Beriberi

Beriberi
A sufferer - Turn of the 20th Century in southeast Asia
ICD-10	E51.1
ICD-9	265.0
DiseasesDB	14107
eMedicine	ped/229  med/221
MeSH	D001602

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Overview

Beriberi is a nervous system and cardiovascular ailment caused by thiamine (vitamin B₁) deficiency.

Etymology

The origin of the word is from a Sinhalese phrase meaning "I cannot, I cannot", the word being doubled for emphasis.

History

Christiaan Eijkman a Dutch physician and pathologist first demonstrated that beriberi is caused by poor diet led to the discovery of vitamins. Together with Sir Frederick Hopkins, he was awarded the 1929 Nobel Prize for Physiology or Medicine for the discovery.

Causes

Beriberi is caused by a lack of thiamine (vitamin B₁). It is common in people whose diet consists mainly of polished white rice, which is very low in thiamine because the thiamine-bearing husk has been removed. It is also seen in chronic alcoholics with an inadequate diet, as well as being a rare side effect of gastric bypass surgery. If a baby is mainly fed on the milk of a mother who suffers from thiamine deficiency then that child may develop beriberi.

The disease has been seen traditionally in people in Asian countries (especially in the 19th century and before), due to those countries' reliance on white rice as a staple food. Beri-beri is a nutritional disorder caused by deficiency of vitamin B charactarized by damage to nerves and heart; general symptoms include loss of appetite and feeling of lassitude.

Pathophysiology

Thiamine deficiency is associated with high output heart failure due to the vasodilation that develops as a result of pyruvate and lactate accumulation .

Diagnosis

Symptoms

Its symptoms include weight loss, emotional disturbances, impaired sensory perception (Wernicke's encephalopathy), weakness and pain in the limbs, and periods of irregular heart rate. Edema (swelling of bodily tissues) is common. In advanced cases, the disease may cause heart failure and death. It may also increase the amount of lactic and pyruvic acids in the blood.

There are two forms of the disease: wet beriberi and dry beriberi.

• Wet beriberi affects the heart; it is sometimes fatal, as it causes a combination of heart failure and weakening of the capillary walls (see capillary leak syndrome), which causes the peripheral tissues to become edematous.
• Dry beriberi causes wasting and partial paralysis resulting from damaged peripheral nerves. It is also referred to as endemic neuritis.

Electrocardiogram

In some studies beriberi heart disease has been associated with a variety of ECG changes including sinus tachycardia , T wave inversion, low voltage, prolognation of the QT interval, and either prolongation or shortening of the PR interval . In many cases, these abnormalities revert with treatment of the thiamine deficiency.

The mechanism by which thiamine deficiency results in ST elevation is not clear. Thiamine deficiency induces ATP depletion and it has been speculated that myocardial energy depletion may result in damage to the myocyte and thereby induce ST elevation.

Treatment

Treatment is with thiamine hydrochloride, either in tablet form or injection. A rapid and dramatic recovery within hours can be made when this is administered to patients with beriberi, and their health can be transformed within an hour of administration of the treatment. Thiamine occurs naturally in unrefined cereals and fresh foods, particularly fresh meat, legumes, green vegetables, fruit, and milk.

Additional Resources

• Christiaan Eijkman bio at whonamedit.com: discovered cause of Beriberi.

• A protection against beriberi. British Medical Journal. 1980 January 19; 280(6208): 187.

• Medical Encyclopedia, Medline, National Institutes of Health.

• Health A-to-Z: Beriberi.

• L Arturo Batres, MD. Beriberi.EMedicine.com

• NAS: Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin and Choline. Washington DC: National Academy Press; 1998.

• Angstadt JD, Bodziner RA: Peripheral polyneuropathy from thiamine deficiency following laparoscopic Roux-en-Y gastric bypass. Obes Surg 2005 Jun-Jul; 15(6): 890-2

• Beriberi, white rice, and vitamin B: a disease, a cause, and a cure Reviewed by Sanjoy Bhattacharya. Medical History. 2002 July; 46(3): 432–433.

