Beriberi (Thiamine Deficiency) Clinical Presentation

  • Author: Dieu-Thu Nguyen-Khoa, MD; Chief Editor: George T Griffing, MD   more...
 
Updated: Dec 13, 2011
 

History and Physical Examination

Most patients have no symptoms and signs of thiamine deficiency; therefore, it must be suspected in the appropriate clinical setting. Early symptoms and signs are often nonspecific and vague, such as fatigue. However, high-output cardiac failure should prompt investigation of thiamine deficiency as a cause. The same applies to neuropathic symptoms, particularly in the distal extremities.

Neurologic symptoms of thiamine deficiency are as follows:

  • Poor memory, irritability, sleep disturbance
  • Wernicke encephalopathy,[12] Korsakoff syndrome
  • Bilateral, symmetrical lower extremities paresthesias, burning pain
  • Muscle cramps
  • Decreased vibratory position sensation
  • Absent knee and ankle jerk
  • Muscle atrophy
  • Foot drop (late stage)

Cardiovascular symptoms are as follows:

  • Tachycardia
  • Chest pain
  • Wide pulse pressure
  • Heart failure[26] (orthopnea with or without edema, warm skin due to vasodilation)
  • Hypotension, shock

Gastroenterologic symptoms are as follows:

  • Anorexia
  • Abdominal discomfort
  • Constipation

Infantile beriberi symptoms are as follows[23] :

  • CHF
  • Aphonia
  • Absent deep tendon reflex

Alcoholism

Persons with chronic alcoholism have low thiamine intake, impaired thiamine uptake and storage, accelerated destruction of thiamine diphosphate, and varying degrees of energy expenditure. Alcohol is a direct neurotoxin. The effects on the body's supply of thiamine and on brain tissue are detrimental. Persons with known alcoholism should be administered parenteral thiamine as a routine action when they present to a medical facility.

Dieting

A patient’s dieting history also may hold a clue regarding thiamine deficiency. Fad diets often do not contain the necessary amounts of thiamine.

Dialysis and high energy consumption

Dialysis also robs thiamine from the circulation. In addition, states of high energy consumption, such as hyperthyroidism, pregnancy, or severe illness, require more thiamine and other nutrients.

Bariatric weight-loss surgery

Persons with a history of gastric bypass may also have beriberi.[27, 28, 17] For bariatric surgery patients, it is believed that a deficiency occurs primarily during the first 6 months after surgery, when individuals undergo the most rapid weight loss.

Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Dieu-Thu Nguyen-Khoa, MD  Associate Professor of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Physician Specialist, Department of Primary Care and Community Medicine, ValleyCare Olive View-UCLA Medical Center

Dieu-Thu Nguyen-Khoa, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Dennis W Cope, MD, FACP  Emeritus Professor of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Chief, Department of Internal Medicine, Olive View-UCLA Medical Center

Dennis W Cope, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Ginette V Busschots, MD  Assistant Professor, Department of Emergency Medicine, Foote Hospital, University of Michigan Medical School

Disclosure: Nothing to disclose.

Phyllis A Vallee, MD  Associate Program Director, Department of Emergency Medicine, Henry Ford Hospital

Phyllis A Vallee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, and Michigan State Medical Society

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Don S Schalch, MD Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, University of Wisconsin Hospitals and Clinics

Don S Schalch, MD is a member of the following medical societies: American Diabetes Association, American Federation for Medical Research, Central Society for Clinical Research, and Endocrine Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Stanley Wallach, MD Executive Director, American College of Nutrition; Clinical Professor, Department of Medicine, New York University School of Medicine

Stanley Wallach, MD is a member of the following medical societies: American College of Nutrition, American Society for Bone and Mineral Research, American Society for Clinical Investigation, American Society for Clinical Nutrition, American Society for Nutritional Sciences, Association of American Physicians, and Endocrine Society

Disclosure: Nothing to disclose.

References

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Table. Nutritional Needs for Specific Age Groups[9]
Population Age Allowance, mg/day
Recommended Dietary Allowances (RDAs)
Boys9-13 years0.9
Men>14 years1.2
Girls9-13 years0.9
Women14-18 years1.0
Women>19 years1.1
Pregnant/lactating women. . .1.4
Children1-3 years0.5
Children4-8 years0.6
Adequate Intakes (AIs)
Infant0-6 months0.2
Infant7-12 months0.3
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