Beriberi differential diagnosis: Difference between revisions

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==Overview==
==Overview==
 
Beriberi should be differentiated from other causes of cardiac dysfunction (wet beriberi), peripheral neuropathy (dry beriberi), delirium (WKS), and other disorders caused by excessive alcohol drinking. However, the differential diagnosis is broad due to the non-specific symptoms of cardiac and neural involvement associated with the condition.
==Differentiating Beriberi from other diseases==
==Differentiating Beriberi from other Diseases==
Beriberi should be differentiated from other causes of cardiac dysfunction (wet beriberi), peripheral neuropathy (dry beriberi), delirium (WKS), and other disorders caused by excessive alcohol drinking. However, the differential diagnosis is broad due to the non-specific symptoms of cardiac and neural involvement associated with the condition.
Beriberi should be differentiated from other causes of cardiac dysfunction (wet beriberi), peripheral neuropathy (dry beriberi), delirium (WKS), and other disorders caused by excessive alcohol drinking. However, the differential diagnosis is broad due to the non-specific symptoms of cardiac and neural involvement associated with the condition.
{| class="wikitable"
{| class="wikitable"
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* Dyspnea/Orthopnea
* Dyspnea/Orthopnea
* Edema
* Edema
* [[Syncope]]
*[[Syncope]]
* Palpitations
* Palpitations
|
|
* [[Hyponatremia]]
*[[Hyponatremia]]
* Elevated [[brain natriuretic peptide]]
* Elevated [[brain natriuretic peptide]]
* Elevated [[troponin]] (in ischemia)
* Elevated [[troponin]] (in ischemia)
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|Delirium and delusional disorders
|Delirium and delusional disorders
|
|
* [[Acute liver failure]]
* Acute metabolic and electrolyte disturbances
* Infections/sepsis
* Toxins/drug overdose
|
|
* Disturbed attention
* Poor cognition
* Impaired psychomotor activity
* Emotional instability
|
|
* [[Arterial blood gas|Arterial blood gases]]
* CBC: [[Leukocytosis|Leucocytosis]]
* [[Blood culture]]
* Glucose and electrolyte levels
|-
|-
|Nerve entrapment disorders
|Nerve entrapment disorders
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|Within the distribution of the affected nerve, the patient may complain of:
|Within the distribution of the affected nerve, the patient may complain of:


* [[Paresthesia|Parasthesia]]
*[[Paresthesia|Parasthesia]]
* Sensory loss
* Sensory loss
* Pain
* Pain
* [[Muscle weakness]]
*[[Muscle weakness]]
* [[Muscle atrophy]]
*[[Muscle atrophy]]


*  
*  
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* Poor insulin compliance
* Poor insulin compliance
* Infections/sepsis
* Infections/[[sepsis]]
* Stress
* Stress
* Idiopathic
* Idiopathic
|
|
* Early: [[Polydipsia]] and [[polyuria]]
* Early: [[Polydipsia]] and [[polyuria]]
* [[Anorexia]]
*[[Anorexia]]
* Nausea and vomiting
* Nausea and vomiting
* Abdominal tenderness
* Abdominal tenderness
* Late: Disturbed consciousness
* Late: Disturbed consciousness
|
|
* Hyperglycemia
*[[Hyperglycemia]]
* Lower PH and bicarbonate levels
* Lower PH and bicarbonate levels
* Ketonemia and ketonuria
* Ketonemia and [[ketonuria]]
* Electrolyte disturbances
* Electrolyte disturbances
* Impaired renal function
* Impaired renal function
|-
|-
|Hyperthyroidism  
|Hyperthyroidism
|
|
* Primary: Grave's disease, toxic thyroid nodules and adenoma
* Primary: [[Graves' disease|Grave's disease]], toxic thyroid nodules and adenoma
* Secondary: Pituitary adenomas and intracranial tumors
* Secondary: [[Pituitary adenoma]]<nowiki/>s and intracranial tumors
* Tertiary:Intracranial tumors involving the hypothalamus
* Tertiary:Intracranial tumors involving the [[hypothalamus]]
|
|
* [[Goiter]]
*[[Goiter]]
* [[Palpitations]]
*[[Palpitations]]
* [[Anxiety]]
*[[Anxiety]]
* Heat intolerance
* Heat intolerance
* [[Insomnia]]
*[[Insomnia]]
* [[Weight loss]]
*[[Weight loss]]
* [[Diarrhea]]
*[[Diarrhea]]
* [[Exophthalmos|Exophthalmus]]  
*[[Exophthalmos|Exophthalmus]]
|
|
* Elevated T3 and T4 hormones
* Elevated T3 and T4 hormones
* TSH: Reduced in 1ry and Elevated in 2ry hyperthyroidism.
*[[Thyroid-stimulating hormone|TSH]]: Reduced in 1ry and Elevated in 2ry hyperthyroidism.
* Thyroid stimulating antibodies: Elevated only in Grave's disease
* Thyroid stimulating antibodies: Elevated only in Grave's disease
|-
|-
|Folic acid deficiency
|Folic acid deficiency
|
|
* [[Malnutrition]]
*[[Malnutrition]]
* Intestinal bacterial overgrowth
* Intestinal bacterial overgrowth
* [[Celiac disease|Celiac]] disease
*[[Celiac disease|Celiac]] disease
* [[Blind loop syndrome]]
*[[Blind loop syndrome]]
* [[Inflammatory bowel disease]]
*[[Inflammatory bowel disease]]
* Pregnancy
* Pregnancy
* Vegetarians
* Vegetarians
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|
|
* Low serum folate <2.5ng/ml
* Low serum folate <2.5ng/ml
* CBC: Macrocytic anemia and low correlated reticulocyte count
* CBC: [[Macrocytic anemia]] and low correlated reticulocyte count
* Peripheral blood smear: Neutrophil granulocytes and anisocytosis
* Peripheral blood smear: Neutrophil granulocytes and [[anisocytosis]]
|}
|}



