What are the signs and symptoms of beriberi?

From the Guidelines

Beriberi is a condition caused by vitamin B1 (thiamine) deficiency that presents with various neurological and cardiovascular symptoms, including fatigue, muscle weakness, decreased reflexes, numbness or tingling in the extremities, difficulty walking, mental confusion, and in severe cases, heart failure with symptoms like rapid heartbeat, shortness of breath, and swelling in the lower legs (edema) 1. The main signs and symptoms of beriberi can be categorized into two main types: dry beriberi, which primarily affects the nervous system, and wet beriberi, which mainly impacts the cardiovascular system with fluid buildup 1. Some key symptoms to look out for include:

• Ataxia
• Confusion
• Coma (Cerebral Beri Beri and Wernicke's encephalopathy)
• Neuropathy and neuritis especially in lower limbs (Dry Beri Beri)
• Cardiac insufficiency with tachycardia and respiratory symptoms (Wet Beri Beri) 1. It is crucial to initiate thiamine supplementation immediately if beriberi is suspected, with typical dosing being 50-100 mg three times daily initially, followed by 5-10 mg daily until symptoms resolve, and intravenous thiamine for severe cases 1. The condition occurs because thiamine is essential for carbohydrate metabolism and proper nerve function, and without adequate thiamine, the body cannot properly convert food into energy, leading to these neurological and cardiovascular manifestations 1. Beriberi is most common in populations with diets heavily dependent on polished white rice or those with alcoholism, as alcohol interferes with thiamine absorption 1. Early suspicion and recognition of thiamine deficiency are needed to enable immediate initiation of therapy, as thiamine reserves are depleted as early as 20 days of inadequate oral intake 1.

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 form of the disease. Beriberi can occur in two main forms: dry beriberi and wet beriberi.

• Dry beriberi affects the nervous system and can cause symptoms such as:
  • Peripheral neuropathy
  • Muscle weakness
  • Altered mental status
  • Cognitive alteration
  • Paresthesia of the lower limbs, arms, and neck
  • Symptoms of encephalopathy 3, 4
• Wet beriberi affects the cardiovascular system and can cause symptoms such as:
  • High-output heart failure
  • Oliguria
  • Edema
  • Metabolic acidosis
  • Renal tubular dysfunction
  • Serum lactate level elevation
  • Dyspnea
  • Cardiac failure 5, 6
• Gastrointestinal beriberi is a subtype that affects the digestive system and can lead to multisystem involvement, including symptoms such as intractable nausea and vomiting 3
• Shoshin beriberi is a severe form of wet beriberi that can cause severe biventricular failure, metabolic acidosis, and sudden death if left untreated 5, 6
• Wernicke's encephalopathy is a condition that can occur due to severe thiamine deficiency and can cause symptoms such as ophthalmoplegia, ataxia, and mental confusion 4, 7

Diagnosis and Treatment

Diagnosis of beriberi is based on clinical presentation and laboratory tests, including thiamine levels. Treatment with thiamine supplementation can lead to rapid improvement of symptoms and prevention of irreversible neurological sequelae 3, 5, 4, 6, 7