Dry Beriberi Presented By: Allister Liu Jennifer Ng Jessica Ng.

Dry BeriberiDry Beriberi

Presented By: Presented By: Allister LiuAllister LiuJennifer NgJennifer NgJessica NgJessica Ng

What is Dry Beriberi?What is Dry Beriberi?

A vitamin deficiency disease caused by A vitamin deficiency disease caused by inadequate bodily stores of thiamine.inadequate bodily stores of thiamine.

It can damage the heart and nervous It can damage the heart and nervous system.system.

What is Thiamine?What is Thiamine?

Also called Vitamin B1Also called Vitamin B1 Found in both plants and animalsFound in both plants and animals

Mainly lean pork, beef, liver, peas, beans, Mainly lean pork, beef, liver, peas, beans, whole or enriched grains and breadswhole or enriched grains and breads

Assists in metabolism and processing of Assists in metabolism and processing of food taken in by the bodyfood taken in by the body Required to form an important coenzyme Required to form an important coenzyme

known as Thiamine Pyrophosphate (TPP)known as Thiamine Pyrophosphate (TPP)

Thiamine PyrophosphateThiamine Pyrophosphate

http://stud.eao.chups.jussieu.fr/polys/biochimie/OCbioch/POLY.Chp.5.2.html

http://elmhcx9.elmhurst.edu/~chm/vchembook/613acetylcoa.html http://elmhcx9.elmhurst.edu/~chm/vchembook/613acetylcoa.html

http://www.uic.edu/classes/phar/phar332/Clinical_Cases/vitamin%20cases/thiamin/

thiamin_pyrophosphate.html

Citric Acid Cycle

Pentose Phosphate Pathway

http://www.uic.edu/classes/phar/phar332/Clinical_Cases/vitamin%20cases/thiamin/thiamin_pyrophosphate.html

OverviewOverviewTwo major manifestations: Two major manifestations:

1) wet beriberi: a cardiovascular disease 1) wet beriberi: a cardiovascular disease 2) dry beriberi: a nervous system disease2) dry beriberi: a nervous system disease

Both types caused by a deficiency in thiamine Both types caused by a deficiency in thiamine (vitamin B1), which can be precipitated by excessive (vitamin B1), which can be precipitated by excessive alcohol consumption or a diet high in white rice.alcohol consumption or a diet high in white rice.

Nervous system symptoms caused by the Nervous system symptoms caused by the degeneration of nerve fibers and their insulation degeneration of nerve fibers and their insulation

Heart failure is the most common cause of death in Heart failure is the most common cause of death in people with beriberi.people with beriberi.

Photo provided by Allister LiuPhoto provided by Allister Liu

Signs and SymptomsSigns and Symptoms

1)1) Early neurologic symptoms :Early neurologic symptoms : Complaints of symmetric Complaints of symmetric

tingling or burning pain in the tingling or burning pain in the extremities extremities

Numbness in the extremities Numbness in the extremities Vomiting Vomiting Strange eye movements Strange eye movements

(nystagmus) (nystagmus)

2)2) Later neurologic symptoms:Later neurologic symptoms: Mental confusion/speech Mental confusion/speech

difficulties difficulties Difficulty walking Difficulty walking Coma Coma Death Death

3)3) Heart Failure Symptoms:Heart Failure Symptoms: Shortness of breath with Shortness of breath with

exertion exertion Symmetric swelling of the Symmetric swelling of the

lower legs lower legs Awakening at night short of Awakening at night short of

breathbreath

4) GI Symptoms:4) GI Symptoms: Loss of appetiteLoss of appetite IndigestionIndigestion Severe constipationSevere constipation Lack of hydrochloric acid in Lack of hydrochloric acid in

the stomachthe stomach

Signs and SymptomsSigns and Symptoms

http://www.nutriweb.org.br/n0201/beriberi2.jpghttp://www.nutriweb.org.br/n0201/beriberi2.jpg

http://www.mca-marines.org/Leatherneck/SecCam.htmhttp://www.mca-marines.org/Leatherneck/SecCam.htm

ComplicationsComplications

1)1) Psychosis Psychosis

2)2) Coma Coma

3)3) Congestive heart failure Congestive heart failure

4)4) Death Death

Diagnosis and TestsDiagnosis and Tests

Tests include:Tests include:1)1) Measurement of blood Measurement of blood

thiamine and whole-blood thiamine and whole-blood or erythrocyte or erythrocyte transketolase activity transketolase activity

2)2) Measurement of urinary Measurement of urinary thiamine excretion thiamine excretion

3)3) Clinical response to Clinical response to administered thiamine administered thiamine

person with late-stage person with late-stage beriberi may be confused or beriberi may be confused or have memory loss and have memory loss and delusions. delusions.