Revision as of 20:34, 6 November 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdelrahman Ibrahim Abushouk, MD[2]

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Overview

Beriberi should be differentiated from other causes of cardiac dysfunction (wet beriberi), peripheral neuropathy (dry beriberi), delirium (WKS), and other disorders caused by excessive alcohol drinking. However, the differential diagnosis is broad due to the non-specific symptoms of cardiac and neural involvement associated with the condition.

Differentiating Beriberi from other Diseases

Beriberi should be differentiated from other causes of cardiac dysfunction (wet beriberi), peripheral neuropathy (dry beriberi), delirium (WKS), and other disorders caused by excessive alcohol drinking. However, the differential diagnosis is broad due to the non-specific symptoms of cardiac and neural involvement associated with the condition.

Disorders Etiology Clinical Presentation Laboratory findings
Cardiomyopathy due to other causes as alcohol or DM
  • Dyspnea/Orthopnea
  • Edema
  • Syncope
  • Palpitations
Delirium and delusional disorders
  • Acute liver failure
  • Acute metabolic and electrolyte disturbances
  • Infections/sepsis
  • Toxins/drug overdose
  • Disturbed attention
  • Poor cognition
  • Impaired psychomotor activity
  • Emotional instability
Nerve entrapment disorders Chronic injuries to nerves as they pass between bones and ligaments:
  • Carpal tunnel syndrome
  • Cubital tunnel syndrome
  • Suprascapular nerve compression
  • Meralgia Paresthetica (lateral femoral cutaneous nerve)
Within the distribution of the affected nerve, the patient may complain of:
  • MRI short inversion imaging recovery (STIR) technique
Alcoholic hepatitis
  • Chronic and excessive alcohol consumption
  • Increased serum levels of ALT and AST
  • Blood picture: Leukemoid reactions (high WBCs count) may be present.
  • Liver US: Changes in liver size and dilatation of hepatic veins.
Diabetic ketoacidosis In patients with type 1 DM, exposed to:
  • Poor insulin compliance
  • Infections/sepsis
  • Stress
  • Idiopathic
  • Hyperglycemia
  • Lower PH and bicarbonate levels
  • Ketonemia and ketonuria
  • Electrolyte disturbances
  • Impaired renal function
Hyperthyroidism
  • Elevated T3 and T4 hormones
  • TSH: Reduced in 1ry and Elevated in 2ry hyperthyroidism.
  • Thyroid stimulating antibodies: Elevated only in Grave's disease
Folic acid deficiency
  • Palpitations
  • Headache
  • Fatigue
  • Poor appetite
  • Sore tongue
  • Low serum folate <2.5ng/ml
  • CBC: Macrocytic anemia and low correlated reticulocyte count
  • Peripheral blood smear: Neutrophil granulocytes and anisocytosis

References


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