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| | __NOTOC__ |
| | {{Beriberi}} |
| | '''For patient information, click [[{{PAGENAME}} (patient information)|here]]''' |
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| | '''For more information about on Wet beriberi, click [[Wet beriberi|here]]''' |
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| {{Infobox_Disease | | | {{Infobox_Disease | |
| Name = Beriberi | | | Name = Beriberi | |
| Image = Beriberi U SNLM.jpg | | | Image = Beriberi U SNLM.jpg | |
| Caption = A sufferer - Turn of the 20th Century in southeast Asia | | | Caption = A sufferer - Turn of the 20th Century in southeast Asia | |
| DiseasesDB = 14107 |
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| ICD10 = {{ICD10|E|51|1|e|50}} |
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| ICD9 = {{ICD9|265.0}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| eMedicineSubj = ped |
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| eMedicineTopic = 229 |
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| eMedicine_mult = {{eMedicine2|med|221}} |
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| MeshID = D001602 |
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| }} | | }} |
| {{SI}}
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| '''Editor-In-Chief:''' [[User:TimothyKoch|Timothy R. Koch, M.D., Professor of Medicine, Gastroenterology, Georgetown University School of Medicine]]. You can email Dr. Koch [mailto:Timothy.R.Koch@MedStar.net here]; Bikram Bal, M.D., Section of Gastroenterology, Washington Hospital Center.
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| '''Associate Editor-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]]
| | {{CMG}}; {{AIA}}; [[User:TimothyKoch|Timothy R. Koch, M.D., Professor of Medicine, Gastroenterology, Georgetown University School of Medicine]]. You can email Dr. Koch [mailto:Timothy.R.Koch@MedStar.net here]; Bikram Bal, M.D., Section of Gastroenterology, Washington Hospital Center. |
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| {{Editor Join}} | | {{SK}} Thiamine (Vitamin B1) deficiency; Wericke disease; Korsakoff disease; Korsakov disease |
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| ==Overview== | | ==[[Beriberi overview|Overview]]== |
| Beriberi is a dietary-deficiency disease caused by a lack of thiamine in the diet. Thiamine, initially named "the anti-beriberi factor" in 1926 was the first B vitamin to be identified and is therefore referred to as vitamin B1. Thiamine is soluble in water and partly soluble in alcohol. It consists of a pyrimidine and a thiazole moiety, both of which are essential for its activity.
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| Thiamine functions in the decarboxylation of α-ketoacids, such as pyruvate α-ketoglutarate, and branched-chain amino acids and thus is a source of energy generation. In addition, thiamine pyrophosphate acts as a coenzyme for a transketolase reaction that mediates the conversion of hexose and pentose phosphates.
| | ==[[Beriberi historical perspective|Historical Perspective]]== |
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| ==Etymology== | | ==[[Beriberi classification|Classification]]== |
| The origin of the word is from a Sinhalese phrase meaning "I cannot, I cannot", the word being doubled for emphasis.<ref>http://www.faqs.org/health/topics/40/Beriberi.html</ref>
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| ==History== | | ==[[Beriberi pathophysiology|Pathophysiology]]== |
| It is a disease that has killed probably close to a million people worldwide. References to this disease can be found in Chinese medical texts dating as far back as 2697 BC. In the 19th century it was the “national disease” of Japan. It first attracted the attention of Western scientists in the 1880s, when Dutch military personnel experienced an epidemic of the disease while operating in Sumatra. Its association with the consumption of highly polished rice was noted in the first decade of the twentieth century. It took some 50 years and lifetimes of dedication by dozens of scientists from many different fields and of various nationalities before the mysteries of beriberi were unraveled. [[Christiaan Eijkman]] a Dutch [[physician]] and [[pathologist]] first demonstrated that [[beriberi]] is caused by poor diet led to the discovery of [[vitamin]]s. Together with Sir [[Frederick Hopkins]], he was awarded the 1929 [[Nobel Prize for Physiology or Medicine]] for the discovery. But the ability to produce a synthetic vitamin on a commercial scale has been by no means the end of the story.