• Toward the Conquest of Beriberi, Reviewed by C. A. Bozman. Medical History. 1962 April; 6(2): 198–199.

• K C Carter The germ theory, beriberi, and the deficiency theory of disease. Medical History. 1977 April; 21(2): 119–136.

• A K Clarke. Beriberi in Bethnal Green. British Medical Journal. 1971 May 1; 2(5756): 278.

• Curran JS, Lewis AB: Vitamin Deficiencies and Excesses. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 16th ed. 2000: 179.

• Djoenaidi W, Notermans SL, Verbeek AL: Subclinical beriberi polyneuropathy in the low income group: an investigation with special tools on possible patients with suspected complaints. Eur J Clin Nutr 1996 Aug; 50(8):549-55

• J G Engbers, G P Molhoek, and A C Arntzenius. Shoshin beriberi: a rare diagnostic problem. British Heart Journal. 1984 May; 51(5): 581–582.

• Alan Hawk. The Great Disease Enemy, Kak'ke (Beriberi) and the Imperial Japanese Army, Military Medicine, Apr 2006 .

• Hirshfeld AB, Getachew A, Sessions J: Drug doses. In: Siberry GK, Iannone R eds. The Harriet Lane Handbook: A Manual for the Pediatrician. 2000: 864.

• Indraccolo U, Gentile G, Pomili G, et al: Thiamine deficiency and beriberi features in a patient with hyperemesis gravidarum. Nutrition 2005 Sep; 21(9):967-8

• Diagnosing Beriberi in Emergency Situations, by Prof Mike Golden, Aberdeen University. (n.d.)
• Eric R. Gubbay. Beri-Beri Heart Disease. Canadian Medical Association Journal. 1966 July 2; 95(1): 21–27.

• A Hardy Beriberi, vitamin B1 and world food policy, 1925-1970. Medical History. 1995 January; 39(1): 61–77.

• Neil McIntyre and Nigel N. Stanley. Cardiac Beriberi: Two Modes of Presentation. British Medical Journal. 1971 September 4; 3(5774): 567–569.

• Jew RK, Mascarenhas M, McCoy B et al, eds: The Children's Hospital of Philadelphia Pharmacy Handbook and Formulary 2000-2001. Lexi-Comp Inc; 2000: 342-3.

• Kitamura K, Yamaguchi T, Tanaka H, et al: TPN-induced fulminant beriberi: a report on our experience and a review of the literature. Surg Today 1996; 26(10): 769-76

• Mouly S, Khuong MA, Cabie A: Beri-Beri and thiamine deficiency in HIV infection [letter]. AIDS 1996 Jul; 10(8): 931-2

• NAS: Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin and Choline. Washington DC, National Academy Press; 1998.

• Shivalkar B, Engelmann I, Carp L: Shoshin syndrome: two case reports representing opposite ends of the same disease spectrum. Acta Cardiol 1998; 53(4): 195-9

• Jeb Sprague and Eunida Alexandra. Haiti: Mysterious Prison Ailment Traced to U.S. Rice - Inter Press Service (IPS). 17 January 2007.

• Tanphaichitr V: Thiamin. In: Shils M, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease. Vol 1. 8th ed. 1994: 359-365.

• Weise Prinzo Z, de Benoist B: Meeting the challenges of micronutrient deficiencies in emergency- affected populations. Proc Nutr Soc 2002 May; 61(2):251-7

• Wilson JD: Vitamin Deficiency and Excess. In: Wilson JD, et al. Harrison's Principles of Internal Medicine. 12th ed. 1991: 436-437.

• Wrenn KD, Murphy F, Slovis CM: A toxicity study of parenteral thiamine hydrochloride. Ann Emerg Med 1989 Aug; 18(8): 867-70

External links

• www.wrongdiagnosis.com : beriberi

See also

• Christiaan Eijkman
• Edward Bright Vedder