Beriberi

Beriberi 

Beriberi is a disease caused by a vitamin B1 deficiency, also known as thiamine deficiency. It often occurs in developing countries among people with a diet that consists mostly of white rice or highly refined carbohydrates.

There are two types of the disease:

• wet beriberi
• dry beriberi

Wet beriberi affects the heart and circulatory system. In extreme cases, wet beriberi can cause heart failure.

Dry beriberi damages the nerves and can lead to decreased muscle strength and eventually muscle paralysis. Beriberi can be life threatening if it isn’t treated.

If you have access to foods rich in thiamine, your chances of developing beriberi are low. Today, in the United States, beriberi mostly occurs in people with an alcohol use disorder and may also occur as a complication of weight loss surgery.

Beriberi from other causes is rare in the United States. Still, the disease can be seen in:

• women who have extreme nausea and vomiting in pregnancy (hyperemesis gravidarum)
• people with AIDS
• people following bariatric surgery

Causes 

Beriberi is not common in the United States or other developed countries. However, certain risk factors may increase the likelihood of developing this rare disease. Not all people with risk factors will get beriberi. Risk factors for beriberi include:

• Alcohol abuse
• Dialysis treatments
• Eating a diet low in thiamine
• Frequent and high doses of diuretics
• Gastric bypass surgery
• Tube-feeding (total parenteral nutrition)

Symptoms 

There are two types of beriberi that affect different parts of the body. Both can be dangerous: 

• Wet beriberi affects the cardiovascular system. Since it involves the functioning of the heart, it's a life-threatening medical emergency that needs immediate treatment. 
• Dry beriberi can damage the central nervous system (CNS). It disrupts motor functioning (the movement of the muscles). It can also cause impaired reflexes and numbness in the extremities, but it’s generally easier to treat than beriberi that impacts the heart. 

Other possible symptoms of beriberi include: 

• Weakness and muscle loss
• Mental confusion
• Tingling or loss of sensitivity in the fingers or feet 
• Fatigue
• Rapid heart beat
• Chest pain
• Nausea or vomiting
• Fever

If these symptoms aren’t attended to when they first appear, beriberi may progress into Korsakoff syndrome, a kind of encephalopathy, which refers to damage or disease that affects the brain. Extensive damage to parts of the brain, particularly the thalamus and hypothalamus, may cause severe confusion and memory loss, one of the main signs of Korsakoff syndrome. 

This is a rare but serious condition and is not reversible once the damage sets in.  It's important to see a doctor as soon as possible when you first start showing signs of thiamin deficiency to avoid the possibility of the condition advancing to Korsakoff.  

Diagnosis 

A physical examination may show signs of congestive heart failure, including:

• Difficulty breathing, with neck veins that stick out
• Enlarged heart
• Fluid in the lungs
• Rapid heartbeat
• Swelling in both lower legs

A person with late-stage beriberi may be confused or have memory loss and delusions. The person may be less able to sense vibrations.

A neurological exam may show signs of:

• Changes in the walk
• Coordination problems
• Decreased reflexes
• Drooping of the eyelids

The following tests may be done:

• Blood tests to measure the amount of thiamine in the blood
• Urine tests to see if thiamine is passing through the urine