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| ==Differential Diagnosis of Underlying Causes== | | ==[[Beriberi causes|Causes]]== |
| Thiamine deficiency can be a result of:
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| '''1. Inadequate intake:'''
| | ==[[Beriberi differential diagnosis|Differentiating Beriberi from other Diseases]]== |
| :[[Alcoholism]]
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| :[[Anorexia]]
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| :Intentional dieting
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| :[[Starvation]]
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| :[[Bulimia]]
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| :Protein energy [[malnutrition]] in developing countries
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| :[[Total parenteral nutrition]]
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| :Infants breast fed by [[thiamine]] deficient mothers
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| '''2. Increased losses:'''
| | ==[[Beriberi epidemiology and demographics|Epidemiology and Demographics]]== |
| :Protracted [[vomiting]] in [[chemotherapy]] patients
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| :[[Hyperemesis gravidarum]] in [[pregnant]] women
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| '''3. Inadequate absorption'''
| | ==[[Beriberi Risk factors|Risk factors]]== |
| :Post gastric bypass surgery patients
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| :Genetic loss of ability to absorb [[thiamine]]
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| ==Pathophysiology== | | ==[[Beriberi screening|Screening]]== |
| Thiamine deficiency is associated with high output [[heart failure]] due to the [[vasodilation]] that develops as a result of [[pyruvate]] and [[lactate]] accumulation <ref>Attas M, Hanley HG, Stultz D, Jones MR, McAllister RG. Fulminant beriberi heart disease with lactic acidosis. Presentation of a case with evaluation of left ventricular function and review of pathophysiologic mechanisms. Circulation 58: 566–572, 1978.</ref>.
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| | ==[[Beriberi natural history, complications and prognosis|Natural History, Complications, and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| ===Signs and Symptoms===
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| There are two forms of the disease: '''wet beriberi''' and '''dry beriberi'''.
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| * '''Wet beriberi''' affects the [[heart]]; it is sometimes fatal, as it causes a combination of [[congestive heart failure|heart failure]] and weakening of the [[capillary]] walls (see [[capillary leak syndrome]]), which causes the peripheral tissues to become edematous.
| | [[Beriberi history and symptoms|History and Symptoms]] | [[Beriberi physical examination|Physical Examination]] | [[Beriberi laboratory findings|Laboratory Findings]] | [[Beriberi electrocardiogram|Electrocardiogram]] | [[Beriberi x ray|X Ray]] | [[Beriberi CT|CT]] | [[Beriberi MRI|MRI]] | [[Beriberi ultrasound|Ultrasound]] | [[Beriberi other imaging findings|Other Imaging Findings]] | [[Beriberi other diagnostic studies|Other Diagnostic Studies]] |
| * '''Dry beriberi''' causes wasting and partial [[paralysis]] resulting from damaged peripheral [[nerve]]s. It is also referred to as ''endemic neuritis''.
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| '''Cardiovascular or wet beriberi:''' is manifested by heart hypertrophy and dilatation (particularly of the right ventricle), [[tachycardia]], respiratory distress, [[edema]] of the legs and [[heart failure]] with high [[cardiac output]]. Severe [[lactic acidosis]] is characteristic (1).
| | ==Treatment== |
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| '''Neurological or dry beriberi:''' is manifested by exaggeration of [[deep tendon reflexes]], [[polyneuritis]] (sometimes associated with paralysis) that typically affects lower extremities and in a subsequent stage, upper extremities, muscle weakness and pain, and [[convulsions]].
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| '''Gastrointestinal beriberi:''' Gastrointestinal symptoms are primarily due to the delayed emptying of the stomach and dilation of the [[colon]]. Loss of appetite, vague abdominal complaints, and [[constipation]] are common manifestations. As the disease progresses [[nausea]] and [[vomiting]] may occur.
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| '''Wernicke-Korsakoff syndrome:''' [[Wernicke's]] disease is a triad of [[nystagmus]], [[ophthalmoplegia]], and [[ataxia]], along with [[confusion]]. [[Korsakoff's]] [[psychosis]] is impaired short-term memory and confabulation with otherwise grossly normal cognition. This combination is almost exclusively described in chronic [[alcoholic]]s with thiamine deficiency. The two entities are not separate diseases, but a spectrum of signs and symptoms. Genetic abnormalities may underlie a predisposition to [[Wernicke-Korsakoff syndrome]].