A physical examination A physical examination may show signs of may show signs of congestive heart failure congestive heart failure

Neurological Neurological examination may show a examination may show a loss of vibratory loss of vibratory sensation, decreased sensation, decreased reflexes, loss of reflexes, loss of coordination, gait coordination, gait changes, nystagmus, changes, nystagmus, ptosis, and ptosis, and opthalmoplegiaopthalmoplegia

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

TreatmentTreatment1)1) Administration of thiamine by injection Administration of thiamine by injection

and with pills. and with pills.

2)2) Patients should also receive therapeutic Patients should also receive therapeutic doses of other water-soluble vitamins.doses of other water-soluble vitamins.

http://www.neogen.com/thiamine.htm http://www.healthmart2000.com/item50.htm

PrognosisPrognosis

Cardiac damage usually reversible Cardiac damage usually reversible Full recovery is expected after treatmentFull recovery is expected after treatmentHowever in conjunction with acute heart failure However in conjunction with acute heart failure

recovery rate is greatly reducedrecovery rate is greatly reducedNervous system damage also reversible, if Nervous system damage also reversible, if

caught early. caught early. If not, symptoms such as memory loss may not If not, symptoms such as memory loss may not

be completely recovered with treatment.be completely recovered with treatment.Untreated beriberi is often fatal.Untreated beriberi is often fatal.

PreventionPrevention

Adequate intake of thiamine, particularly Adequate intake of thiamine, particularly by pregnant or breast-feeding womenby pregnant or breast-feeding women

Heavy drinkers should try to cut down or Heavy drinkers should try to cut down or quit and supplement diets with B-vitamins quit and supplement diets with B-vitamins to ensure appropriate intake of thiamine.to ensure appropriate intake of thiamine.

References (1)References (1)““Beriberi.” Beriberi.” AllRefer Health.AllRefer Health. 2005. <http://health.allrefer.com/health/beriberi.html>. 2005. <http://health.allrefer.com/health/beriberi.html>.

Ericson, Karen., RN. “Beriberi.” Ericson, Karen., RN. “Beriberi.” Health AtoZ – Your Family Health Site.Health AtoZ – Your Family Health Site. 2006. 2006.<http://www.healthatoz.com/healthatoz/Atoz/ency/beriberi.jsp>.<http://www.healthatoz.com/healthatoz/Atoz/ency/beriberi.jsp>.

Hart, Jacqueline A., M.D. “Beriberi.” Hart, Jacqueline A., M.D. “Beriberi.” MedlinePlus Medical Encyclopedia.MedlinePlus Medical Encyclopedia. 06 06 January 2006. <http://www.nlm.nih.gov/medlineplus/ency/article/000339.htm>January 2006. <http://www.nlm.nih.gov/medlineplus/ency/article/000339.htm>

Kirk, Terence S. “The Secret POW Camera.” Photo. Kirk, Terence S. “The Secret POW Camera.” Photo. Leatherneck – Magazine of Leatherneck – Magazine of the Marines.the Marines. 2004. <http://www.mca-marines.org/Leatherneck/SecCam.htm>. 2004. <http://www.mca-marines.org/Leatherneck/SecCam.htm>.

Ophardt, Charles, E. “Formation of Acetyl CoA from Pyruvic Acid.” Photo. Ophardt, Charles, E. “Formation of Acetyl CoA from Pyruvic Acid.” Photo. Virtual Virtual Chembook Elmhurst College.Chembook Elmhurst College. 2003. 2003. <http://elmhcx9.elmhurst.edu/~chm/vchembook/613acetylcoa.html>.<http://elmhcx9.elmhurst.edu/~chm/vchembook/613acetylcoa.html>.

Sewell, R Andrew., MD and Lawrence D Recht, MD. “Nutritional Neuropathy.” Sewell, R Andrew., MD and Lawrence D Recht, MD. “Nutritional Neuropathy.” eMedicine.eMedicine. 15 September 2005. 15 September 2005. <http://www.emedicine.com/NEURO/topic278.htm>.<http://www.emedicine.com/NEURO/topic278.htm>.

References (2)References (2)““Thiaminases.” Thiaminases.” Cornell University.Cornell University. 4 October 2001. 4 October 2001.

<http://www.ansci.cornell.edu/plants/toxicagents/thiaminase/thiaminase.html><http://www.ansci.cornell.edu/plants/toxicagents/thiaminase/thiaminase.html>

““Thiamine Hydrochloride.” Photo. Thiamine Hydrochloride.” Photo. Neogen Corporation.Neogen Corporation. 13 February 2006. 13 February 2006. <http://www.neogen.com/thiamine.htm>.<http://www.neogen.com/thiamine.htm>.

