Dry Beriberi

1
Dry Beriberi

• Presented By
• Allister Liu
• Jennifer Ng
• Jessica Ng

2
What is Dry Beriberi?

• A vitamin deficiency disease caused by inadequate
  bodily stores of thiamine.
• It can damage the heart and nervous system.

3
What is Thiamine?

• Also called Vitamin B1
• Found in both plants and animals
• Mainly lean pork, beef, liver, peas, beans, whole
  or enriched grains and breads
• Assists in metabolism and processing of food
  taken in by the body
• Required to form an important coenzyme known as
  Thiamine Pyrophosphate (TPP)

4
Thiamine Pyrophosphate
http//stud.eao.chups.jussieu.fr/polys/biochimie/O
Cbioch/POLY.Chp.5.2.html
5
http//elmhcx9.elmhurst.edu/chm/vchembook/613acet
ylcoa.html
6
http//www.uic.edu/classes/phar/phar332/Clinical_C
ases/vitamin20cases/thiamin/thiamin_pyrophosphate
.html
Citric Acid Cycle
7
Pentose Phosphate Pathway
http//www.uic.edu/classes/phar/phar332/Clinical_C
ases/vitamin20cases/thiamin/thiamin_pyrophosphate
.html
8
Overview

• Two major manifestations
• 1) wet beriberi a cardiovascular disease
• 2) dry beriberi a nervous system disease
• Both types caused by a deficiency in thiamine
  (vitamin B1), which can be precipitated by
  excessive alcohol consumption or a diet high in
  white rice.
• Nervous system symptoms caused by the
  degeneration of nerve fibers and their insulation
  
• Heart failure is the most common cause of death
  in people with beriberi.

9

• Photo provided by Allister Liu

10
Signs and Symptoms

• Early neurologic symptoms
• Complaints of symmetric tingling or burning pain
  in the extremities
• Numbness in the extremities
• Vomiting
• Strange eye movements (nystagmus)
• Later neurologic symptoms
• Mental confusion/speech difficulties
• Difficulty walking
• Coma
• Death

• Heart Failure Symptoms
• Shortness of breath with exertion
• Symmetric swelling of the lower legs
• Awakening at night short of breath
• 4) GI Symptoms
• Loss of appetite
• Indigestion
• Severe constipation
• Lack of hydrochloric acid in the stomach

11
Signs and Symptoms

• http//www.nutriweb.org.br/n0201/beriberi2.jpg

http//www.mca-marines.org/Leatherneck/SecCam.htm
12
Complications

• Psychosis
• Coma
• Congestive heart failure
• Death

13
Diagnosis and Tests

• Tests include
• Measurement of blood thiamine and whole-blood or
  erythrocyte transketolase activity
• Measurement of urinary thiamine excretion
• Clinical response to administered thiamine
• person with late-stage beriberi may be confused
  or have memory loss and delusions.

• A physical examination may show signs of
  congestive heart failure
• Neurological examination may show a loss of
  vibratory sensation, decreased reflexes, loss of
  coordination, gait changes, nystagmus, ptosis,
  and opthalmoplegia

14
Cardiac enlargement in a pig.On the left, the
heart of a normal pig. On the right, the heart of
a thiamin deficient pig. http//www.ansci.cornell
.edu/plants/toxicagents/thiaminase/thiaminase.html

15
Treatment

• Administration of thiamine by injection and with
  pills.
• Patients should also receive therapeutic doses of
  other water-soluble vitamins.

http//www.neogen.com/thiamine.htm
http//www.healthmart2000.com/item50.htm
16
Prognosis

• Cardiac damage usually reversible
• Full recovery is expected after treatment
• However in conjunction with acute heart failure
  recovery rate is greatly reduced
• Nervous system damage also reversible, if caught
  early.
• If not, symptoms such as memory loss may not be
  completely recovered with treatment.
• Untreated beriberi is often fatal.

17
Prevention

• Adequate intake of thiamine, particularly by
  pregnant or breast-feeding women
• Heavy drinkers should try to cut down or quit and
  supplement diets with B-vitamins to ensure
  appropriate intake of thiamine.