| | [[Beriberi medical therapy|Medical Therapy]] | [[Beriberi surgery|Surgery]] | [[Beriberi primary prevention|Primary Prevention]] | [[Beriberi secondary prevention|Secondary Prevention]] | [[Beriberi cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Beriberi future or investigational therapies|Future or Investigational Therapies]] |
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| '''Bariatric beriberi:''' Thiamine deficiency after Roux-en-Y [[gastric bypass]] surgery is common. After Roux-en-Y gastric bypass, thiamine deficiency has been reported in 18% of patients at one year post-surgical follow-up in a university hospital setting. Our group previously published that persistent thiamine deficiency is associated with small bowel bacterial overgrowth following gastric bypass surgery. Oral thiamine supplementation does not reverse thiamine deficiency in this patient population. Concurrent treatment of small intestinal bacterial overgrowth with antibiotics is needed to adequately treat the condition.
| | ==Case Studies== |
| | [[Beriberi case study one|Case #1]] |
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| '''Psychotic beriberi:''' Psychotic beriberi manifesting with auditory and visual hallucinations, odd and aggressive behavior has been recently described in gastric bypass patients.
| | ==Related Chapters== |
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| ===Laboratory Studies=== | |
| The diagnosis of beriberi is assisted by a dietary history suggestive of a low thiamine intake and clinical manifestations. However, objective biochemical tests of thiamine status, particularly measurement of [[erythrocyte transketolase activity]] ([[ETKA]]) and the [[thiamine pyrophosphate effect]] ([[TPPE]]), provide a sensitive test for thiamine deficiency.
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| ==Treatment==
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| 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. Thiamine occurs naturally in unrefined cereals and fresh foods, particularly fresh meat, legumes, green vegetables, fruit, and milk.
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| == References ==
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| - Tanphaichitr, V., Shils, M. Modern Nutrition in Health and Medicine, 9th Ed, Lippincott, Philadelphia 2000. p.381.
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| - Carpenter, K.J. Beriberi, White Rice, and Vitamin B: A disease, a cause, and a cure, Berkeley, University of California Press, 2000.
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| - Hardy, A. Beriberi, White Rice, and Vitamin B: A disease, a cause, and a cure N Engl J Med 343:588, August 24, 2000. Book review.
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| - Gubler, CJ. Thiamin. In: Handbook of vitamins: Nutritional, biochemical, and clinical aspects, Machlin, LJ (Ed), Marcel Dekker, New York 1984. p.245.
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| - Rindi, G. Thiamine. In: Present knowledge in nutrition, 7th edn. Washington, DC: International Life Sciences Institute, 1996: 160-6.
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| - Thiamine deficiency and its prevention and control in major emergenciesWHO/NHD/99.13
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| - Clements RH, Katasani VG, Palepu R, Leeth RR, Leath TD, Roy BP, Vickers SM. Incidence of vitamin deficiency after laparoscopic Roux-en-Y gastric bypass in a university hospital setting. Am Surg 2006; 72(12): 1196 1202.
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| - S. Lakhani, H. Shah, K. Alexander, F. Finelli, J. Kirkpatrick, T. Koch. Small intestinal bacterial overgrowth and thiamine deficiency after Roux-en-Y gastric bypass surgery in obese patients. Nutrition Research, Volume 28, Issue 5, Pages 293-298
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| - Wei Jiang, M.D., Jane P. Gagliardi, M.D., Y. Pritham Raj, M.D., Erin J. Silvertooth, M.D., Eric J. Christopher, M.D., and K. Ranga R. Krishnan, M.D. Acute Psychotic Disorder After Gastric Bypass Surgery: Differential Diagnosis and Treatment. Am J Psychiatry 163:15-19, January 2006.
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| ==See also==
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| * [[Christiaan Eijkman]] | | * [[Christiaan Eijkman]] |
| * [[Edward Bright Vedder]] | | * [[Edward Bright Vedder]] |
| | * [[wet beriberi|Wet Beriberi]] |
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| {{Nutritional pathology}} | | {{Nutritional pathology}} |
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| [[Category:Malnutrition]]
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| [[Category:Reduplicants]]
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| [[Category:Gastroenterology]]
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| [[Category:Cardiology]]
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| [[ar:بري بري]] | | [[ar:بري بري]] |
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| [[uk:Бері-бері]] | | [[uk:Бері-бері]] |
| [[zh:脚气病]] | | [[zh:脚气病]] |
| {{SIB}}
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| {{WikiDoc Help Menu}} | | {{WikiDoc Help Menu}} |
| {{WikiDoc Sources}} | | {{WikiDoc Sources}} |
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| | [[Category:Endocrinology]] |
| | [[Category:Gastroenterology]] |
| | [[Category:Cardiology]] |
