II. Definitions

  1. Beriberi
    1. Literal translation from Sinhalese: "I can't, I can't"
    2. Chronic Thiamine deficiency (contrast with Acute Thiamine Deficiency in Wernicke's Encephalopathy)

III. Epidemiology

  1. Rare in United States
  2. Long history in East Asia (related to diet high in polished rice)

IV. Pathophysiology

  1. Nutritional disease from Chronic Thiamine deficiency

V. Causes

  1. Chronic Alcoholism (Wernicke's Encephalopathy - which differs as an Acute Thiamine Deficiency)
  2. Thiamine deficiency
  3. Malnutrition
  4. Total Parenteral Nutrition (TPN)
  5. Bariatric Surgery history (especially recent)
  6. Recurrent Vomiting
  7. Hyperemesis Gravidarum
  8. Diuresis
  9. Dialysis
  10. High Carbohydrate intake
  11. Malignancy
  12. Exclusively Breast fed children of Thiamine deficient mothers

VI. Symptoms

  1. Weakness, irritability
  2. Nausea, Vomiting
  3. Burning feet
  4. Pruritus
  5. Xerostomia

VII. Signs

  1. Neurologic
    1. Ataxia (see Wernicke's Encephalopathy)
    2. Tremor
    3. Diminished reflexes in lower limbs
    4. Symmetric distal peripheral sensory-motor Neuropathy (Dry Beriberi)
    5. Muscle atrophy
    6. Aphonia (laryngeal nerve paralysis)
    7. Vision Loss may occur due to optic atrophy
    8. Children may initially present with irritability, restlessness and Vomiting
  2. Cardiac: Congestive Heart Failure, esp. right sided (Wet Beriberi)
    1. Pedal Edema
    2. Pleural Effusions
    3. Tachycardia


  1. Complete Blood Count
    1. Anemia
  2. Specific diagnostic testing for Thiamine deficiency
    1. Blood Thiamine (decreased)
    2. Erythrocyte Thiamine transketolase (decreased)
    3. Thiamine Pyrophosphate effect (TPPE)
      1. Most accurate test for Thiamine deficiency
      2. Erythrocyte Thiamine transketolase measured before and after Thiamine administration
      3. Thiamine deficiency confirmed with comparative increase of more than 15%
  3. Other labs
    1. Serum Magnesium (typically low)

IX. Diagnosis

  1. Test dose of Thiamine results in no urinary excretion

X. Imaging: Chest XRay

  1. Cardiomegaly

XI. Management

  1. Thiamine 50-100 mg IV or PO daily for 7-14 days

XII. References

  1. Rendon et al. (2017) Crit Dec Emerg Med 31(6): 15-21

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Related Studies

Ontology: Beriberi (C0005122)

Definition (MSH) A disease caused by a deficiency of thiamine (vitamin B1) and characterized by polyneuritis, cardiac pathology, and edema. The epidemic form is found primarily in areas in which white (polished) rice is the staple food, as in Japan, China, the Philippines, India, and other countries of southeast Asia. (Dorland, 27th ed)
Concepts Disease or Syndrome (T047)
MSH D001602
ICD9 265.0
ICD10 E51.1 , E51.11
SnomedCT 267491008, 154725000, 190625009, 36656008, 35843007
English Beriberi, Beri-beri, beriberi (diagnosis), beriberi, Beri beri, Beriberi NOS, Beriberi [Disease/Finding], beri-beri, endemic polyneuritis, bery bery, beri beri, Beriberi (disorder), Kakkè, deficiency; vitamin, B1, beriberi, deficiency; vitamin, thiamine, beriberi, vitamin; deficiency, B1, beriberi, vitamin; deficiency, thiamine, beriberi, Beriberi, NOS, Beri Beri
Dutch beriberi, deficiëntie; vitamine, B1, beriberi, deficiëntie; vitamine, thiamine, beriberi, vitamine; deficiëntie, B1, beriberi, vitamine; deficiëntie, thiamine, beriberi, Beriberi, Beriberi (droog), Beriberi (nat), Vitamine-B1-tekort
Italian Beri Beri, Beriberi
Portuguese Beribéri, Beriberi
Spanish Beri beri, beriberi (trastorno), beriberi, hipovitaminosis B1, Beriberi
Japanese 脚気, カッケ
Swedish Beriberi
Czech beri-beri, Beri beri
Finnish Beriberi
Korean 각기
Polish Awitaminoza B1, Beri-beri
Hungarian Beriberi
Norwegian Beriberi
French Béribéri
German Beriberi, Thiamin-Mangelkrankheit

