Beriberi: Alternative names: thiamine deficiency; vitamin B1 deficiency

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I think that this disease is more common than generaly thought to

exist although most would be subclinical cases. F.

 

http://www.healthcentral.com/mhc/top/000339.cfm

 

Beriberi

 

Alternative names: thiamine deficiency; vitamin B1 deficiency

 

Definition: A vitamin deficiency disease, caused by a lack of vitamin

B1 (thiamine); the most significant manifestations are damage to the

heart and nervous system.

 

Causes, incidence, and risk factors:

Beriberi has become almost nonexistent in the United States since the

discovery of its cause, thiamine deficiency. Most foods are vitamin

enriched and a normal diet contains adequate amounts of thiamine.

 

Beriberi can appear, however, in breast-fed infants when the mother

has an inadequate intake of thiamine or among people whose diet

includes certain types of fish that produce an enzyme which

inactivates thiamine.

 

Early symptoms of beriberi are nonspecific and include fatigue,

irritability, restlessness, loss of appetite, and vague abdominal

discomfort.

 

As the disease progresses, patients develop burning sensations,

tingling in the extremities, and changes in sensation such as

numbness. Patients may develop psychosis. Heart manifestations are

caused by degeneration of the heart muscle and include heart failure

with shortness of breath (dyspnea) and cyanosis (bluish tinged skin).

Neurologic symptoms are caused by degeneration of the nerve fiber and

its insulation (myelin). Death is generally a result of heart failure.

 

Prevention:

Adequate intake of thiamine will prevent beriberi. Nursing mothers

should insure that their diet is adequate in all vitamins.

 

Symptoms:

Early symptoms:

 

* irritability

* fatigue

* restlessness

* decreased appetite

 

Later symptoms:

 

* complaints of tingling or burning in the extremities

* numbness in the extremities

* shortness of breath (dyspnea)

* bluish coloration to the skin (cyanosis)

* decreased mental ability

* unusual behavior

* seizures

* loss of consciousness

 

Signs and tests:

Physical examination may show signs of congestive heart failure,

including difficulty breathing, bluish skin (cyanosis), and others.

The person with late-stage beriberi may be confused or psychotic.

Neurological examination shows a loss of vibratory sensation (the

person is less able to sense vibration), loss of coordination, gait

changes (ataxia), and other changes. The liver may be enlarged

(hepatomegaly).

 

Tests include:

 

* ECG (to rule out other causes of seizures and neurologic changes)

* clinical response to administered thiamine (symptoms improve

after the person is given thiamine supplements)

 

Treatment:

Administration of thiamine reverses the deficiency and symptoms

improve rapidly.

 

Expectations (prognosis):

Cardiac damage is reversible and is not permanent. Full recovery is

expected after treatment. Untreated, beriberi is often fatal.

Complications:

 

* seizures and subsequent injuries

* psychosis

* congestive heart failure

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http://www.sci.uidaho.edu/med532/wernicke_korsakoff.htm

 

Wernicke-Korsakoff Syndrome

 

This disease, notably frequent among chronic alcoholics, is due to a

deficiency of vitamin B1 or thiamine. The poor diet of alcoholics who

are suffering from this syndrome leads to lesions and increased

microhemorrhages in the mammillary bodies, thalamus and brainstem.

This syndrome can also be associated with diseases of the GI tract

when there is inadequate thiamine absorption.

 

Neurologic symptoms include confusion, memory loss, impaired movements

and peripheral neuropathy. Immediate administration of thiamine is

usually successful in treating the symptoms, but sometimes permanent

memory loss occurs.

 

http://www.healthcentral.com/mhc/top/000771.cfm

 

Alternative names: Korsakoff psychosis; alcoholic encephalopathy;

encephalopathy, alcoholic; Wernicke's disease

 

Definition: A brain disorder involving loss of specific brain

functions, due to thiamine deficiency.

Causes, incidence, and risk factors:

Wernicke-Korsakoff syndrome usually affects people between 40 and 80

years old. The onset is gradual.

 

The syndrome is actually two disorders that may occur independently or

together. Wernicke's disease involves damage to multiple nerves in

both the central nervous system (brain and spinal cord) and the

peripheral nervous system (the rest of the body). It may also include

symptoms caused by alcohol withdrawal. The cause is generally

attributed to malnutrition, especially lack of vitamin B-1 (thiamine),

which commonly accompanies habitual alcohol use or alcoholism.

