B–C

beriberi A health condition resulting from long-
term deficiency of thiamine (vitamin B 1 ). Beriberi
affects neurologic, musculoskeletal, cardiovascu-
lar, and gastrointestinal structures and functions.
Though common in developing parts of the world,
beriberi occurs primarily in people who have gas-
trointestinal disorders that interfere with thiamine
absorption and in long-term, chronic ALCOHOLISM.
A BREASTFEEDINGinfant whose mother is thiamine
deficient may also develop beriberi. Beriberi is also
common among people whose primary food is
white rice. Thiamine is necessary for cells in the
body to convert GLUCOSEto energy and to convert
glucose to energy storage forms (fat).
There are two main forms of beriberi: dry and
wet. Dry beriberi is more common and affects pri-
marily the NERVOUS SYSTEMand the musculoskeletal
system. Wet beriberi affects primarily the cardio-
vascular system; its most apparent symptom is
edema (swelling due to fluid accumulation),
which accounts for the “wet” designation. People
who have mild to moderate beriberi typically have
distinctly one form or the other; people who have
moderate to severe disease generally have both
forms as the deficiency is severe enough to affect
all body functions.

Symptoms and Diagnostic Path

The early symptoms of beriberi are the same for
either the wet or the dry form and include

• fatigue


• difficulty concentrating and cognitive dysfunc-
  tion


• irritability


• loss of APPETITE


• NAUSEA, VOMITING, andCONSTIPATION
  
  
  • abdominal tenderness
  
  
  
  

As the condition progresses symptoms become

specific for the body system affected. Neurologic

and musculoskeletal (dry beriberi) symptoms

include

• peripheral NEURITIS(INFLAMMATIONof the nerves)
  or peripheral NEUROPATHY


• PARESTHESIA(disturbances of sensation such as
  tingling and numbness)


• cramps in the lower legs


• PAINand weakness in muscles throughout the
  body


• difficulty walking and rising from a sitting or
  squatting position

Cardiovascular (wet beriberi) symptoms are

those of congestive HEART FAILUREand include

• tachycardia (rapid HEART RATE)


• diaphoresis (“cold sweats”)


• edema


• shortness of breath (DYSPNEA)

The diagnostic path begins with a careful

assessment of the PERSONAL HEALTH HISTORYwith an

emphasis on EATING HABITS. BLOODtests can meas-

ure the amount of thiamine in the blood as well as

enzyme levels related to thiamine activity in the

body. When symptoms are cardiovascular, the

doctor is likely to conduct an ELECTROCARDIOGRAM

(ECG) and an ECHOCARDIOGRAM.

Treatment Options and Outlook

Treatment is injections of thiamine until blood

levels return to normal and symptoms begin to

179