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 |
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.
Purpose: To evaluate a patient for clinical features of thiamine deficiency (beriberi).
Specialty: Nutrition
Objective: risk factors, clinical diagnosis, including family history for genetics, criteria for diagnosis
ICD-10: E51.1,