Thiamine (vitamin B1) deficiency in older children, adolescents and adults results in clinical beriberi. This may present with either cardiac and/or neurologic dysfunctions. Diagnosis often depends on a high index of clinical suspicion in a patient with risk factors for a nutritional deficiency.


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


warm with sweating, from vasodilation

cold from vasoconstriction

cardiac output


variable, often low

blood pressure

wide pulse pressure


respiratory function

no cyanosis


renal function



acid base status


metabolic acidosis





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.


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