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Overview :
Thiamine (vitamin B1) deficiency in older children,
adolescents and adults results in clinical beriberi. This may present with
either cardiac and/or neurologic dysfunctions. Diagnosis often depends on a
high index of clinical suspicion in a patient with risk factors for a
nutritional deficiency.
Clinical forms - cardiac:
(1) wet beriberi
(2) shoshin beriberi
Clinical forms - neurological:
(1) dry beriberi
(2) Korsakoff's psychosis
(3) Wenicke's encephalopathy
(4) gastrointestinal
Features of wet beriberi:
(1) peripheral
edema
(2) lung fields
usually clear
(3) no cyanosis
(4) high output
heart failure with increased systolic and decreased diastolic blood pressures
(wide pulse pressure)
Features of shoshin (Japanese for acute heart damage)
beriberi:
(1) classic heart failure (low output)
(2) breathlessness with crackles in lungs progressing to
cyanosis
(3) lactic acidosis
(4) often a fulminant clinical course
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Clinical Findings
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Wet Classic
Beriberi
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Shoshin Beriberi
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extremities
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warm with sweating, from vasodilation
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cold from vasoconstriction
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cardiac output
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high
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variable, often low
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blood pressure
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wide pulse pressure
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hypotension
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respiratory function
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no cyanosis
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cyanosis
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renal function
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oliguria
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acid base status
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metabolic acidosis
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course
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subacute
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fulminant
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Features of dry beriberi:
(1) peripheral neuritis with paresthesias in extremities
(2) touch sensation diminished
(3) joint position, vibration and pain sensation normal
(4) loss of tendon reflexes, especailly the ankle and knee
reflexes
(5) distal muscle weakness
Features of Korsakoff's psychosis:
(1) profound loss of recent memory
(2) preservation of past memories
(3) active imagination intact
Features of Wernicke's encephalopathy:
(1) irritable and forgetful
(2) ptosis and ophthalmoplegia
(3) nystagmus
(4) cerebellar ataxia
(5) confusion and delerium
Features of gastrointestinal dysfunction:
(1) abnormal motility, usually with constipation
(2) colicy abdominal pains
(3) nausea and vomiting
(4) anorexia
A patient may present with any combination of the above
presentations.
Each of the clinical presentations may mimic many other
conditions that need to be excluded.
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