Ontology: Thiamine Deficiency (C0039841)

Definition (MSH) A nutritional condition produced by a deficiency of THIAMINE in the diet, characterized by anorexia, irritability, and weight loss. Later, patients experience weakness, peripheral neuropathy, headache, and tachycardia. In addition to being caused by a poor diet, thiamine deficiency in the United States most commonly occurs as a result of alcoholism, since ethanol interferes with thiamine absorption. In countries relying on polished rice as a dietary staple, BERIBERI prevalence is very high. (From Cecil Textbook of Medicine, 19th ed, p1171)
Definition (CSP) nutritional condition produced by a deficiency of thiamine in the diet, characterized by anorexia, irritability, and weight loss; later, patients experience weakness, peripheral neuropathy, headache, and tachycardia; in addition to being caused by a poor diet, thiamine deficiency in the United States most commonly occurs as a result of alcoholism, since ethanol interferes with thiamine absorption.
Concepts Disease or Syndrome (T047)
MSH D013832
ICD10 E51.9 , E51
SnomedCT 35843007, 267491008, 154725000, 190628006, 191088004, 190624008, 399357009
English Deficiencies, Thiamine, Deficiency, Thiamine, Thiamine Deficiencies, Thiamine Deficiency, Thiamine defic, unspecif, Thiamine deficiency, unspecified, [X]Thiamine defic, unspecif, [X]Thiamine deficiency, unspecified, THIAMINE DEFIC, DEFIC THIAMINE, vitamin B1 deficiency, vitamin B1 deficiency (diagnosis), Thiamine Deficiency [Disease/Finding], deficiency vitamin b1, thiamin deficiency, deficiency thiamin, thiamine deficiency, deficiencies thiamin, deficiency thiamine, vitamin b1 deficiency, [X]Thiamine deficiency, unspecified (disorder), Aneurin deficiency, Thiamin deficiency, Vitamin B1 deficiency, Thiamine deficiency, Thiamin deficiency (disorder), deficiency; aneurin, deficiency; thiamine, deficiency; vitamin, B1, deficiency; vitamin, thiamine, aneurin; deficiency, thiamine; deficiency, vitamin; deficiency, B1, vitamin; deficiency, thiamine, Thiamin deficiency, NOS, Vitamin B1 deficiency, NOS
Italian Carenza di vitamina B1, Carenza di tiamina
Japanese ビタミンB1欠乏, ビタミンB1ケツボウ, サイアミン欠乏症, チアミン欠乏症, ビタミンB1欠乏症, チアミン欠乏, ビタミンB1欠乏
Swedish Tiaminbrist
Finnish Tiamiinipuutos
German Thiaminmangel [Vitamin-B1-Mangel], Thiaminmangel, nicht naeher bezeichnet, VITAMIN B A 01 MANGEL, Vitamin B1-Mangel, Thiaminmangel, Vitamin-B1-Mangel
Czech Deficit vitaminu B1, thiamin - nedostatek, deficit thiaminu, nedostatek thiaminu, nedostatek vitaminu B1, deficit vitaminu B1
Korean 상세불명의 티아민 결핍증, 티아민 결핍증
Polish Niedobór tiaminy, Hipowitaminoza B1
Hungarian B1 vitaminhiány
Norwegian Tiaminmangel, B1-vitaminmangel, Vitamin B1-mangel
Spanish [X]deficiencia de tiamina, no especificada, deficiencia de vitamina B1, [X]deficiencia de tiamina, no especificada (trastorno), Deficiencia de Vitamina B 1, Deficiencia de Vitamina B1, deficiencia de tiamina (trastorno), deficiencia de tiamina, Déficit de vitamina B1, Deficiencia de Tiamina
Portuguese Deficiência de Vitamina B 1, Deficiência de Vitamina B1, Carência de vitamina B1, Deficiência de Tiamina
Dutch aneurine; deficiëntie, deficiëntie; aneurine, deficiëntie; thiamine, deficiëntie; vitamine, B1, deficiëntie; vitamine, thiamine, thiamine; deficiëntie, vitamine; deficiëntie, B1, vitamine; deficiëntie, thiamine, Thiaminedeficiëntie, niet gespecificeerd, vitamine-B1-deficiëntie, Thiaminegebrek, Vitamine-B1-gebrek, Deficiëntie, thiamine-, Thiaminedeficiëntie
French Carence en vitamine B1, Carence en thiamine, Carence en vit B1, Déficit en thiamine