Beriberi physical examination: Difference between revisions
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{{Beriberi}} | {{Beriberi}} | ||
{{CMG}}; {{AE}} {{AIA}} | |||
==Overview== | |||
There are no specific signs for Beriberi. Therefore, it should be suspected in light of the patient's symptoms and clinical setting. However, in advanced stages, the signs of cardiac dysfunction (wet beriberi) or peripheral neuropathy (dry beriberi) may be present. In Wernicke-Korsakoff syndrome patients, the triad of nystagmus, ophthalmoplegia, and ataxia may be present. | |||
==Physical Examination== | |||
Beriberi itself has no specific examination signs. In advanced stages, the signs of related complications as cardiac dysfunction or peripheral neuritis are present. Therefore, for earlier diagnosis of Beriberi, clinical sense in light of the clinical setting and patient symptoms is required.<ref name="pmid23849362">{{cite journal| author=Chisolm-Straker M, Cherkas D| title=Altered and unstable: wet beriberi, a clinical review. | journal=J Emerg Med | year= 2013 | volume= 45 | issue= 3 | pages= 341-4 | pmid=23849362 | doi=10.1016/j.jemermed.2013.04.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23849362 }}</ref><ref name="pmid30862772">{{cite journal| author=Shible AA, Ramadurai D, Gergen D, Reynolds PM| title=Dry Beriberi Due to Thiamine Deficiency Associated with Peripheral Neuropathy and Wernicke's Encephalopathy Mimicking Guillain-Barré syndrome: A Case Report and Review of the Literature. | journal=Am J Case Rep | year= 2019 | volume= 20 | issue= | pages= 330-334 | pmid=30862772 | doi=10.12659/AJCR.914051 | pmc=6429982 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30862772 }}</ref><ref name="pmid30725889">{{cite journal| author=| title=StatPearls | journal= | year= 2019 | volume= | issue= | pages= | pmid=30725889 | doi= | pmc= | url= }}</ref><ref name="pmid30281514">{{cite journal| author=Chandrakumar A, Bhardwaj A, 't Jong GW| title=Review of thiamine deficiency disorders: Wernicke encephalopathy and Korsakoff psychosis. | journal=J Basic Clin Physiol Pharmacol | year= 2018 | volume= 30 | issue= 2 | pages= 153-162 | pmid=30281514 | doi=10.1515/jbcpp-2018-0075 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30281514 }}</ref> The examination signs in advanced stages of beriberi may include: | |||
=== Appearance of the Patient === | |||
* Patients with beriberi usually appear normal in early stages. | |||
*But in late stages, the general appearances of cachexia and heart failure kick in. | |||
=== Vital Signs === | |||
* [[Tachycardia]] with regular pulse | |||
* Tachypnea / bradypnea | |||
* Normal/low blood pressure | |||
=== Skin === | |||
* [[Cyanosis]] | |||
=== HEENT === | |||
*[[Nystagmus]] (WKS) | |||
*[[Ophthalmoplegia]] (WKS) | |||
=== Neck === | |||
* [[Jugular venous distension]] | |||
* | |||
=== Lungs === | |||
* Fine [[crackles]] upon auscultation of the lungs bilaterally | |||
* [[Wheezing]] may be present | |||
=== Heart === | |||
* [[Heart sounds#Summation%20Gallop|Gallops]] | |||
*Shift in the heart apex (enlarged cardiac chambers) | |||
* A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope | |||
=== Abdomen === | |||
* [[Hepatomegaly]] | |||
=== Back === | |||
* Back examination of patients with beriberi is usually normal | |||
=== Genitourinary === | |||
* Genitourinary examination of patients with beriberi is usually normal | |||
=== Neuromuscular === | |||
* Altered mental status | |||
*[[Ataxia]] | |||
*Amnesia (WKS) | |||
* Altered deep tendon reflexes | |||
* Muscle weakness bilaterally | |||
* Bilateral upper and lower extremities weakness | |||
* Bilateral sensory loss in the upper and lower extremities (Dry beriberi) | |||
=== Extremities === | |||
* [[Cyanosis]] | |||
* Pitting/non-pitting [[edema]] of the upper/lower extremities | |||
* Muscle atrophy | |||
*Wrist and ankle drop in advanced stages. | |||
* | |||
* | |||
==References== | ==References== | ||
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Latest revision as of 15:38, 13 November 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdelrahman Ibrahim Abushouk, MD[2]
Overview
There are no specific signs for Beriberi. Therefore, it should be suspected in light of the patient's symptoms and clinical setting. However, in advanced stages, the signs of cardiac dysfunction (wet beriberi) or peripheral neuropathy (dry beriberi) may be present. In Wernicke-Korsakoff syndrome patients, the triad of nystagmus, ophthalmoplegia, and ataxia may be present.
Physical Examination
Beriberi itself has no specific examination signs. In advanced stages, the signs of related complications as cardiac dysfunction or peripheral neuritis are present. Therefore, for earlier diagnosis of Beriberi, clinical sense in light of the clinical setting and patient symptoms is required.[1][2][3][4] The examination signs in advanced stages of beriberi may include:
Appearance of the Patient
- Patients with beriberi usually appear normal in early stages.
- But in late stages, the general appearances of cachexia and heart failure kick in.
Vital Signs
- Tachycardia with regular pulse
- Tachypnea / bradypnea
- Normal/low blood pressure
Skin
HEENT
- Nystagmus (WKS)
- Ophthalmoplegia (WKS)
Neck
Lungs
Heart
- Gallops
- Shift in the heart apex (enlarged cardiac chambers)
- A high/low grade early/late systolic murmur / diastolic murmur best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope
Abdomen
Back
- Back examination of patients with beriberi is usually normal
Genitourinary
- Genitourinary examination of patients with beriberi is usually normal
Neuromuscular
- Altered mental status
- Ataxia
- Amnesia (WKS)
- Altered deep tendon reflexes
- Muscle weakness bilaterally
- Bilateral upper and lower extremities weakness
- Bilateral sensory loss in the upper and lower extremities (Dry beriberi)
Extremities
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities
- Muscle atrophy
- Wrist and ankle drop in advanced stages.
References
- ↑ Chisolm-Straker M, Cherkas D (2013). "Altered and unstable: wet beriberi, a clinical review". J Emerg Med. 45 (3): 341–4. doi:10.1016/j.jemermed.2013.04.022. PMID 23849362.
- ↑ Shible AA, Ramadurai D, Gergen D, Reynolds PM (2019). "Dry Beriberi Due to Thiamine Deficiency Associated with Peripheral Neuropathy and Wernicke's Encephalopathy Mimicking Guillain-Barré syndrome: A Case Report and Review of the Literature". Am J Case Rep. 20: 330–334. doi:10.12659/AJCR.914051. PMC 6429982. PMID 30862772.
- ↑ "StatPearls". 2019. PMID 30725889.
- ↑ Chandrakumar A, Bhardwaj A, 't Jong GW (2018). "Review of thiamine deficiency disorders: Wernicke encephalopathy and Korsakoff psychosis". J Basic Clin Physiol Pharmacol. 30 (2): 153–162. doi:10.1515/jbcpp-2018-0075. PMID 30281514.