““Thiamine Pyrophosphate.” Photo. Thiamine Pyrophosphate.” Photo. Chups.Chups.<http://stud.eao.chups.jussieu.fr/polys/biochimie/OCbioch/POLY.Chp.5.2.html><http://stud.eao.chups.jussieu.fr/polys/biochimie/OCbioch/POLY.Chp.5.2.html>

““Vitamin B1, Thiamine.” Photo. Vitamin B1, Thiamine.” Photo. Healthmart2000.Healthmart2000. 13 February 2006. 13 February 2006.<http://www.healthmart2000.com/item50.htm>.<http://www.healthmart2000.com/item50.htm>.

““Vitamin B1 (Thiamine).” Vitamin B1 (Thiamine).” University of Maryland Medical Center.University of Maryland Medical Center. 2004. 2004.<http://www.umm.edu/altmed/ConsSupplements/VitaminB1Thiaminecs.html>.<http://www.umm.edu/altmed/ConsSupplements/VitaminB1Thiaminecs.html>.

Woodbury, Charles. “Thiamine Pyrophosphate.” Woodbury, Charles. “Thiamine Pyrophosphate.” University of Illinois at Chicago.University of Illinois at Chicago. 05 January 2005. <http://www.uic.edu/classes/phar/phar332/Clinical_Cases/vitamin05 January 2005. <http://www.uic.edu/classes/phar/phar332/Clinical_Cases/vitamin%20cases/thiamin/thiamin_pyrophosphate.htm>%20cases/thiamin/thiamin_pyrophosphate.htm>

““Lucky Charms?”Lucky Charms?”

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Summary SlideSummary Slide A vitamin deficiency disease caused by inadequate bodily stores of thiamine.A vitamin deficiency disease caused by inadequate bodily stores of thiamine. Thiamine:Thiamine:

Vitamin B1Vitamin B1 Found in both plants and animalsFound in both plants and animals

Mainly lean pork, beef, liver, peas, beans, whole or enriched grains and breadsMainly lean pork, beef, liver, peas, beans, whole or enriched grains and breads Assists in metabolism and processing of food taken in by the bodyAssists in metabolism and processing of food taken in by the body Required to form an important coenzyme known as Thiamine Pyrophosphate (TPP) Required to form an important coenzyme known as Thiamine Pyrophosphate (TPP)

made up of pyrimidine + thiazole + 2 phosphatesmade 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 TPP is required in the Krebs Cycle to convert pyruvic acid into Acetyl CoA, generating NADH for the electron

transport chain transport chain Signs and SymptomsSigns and Symptoms1) Early neurologic symptoms : tingling/pain and numbness in extremities, vomiting, nystagmus1) Early neurologic symptoms : tingling/pain and numbness in extremities, vomiting, nystagmus2)2) Later neurologic symptoms: mental confusion, speech difficulties, difficulty walking, coma, deathLater neurologic symptoms: mental confusion, speech difficulties, difficulty walking, coma, death3)3) Heart Failure Symptoms: SOB (leading to disturbed sleep), symmetric swelling of lower legsHeart Failure Symptoms: SOB (leading to disturbed sleep), symmetric swelling of lower legs4)4) GI Symptoms: loss of appetite, indigestion, severe constipation, lack of HCl in stomachGI Symptoms: loss of appetite, indigestion, severe constipation, lack of HCl in stomach Complications: Psychosis, Coma, Congestive Heart Failure, DeathComplications: Psychosis, Coma, Congestive Heart Failure, Death DiagnosisDiagnosis

person with late-stage beriberi may be confused or have memory loss and delusions. person with late-stage beriberi may be confused or have memory loss and delusions. A physical examination may show signs of congestive heart failure 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 Neurological examination may show a loss of vibratory sensation, decreased reflexes, loss of coordination, gait

changes, nystagmus, ptosis, and opthalmoplegiachanges, nystagmus, ptosis, and opthalmoplegia TestsTests

1)1) Measurement of blood thiamine and whole-blood or erythrocyte transketolase activity Measurement of blood thiamine and whole-blood or erythrocyte transketolase activity 2)2) Measurement of urinary thiamine excretion Measurement of urinary thiamine excretion 3)3) Clinical response to administered thiamine Clinical response to administered thiamine

TreatmentTreatment1)1) Administration of thiamine by injection and with pills. Administration of thiamine by injection and with pills. 2)2) Patients should also receive therapeutic doses of other water-soluble vitamins.Patients should also receive therapeutic doses of other water-soluble vitamins.