What is beriberi?

From the Guidelines

Beriberi is a severe medical condition caused by a deficiency of vitamin B1 (thiamine) that can lead to significant morbidity and mortality if left untreated, and it is crucial to initiate treatment immediately if suspected. Beriberi primarily affects the cardiovascular and nervous systems, resulting in symptoms such as fatigue, muscle weakness, nerve damage, and heart problems 1. There are two main types: wet beriberi, which affects the cardiovascular system causing rapid heart rate, shortness of breath, and fluid retention; and dry beriberi, which damages the peripheral nerves leading to muscle weakness, pain, and numbness in the extremities 1.

Key Points to Consider

• Symptoms of thiamine deficiency include ataxia, confusion and coma (Cerebral Beri Beri and Wernicke's encephalopathy), neuropathy and neuritis especially in lower limbs (Dry Beri Beri) or cardiac insufficiency with tachycardia and respiratory symptom (Wet Beri Beri) 1.
• Treatment involves thiamine supplementation, and it is essential to start treatment immediately if thiamine deficiency is suspected, either because of risk factors or clinical symptoms 1.
• A balanced diet rich in thiamine sources like whole grains, legumes, nuts, and pork is essential for prevention, and early treatment is crucial to prevent permanent nerve damage or life-threatening heart complications 1.

Prevention and Management

• The DRI for thiamin should be included in the routine multivitamin supplementation after surgery for the prevention of deficiency 1.
• Prophylactic thiamin should be administered to patients with predisposing factors, such as rapid weight loss, decrease in consumption, and persistent vomiting postoperatively 1.

From the FDA Drug Label

Dosage and Administration “Wet” beriberi with myocardial failure must be treated as an emergency cardiac condition, and thiamine must be administered slowly by the IV route in this situation (see WARNINGS). In the treatment of beriberi, 10 to 20 mg of thiamine hydrochloride are given IM three times daily for as long as two weeks. Beriberi is a condition that can be treated with thiamine, and it has different forms, including "wet" beriberi, which is a serious condition that requires emergency treatment. The treatment of beriberi involves administering thiamine hydrochloride, with specific dosages and administration routes depending on the severity and type of the condition 2. Key points about beriberi treatment include:

• Emergency treatment for "wet" beriberi with myocardial failure
• Thiamine administration via IV or IM routes
• Dosage of 10 to 20 mg of thiamine hydrochloride, given IM three times daily for up to two weeks.

From the Research

Definition of Beriberi

• Beriberi is a nutritional disorder caused by a lack of thiamine (vitamin B1) in the diet 3.
• It can occur in two forms: dry beriberi, which affects the nervous system, and wet beriberi, which affects the cardiovascular system 3.
• Gastrointestinal beriberi is a subtype that affects the digestive system and can lead to multisystem involvement 3.

Causes and Risk Factors

• Thiamine deficiency often arises from chronic malnutrition secondary to alcoholism, known as Wernicke-Korsakoff Syndrome 3.
• Beriberi can also occur in people with gastrointestinal diseases with malabsorption 4.
• Patients who have received total parenteral nutrition (TPN) without proper replacement of thiamine have also developed beriberi 4.
• A shortage of multivitamin infusion (MVI) can lead to beriberi in patients on chronic TPN 4.

Symptoms and Diagnosis

• Symptoms of beriberi can include altered mental status, neurological symptoms, and cardiovascular collapse 3, 4.
• Dry beriberi can mimic the symptoms of Guillain-Barre syndrome (GBS) 5.
• Wernicke's encephalopathy is a severe form of thiamine deficiency that can cause irreversible neurologic sequelae if left untreated 5.
• Early diagnosis and treatment with thiamine supplementation can lead to significant improvement in symptoms and prevention of long-term damage 3, 4, 5, 6.

Treatment and Management

• Treatment with thiamine supplementation can lead to rapid clinical improvement and prevention of irreversible neurologic sequelae 3, 4, 5, 6.
• In severe cases, salvage venoarterial extracorporeal membrane oxygenation (VA-ECMO) may be necessary to support cardiac function 6.
• Nutritional counseling and management of underlying conditions can help prevent recurrence of beriberi 3.