Beriberi differential diagnosis

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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

Beriberi should be differentiated from other causes of cardiac dysfunction (wet beriberi), peripheral neuropathy (dry beriberi), delirium (Wernicke-Korsakoff syndrome) andexcessive alcohol drinking. However, the differential diagnosis is broad due to the non-specific symptoms of cardiac and neural involvement associated with the condition.

Differentiating Beriberi from other Diseases

Beriberi should be differentiated from other causes of cardiac dysfunction (wet beriberi), peripheral neuropathy (dry beriberi), delirium (WKS), and other disorders caused by excessive alcohol drinking. However, the differential diagnosis is broad due to the non-specific symptoms of cardiac and neural involvement associated with beriberi.

Disorders	Etiology	Clinical Presentation	Laboratory findings
Cardiomyopathy due to other causes as alcohol or DM	Idiopathic Alcoholic cardiomyopathy Diabetic cardiomyopathy Infections: HIV, Coxsackie	Dyspnea/Orthopnea Edema Syncope Palpitations	Hyponatremia Elevated brain natriuretic peptide Elevated troponin (in ischemia)
Delirium and delusional disorders	Acute liver failure Acute metabolic and electrolyte disturbances Infections/sepsis Toxins/drug overdose	Disturbed attention Poor cognition Impaired psychomotor activity Emotional instability	Arterial blood gases CBC: Leucocytosis Blood culture Glucose and electrolyte levels
Nerve entrapment disorders	Chronic injuries to nerves as they pass between bones and ligaments: Carpal tunnel syndrome Cubital tunnel syndrome Suprascapular nerve compression Meralgia Paresthetica (lateral femoral cutaneous nerve)	Within the distribution of the affected nerve, the patient may complain of: Parasthesia Sensory loss Pain Muscle weakness Muscle atrophy	MRI short inversion imaging recovery (STIR) technique
Alcoholic hepatitis	Chronic and excessive alcohol consumption	Poor appetite Fatigue Emesis Low grade fever Abdominal tenderness	Increased serum levels of ALT and AST Blood picture: Leukemoid reactions (high WBCs count) may be present. Liver US: Changes in liver size and dilatation of hepatic veins.
Diabetic ketoacidosis	In patients with type 1 DM, exposed to: Poor insulin compliance Infections/sepsis Stress Idiopathic	Early: Polydipsia and polyuria Anorexia Nausea and vomiting Abdominal tenderness Late: Disturbed consciousness	Hyperglycemia Lower PH and bicarbonate levels Ketonemia and ketonuria Electrolyte disturbances Impaired renal function
Hyperthyroidism	Primary: Grave's disease, toxic thyroid nodules and adenoma Secondary: Pituitary adenomas and intracranial tumors Tertiary:Intracranial tumors involving the hypothalamus	Goiter Palpitations Anxiety Heat intolerance Insomnia Weight loss Diarrhea Exophthalmus	Elevated T3 and T4 hormones TSH: Reduced in 1ry and Elevated in 2ry hyperthyroidism. Thyroid stimulating antibodies: Elevated only in Grave's disease
Folic acid deficiency	Malnutrition Intestinal bacterial overgrowth Celiac disease Blind loop syndrome Inflammatory bowel disease Pregnancy Vegetarians	Palpitations Headache Fatigue Poor appetite Sore tongue	Low serum folate <2.5ng/ml CBC: Macrocytic anemia and low correlated reticulocyte count Peripheral blood smear: Neutrophil granulocytes and anisocytosis

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