Clinical Features of Non-Infantile Thiamine Deficiency (Adult Beriberi)

 

Clinical forms - cardiac:

(1) wet beriberi

(2) shoshin beriberi

 

Clinical forms - neurological:

(1) dry beriberi

(2) Korsakoff's psychosis

(3) Wenicke's encephalopathy

(4) gastrointestinal

 

Features of wet beriberi:

(1) peripheral edema

(2) lung fields usually clear

(3) no cyanosis

(4) high output heart failure with increased systolic and decreased diastolic blood pressures (wide pulse pressure)

 

Features of shoshin (Japanese for acute heart damage) beriberi:

(1) classic heart failure (low output)

(2) breathlessness with crackles in lungs progressing to cyanosis

(3) lactic acidosis

(4) often a fulminant clinical course

Clinical Findings	Wet Classic Beriberi	Shoshin Beriberi
extremities	warm with sweating, from vasodilation	cold from vasoconstriction
cardiac output	high	variable, often low
blood pressure	wide pulse pressure	hypotension
respiratory function	no cyanosis	cyanosis
renal function		oliguria
acid base status		metabolic acidosis
course	subacute	fulminant

 

Features of dry beriberi:

(1) peripheral neuritis with paresthesias in extremities

(2) touch sensation diminished

(3) joint position, vibration and pain sensation normal

(4) loss of tendon reflexes, especially the ankle and knee reflexes

(5) distal muscle weakness

 

Features of Korsakoff's psychosis:

(1) profound loss of recent memory

(2) preservation of past memories

(3) active imagination intact

 

Features of Wernicke's encephalopathy:

(1) irritable and forgetful

(2) ptosis and ophthalmoplegia

(3) nystagmus

(4) cerebellar ataxia

(5) confusion and del1rium

 

Features of gastrointestinal dysfunction:

(1) abnormal motility, usually with constipation

(2) colicy abdominal pains

(3) nausea and vomiting

(4) anorexia

 

A patient may present with any combination of the above presentations.

 

Each of the clinical presentations may mimic many other conditions that need to be excluded.