Beriberi (Thiamine Deficiency) Clinical Presentation

Updated: Mar 02, 2017
  • Author: Dieu-Thu Nguyen-Khoa, MD, FACP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Presentation

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, [13] 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 [31] (orthopnea with or without edema, warm skin due to vasodilation)
  • Hypotension, shock

Gastroenterologic symptoms are as follows:

  • Anorexia
  • Abdominal discomfort
  • Constipation
  • Dysphagia [32]

Infantile beriberi symptoms are as follows [27] :

  • CHF
  • Aphonia
  • Absent deep tendon reflex

A study by Isenberg-Grzeda et al indicated that thiamine deficiency may be a frequent occurrence among inpatients with cancer, even in those who are of normal weight or overweight, lack other vitamin deficiencies, and are receiving multivitamin supplements. The single-center study found thiamine deficiency in 55.3% of 217 patients, with risk factors for the deficiency including active cancer treatment and fluorouracil-based chemotherapy. [33]

A literature review by Jain et al comparing the incidence of thiamine deficiency in patients with heart failure to that in controls reported an odds ratio of 2.53, with possible reasons for the deficiency in heart failure including diuretic use, dietary changes, and alterations in the absorption and metabolism of thiamine. The literature also indicated that thiamine supplementation may improve symptoms and ejection fraction in patients with heart failure. [34]

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. [18, 35, 36] 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.