What are the signs and symptoms of beriberi?

From the Guidelines

Beriberi is a condition caused by thiamine (vitamin B1) deficiency, presenting with various signs and symptoms, including neurological, psychiatric, and cardiovascular manifestations, as highlighted in the espen micronutrient guideline 1. The signs and symptoms of beriberi can be categorized into different types, including:

• Dry beriberi, which affects the nervous system, causing peripheral neuropathy with symptoms such as numbness and tingling in the feet and legs, muscle weakness, difficulty walking, decreased reflexes, and in severe cases, muscle wasting and paralysis.
• Wet beriberi, which affects the cardiovascular system, causing rapid heart rate, shortness of breath, swelling in the lower legs (edema), increased cardiac output, and potentially heart failure. Additional symptoms can include confusion, memory problems, speech difficulties, pain, vomiting, and in severe cases, Wernicke-Korsakoff syndrome with confusion, abnormal eye movements, and coordination problems, as noted in the british obesity and metabolic surgery society guidelines 1. Early recognition and treatment of beriberi are essential to prevent permanent neurological damage, and treatment involves immediate thiamine supplementation, typically 100mg intravenously or intramuscularly for severe cases, followed by oral supplements of 10-25mg daily until symptoms resolve 1. It is crucial to be aware of the potential risk factors for thiamine deficiency, including prolonged vomiting, rapid weight loss, poor dietary intake, alcohol abuse, and symptoms of neuropathy, as emphasized in the british obesity and metabolic surgery society guidelines 1. In clinical practice, it is essential to prioritize the single most recent and highest quality study, which in this case is the espen micronutrient guideline 1, to guide diagnosis and treatment decisions for beriberi.

From the FDA Drug Label

Thiamine hydrochloride injection is effective for the treatment of thiamine deficiency or beriberi whether of the dry (major symptoms related to the nervous system) or wet (major symptoms related to the cardiovascular system) variety The signs and symptoms of beriberi include:

• Dry beriberi: major symptoms related to the nervous system
• Wet beriberi: major symptoms related to the cardiovascular system 2

From the Research

Signs and Symptoms of Beriberi

The signs and symptoms of beriberi can vary depending on the type of beriberi. There are two main types: dry beriberi and wet beriberi.

• Dry beriberi presents with neuropathy, while wet beriberi presents with heart failure, with or without neuropathy 3.
• Dry beriberi can mimic the symptoms of Guillain-Barré syndrome, including paresthesia of the lower limbs, arms, and neck, and symptoms of encephalopathy 3.
• Wet beriberi, also known as "shoshin" beriberi, can present with severe biventricular failure, metabolic acidosis, and renal tubular dysfunction 4.
• Other symptoms of beriberi include:
  • Loss of appetite
  • Dizziness
  • Tachycardia
  • Urinary bladder retention
  • Confusion or delirium
  • Visual complaints due to optic neuropathy in thiamine deficiency 5
• Beriberi can also lead to Wernicke's encephalopathy, a condition characterized by a triad of ophthalmoplegia, ataxia, and mental confusion 6.
• If left untreated, Wernicke's encephalopathy can progress to Korsakoff's syndrome, a chronic amnesia resulting from thiamine deficiency 7.

Diagnosis and Treatment

Early diagnosis of beriberi and Wernicke's encephalopathy is crucial to prevent irreversible neurologic sequelae.

• Treatment with high-dose intravenous thiamine can lead to rapid clinical improvement and prevent irreversible neurologic sequelae 3, 6.
• Clinicians should consider thiamine deficiency in malnourished patients presenting with symptoms and signs of beriberi or Wernicke's encephalopathy 3, 5.