18
References (1)

• Beriberi. AllRefer Health. 2005.
  lthttp//health.allrefer.com/health/beriberi.htmlgt.
  
• Ericson, Karen., RN. Beriberi. Health AtoZ
  Your Family Health Site. 2006.
• lthttp//www.healthatoz.com/healthatoz/Atoz/ency/b
  eriberi.jspgt.
• Hart, Jacqueline A., M.D. Beriberi.
  MedlinePlus Medical Encyclopedia. 06 January
  2006. lthttp//www.nlm.nih.gov/medlineplus/ency/art
  icle/000339.htmgt
• Kirk, Terence S. The Secret POW Camera. Photo.
  Leatherneck Magazine of the Marines. 2004.
  lthttp//www.mca-marines.org/Leatherneck/SecCam.htm
  gt.
• Ophardt, Charles, E. Formation of Acetyl CoA
  from Pyruvic Acid. Photo. Virtual
• Chembook Elmhurst College. 2003.
• lthttp//elmhcx9.elmhurst.edu/chm/vchembook/613ac
  etylcoa.htmlgt.
• Sewell, R Andrew., MD and Lawrence D Recht, MD.
  Nutritional Neuropathy.
• eMedicine. 15 September 2005. lthttp//www.emedici
  ne.com/NEURO/topic278.htmgt.

19
References (2)

• Thiaminases. Cornell University. 4 October
  2001.
• lthttp//www.ansci.cornell.edu/plants/toxicagents/
  thiaminase/thiaminase.htmlgt
• Thiamine Hydrochloride. Photo. Neogen
  Corporation. 13 February 2006. lthttp//www.neogen.
  com/thiamine.htmgt.
• Thiamine Pyrophosphate. Photo. Chups.
• lthttp//stud.eao.chups.jussieu.fr/polys/biochimie
  /OCbioch/POLY.Chp.5.2.htmlgt
• Vitamin B1, Thiamine. Photo. Healthmart2000. 13
  February 2006.
• lthttp//www.healthmart2000.com/item50.htmgt.
• Vitamin B1 (Thiamine). University of Maryland
  Medical Center. 2004.
• lthttp//www.umm.edu/altmed/ConsSupplements/Vitami
  nB1Thiaminecs.htmlgt.
• Woodbury, Charles. Thiamine Pyrophosphate.
  University of Illinois at Chicago.
• 05 January 2005. lthttp//www.uic.edu/classes/phar
  /phar332/Clinical_Cases/vitamin20cases/thiamin/th
  iamin_pyrophosphate.htmgt

20
Lucky Charms?

• http//www.suburbangarbage.com/Leprechaun-2004.jpg

21
Summary Slide

• A vitamin deficiency disease caused by inadequate
  bodily stores of thiamine.
• Thiamine
• Vitamin B1
• Found in both plants and animals
• Mainly lean pork, beef, liver, peas, beans, whole
  or enriched grains and breads
• Assists in metabolism and processing of food
  taken in by the body
• Required to form an important coenzyme known as
  Thiamine Pyrophosphate (TPP)
• made up of pyrimidine thiazole 2 phosphates
• TPP is required in the Krebs Cycle to convert
  pyruvic acid into Acetyl CoA, generating NADH for
  the electron transport chain
• Signs and Symptoms
• 1) Early neurologic symptoms tingling/pain
  and numbness in extremities, vomiting, nystagmus
• Later neurologic symptoms mental confusion,
  speech difficulties, difficulty walking, coma,
  death
• Heart Failure Symptoms SOB (leading to disturbed
  sleep), symmetric swelling of lower legs
• GI Symptoms loss of appetite, indigestion,
  severe constipation, lack of HCl in stomach
• Complications Psychosis, Coma, Congestive Heart
  Failure, Death
• Diagnosis
• person with late-stage beriberi may be confused
  or have memory loss and delusions.
• A physical examination may show signs of
  congestive heart failure
• Neurological examination may show a loss of
  vibratory sensation, decreased reflexes, loss of
  coordination, gait changes, nystagmus, ptosis,
  and opthalmoplegia