, Korsakoff syndrome (or Korsakoff psychosis) tends to develop as Wernicke's symptoms go away. Symptoms include memory loss, learning problems, and confabulation (making up stories about experiences or situations to cover gaps in memory).

Possible Complications

• Psychosis
• Coma
• Congestive heart failure
• Death

When to Contact a Medical Professional

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.

Prevention

Eating a proper diet that is rich in thiamine and other vitamins will prevent beriberi. Nursing mothers should make sure that their diet contains all vitamins and be sure that infant formulas contain thiamine.

People who drink heavily should try to cut down or quit, and take B vitamins to make sure their body is properly absorbing and storing thiamine.