 

Korsakoff syndrome, or Korsakoff psychosis, involves impairment of

memory and intellect/cognitive skills such as problem solving or

learning, along with multiple symptoms of nerve damage. The most

distinguishing symptom is confabulation (fabrication) where the person

makes up detailed, believable stories about experiences or situations

to cover the gaps in the memory. Korsakoff psychosis involves damage

to areas of the brain.

 

Prevention:

Minimal or moderate alcohol use and adequate nutrition reduce the risk

of developing Wernicke-Korsakoff syndrome.

 

Symptoms:

 

* vision changes

o double vision

o eye movements, uncontrollable or twitching of the eyes

o eyelid drooping

* loss of muscle coordination

o unsteady, uncoordinated walking

o weakness

o movement, dysfunctional

o hand tremor

* muscle contractions

* muscle atrophy

* facial paralysis

* sensation changes

o decreased sensation in the feet or hands, numbness

o abnormal sensations, tingling

* thin, malnourished appearance

* loss of hair

* dry skin

* swallowing difficulty

* speech impairment

* hoarseness or changing voice

* mood changes, emotional changes, and behavior changes

* loss of memory, can be profound

* confabulation

* decreased intellect/cognitive skills

o decreased problem solving

o loss of ability to think abstractly

* autonomic disturbances:

o orthostatic dizziness

o constipation

o inability to tolerate cold environment

 

Note: Symptoms that indicate alcohol withdrawal may also be present or

may develop.

 

Signs and tests:

History is significant for chronic alcohol use. Examination of the

nervous/muscular system may show polyneuropathy (damage to multiple

nerve systems). Reflexes may be decreased or of abnormal intensity, or

abnormal reflexes may be present. Testing of gait and coordination

indicate damage to portions of the brain that control muscle

coordination. Muscles may be weak and may show atrophy (loss of tissue

mass). Examination of the eyes shows abnormalities of eye movement.

Blood pressure and body temperature measurement may be low; pulse

(heart rate) may be rapid. The person may appear cachectic (malnourished).

 

A nutritional assessment may confirm malnourished state, serum B-1

levels may be low, pyruvate is elevated, and transhetolase activity is

decreased. Serum or urine alcohol levels may be elevated (see

toxicology screen).

 

A cranial MRI rarely shows changes in the tissue of the brain

indicating Wernicke-Korsakoff syndrome.

 

Treatment:

The goals of treatment are to control symptoms as much as possible and

to prevent progression of the disorder. Hospitalization is required

for initial control of symptoms. If the person is lethargic,

unconscious, or comatose, monitoring and care appropriate to the

condition may be required. The airway should be monitored and

protected as appropriate.

 

Thiamine (vitamin B-1) may improve symptoms of confusion or delirium,

difficulties with vision and eye movement, and muscle incoordination.

B-1 may be given by injection into a vein or a muscle, or by mouth.

Thiamine does not generally improve loss of memory and intellect

associated with Korsakoff psychosis.

 

Total abstinence from alcohol is required to prevent progressive loss

of brain function and damage to peripheral nerves. A well-balanced,

nourishing diet is recommended.

 

Support groups:

The stress of illness can often be helped by joining a support group

where members share common experiences and problems. See alcoholism -

support group.

 

Expectations (prognosis):

Without treatment, Wernicke-Korsakoff syndrome progresses steadily to

death. With treatment, symptoms such as incoordination and vision

difficulties may be controlled, and progression of the disorder may be

slowed or stopped. Some of the symptoms, particularly the loss of

memory and intellect/cognitive skills, may be permanent. There may be

a need for custodial care if the loss of intellect/cognitive skills is

severe. Other disorders related to the abuse of alcohol may also be

present.

 

Complications:

 

* permanent loss of memory

* permanent loss of cognitive/intellectual skills

* injury caused by falls

* difficulty with personal/social interaction

* alcohol withdrawal state

* permanent alcoholic neuropathy

* shortened life span

 

Calling your health care provider:

Call your health care provider if Wernicke-Korsakoff syndrome is

present and symptoms worsen or reappear. Also call if new symptoms

develop, including symptoms of alcohol withdrawal:

 

* delirium or confusion.

* agitation.

* jumpiness or nervousness

* insomnia

* hallucinations

* palpitations

* heart rate that is faster than normal without an observable

cause such as:

o increased activity.

o pale skin

o profuse sweating

o muscle tremors

o seizures

o headache

o fever.

o nausea/vomiting

 

Discuss the situation with your health care provider if you are unable

to care for the person at home.