II. Definitions
- Beriberi
- Literal translation from Sinhalese: "I can't, I can't"
- Chronic Thiamine deficiency (contrast with Acute Thiamine Deficiency in Wernicke's Encephalopathy)
III. Epidemiology
- Rare in United States
- Long history in East Asia (related to diet high in polished rice)
IV. Pathophysiology
- Nutritional disease from Chronic Thiamine deficiency
V. Causes
- Chronic Alcoholism (Wernicke's Encephalopathy - which differs as an Acute Thiamine Deficiency)
- Thiamine deficiency
- Malnutrition
- Total Parenteral Nutrition (TPN)
- Bariatric Surgery history (especially recent)
- Recurrent Vomiting
- Hyperemesis Gravidarum
- Diuresis
- Dialysis
- High Carbohydrate intake
- Malignancy
- Exclusively Breast fed children of Thiamine deficient mothers
VI. Symptoms
- Weakness, irritability
- Nausea, Vomiting
- Burning feet
- Pruritus
- Xerostomia
VII. Signs
- Neurologic
- Ataxia (see Wernicke's Encephalopathy)
- Tremor
- Diminished reflexes in lower limbs
- Symmetric distal peripheral sensory-motor Neuropathy (Dry Beriberi)
- Muscle atrophy
- Aphonia (laryngeal nerve paralysis)
- Vision Loss may occur due to optic atrophy
- Children may initially present with irritability, restlessness and Vomiting
- Cardiac: Congestive Heart Failure, esp. right sided (Wet Beriberi)
VIII. Lab
- Complete Blood Count
- Specific diagnostic testing for Thiamine deficiency
- Blood Thiamine (decreased)
- Erythrocyte Thiamine transketolase (decreased)
- Thiamine Pyrophosphate effect (TPPE)
- Other labs
- Serum Magnesium (typically low)
IX. Diagnosis
- Test dose of Thiamine results in no urinary excretion
X. Imaging: Chest XRay
- Cardiomegaly
XI. Management
- Thiamine 50-100 mg IV or PO daily for 7-14 days
XII. References
- Rendon et al. (2017) Crit Dec Emerg Med 31(6): 15-21