What is wet beriberi?

Answer

Wet beriberi is the term used for thiamine deficiency with cardiovascular involvement. The chronic form of wet beriberi consists of 3 stages. In the first stage, peripheral vasodilation occurs, leading to a high cardiac output state. This leads to salt and water retention mediated through the renin-angiotensin-aldosterone system in the kidneys. As the vasodilation progresses, the kidneys detect a relative loss of volume and respond by conserving salt. With the salt retention, fluid is also absorbed into the circulatory system. The resulting fluid overload leads to edema of the dependent extremities.

By the time significant edema occurs, the heart has been exposed to a severely high workload in order to pump the required cardiac output needed to satisfy end organ requirements. Parts of the heart muscle undergo overuse injury, which results in the physical symptoms of tachycardia, edema, and high arterial and venous pressures. These changes can lead to myocardial injury, expressed as chest pain.

A more rapid form of wet beriberi is termed acute fulminant cardiovascular beriberi, or Shoshin beriberi. The predominant injury is to the heart, and rapid deterioration follows the inability of the heart muscle to satisfy the body's demands because of its own injury. In this case, edema may not be present. Instead, cyanosis of the hands and feet, tachycardia, distended neck veins, restlessness, and anxiety occur. Treatment with thiamine causes low-output cardiac failure, because systemic vasoconstriction is reinstated before the heart muscle recovers. Support of heart function is an added requirement at this stage, and recovery is usually fairly quick and complete if treatment is initiated promptly. However, if no treatment is available, death occurs just as rapidly (within hours or days).

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Wiley KD, Gupta M. Vitamin B1 Thiamine Deficiency (Beriberi). StatPearls. 2020 Jan. [Medline]. [Full Text].
Wooley, JA. Characteristics of thiamin and its relevance to the management of heart failure. Nutr Clin Pract. Oct-Nov 2008. 23:487-93. [Medline].
Isselbacher KJ, Braunwald E, Wilson JD. Harrison's Principles of Internal Medicine. 13th ed. New York, NY: McGraw-Hill; 1994. 474-475.
McCormick DB. Shils ME, Young VR, eds. Modern Nutrition in Health and Disease. Philadelphia, Pa: Lea and Febiger; 1988. 355-61.
Rosen P, Barkin R. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St. Louis, Mo: Mosby Year Book; 1998. 2138-40.
Thiamine. Monograph. Altern Med Rev. 2003 Feb. 8(1):59-62. [Medline].
Beers MH, Berkow R, Bogin RM, eds. The Merck Manual. 17th ed. Whitehouse Station, NJ: Merck & Co; 1999. 45-6.
Cole PD, Kamen BA. "Beriberi" interesting!. J Pediatr Hematol Oncol. 2003 Dec. 25(12):924-6. [Medline].
National Academy of Sciences. Dietary Guidance: Dietary Reference Intake Reports. USDA National Agricultural Library. Available at http://fnic.nal.usda.gov/nal_display/index.php?info_center=4&tax_level=3&tax_subject=256&topic_id=1342&level3_id=5141.
The National Academies Press. Nutrition - Dietary Reference Intakes: DRIs): Recommended Dietary Allowances and Adequate Intakes, Vitamins. Available at http://iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity Files/Nutrition/DRIs/RDA and AIs_Vitamin and Elements.pdf. Accessed: July 27, 2011.
Dhir S, Tarasenko M, Napoli E, Giulivi C. Neurological, Psychiatric, and Biochemical Aspects of Thiamine Deficiency in Children and Adults. Front Psychiatry. 2019. 10:207. [Medline]. [Full Text].
Zuccoli G, Gallucci M, Capellades J, et al. Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients. AJNR Am J Neuroradiol. 2007 Aug. 28(7):1328-31. [Medline].
Shenoy VV, Patil PV, Nagar VS, et al. Congestive cardiac failure and anemia in a 15-year-old boy. J Postgrad Med. 2005 Jul-Sep. 51(3):225-7. [Medline].
Karaiskos I, Katsarolis I, Stefanis L. Severe dysphagia as the presenting symptom of Wernicke-Korsakoff syndrome in a non-alcoholic man. Neurol Sci. February 2008. 29:45-6. [Medline].
Rao SN, Mani S, Madap K, et al. High prevalence of infantile encephalitic beriberi with overlapping features of Leigh's disease. J Trop Pediatr. 2008 May 8. [Medline].
Lu J, Frank EL. Rapid HPLC measurement of thiamine and its phosphate esters in whole blood. Clin Chem. 2008 May. 54(5):901-6. [Medline].
Karuppagounder SS, Xu H, Pechman D, et al. Translocation of amyloid precursor protein C-terminal fragment(s) to the nucleus precedes neuronal death due to thiamine deficiency-induced mild impairment of oxidative metabolism. Neurochem Res. 2008 Mar 4. [Medline].
Vasan S, Dulebohn SC. Wernicke Encephalopathy. 2018 Jan. [Medline]. [Full Text].
Indraccolo U, Gentile G, Pomili G, et al. Thiamine deficiency and beriberi features in a patient with hyperemesis gravidarum. Nutrition. 2005 Sep. 21(9):967-8. [Medline].
Hazell AS. Astrocytes are a major target in thiamine deficiency and Wernicke's encephalopathy. Neurochem Int. 2009 Jul-Aug. 55(1-3):129-35. [Medline].
Zuccoli G, Pipitone N. Neuroimaging findings in acute Wernicke's encephalopathy: review of the literature. AJR Am J Roentgenol. 2009 Feb. 192(2):501-8. [Medline].
Masumoto K, Esumi G, Teshiba R, et al. Need for thiamine in peripheral parenteral nutrition after abdominal surgery in children. JPEN J Parenter Enteral Nutr. 2009 Jul-Aug. 33(4):417-22. [Medline].
Matrana MR, Davis WE. Vitamin deficiency after gastric bypass surgery: a review. South Med J. October/ 2009. 102:1025-31. [Medline].
Ahmed A, Daida Y, Novotny R. PS2-02: Micronutrient Deficiencies After Bariatric Surgery: Does Ethnicity Matter?. Clin Med Res. 2011 Nov. 9(3-4):165. [Medline].
Francini-Pesenti F, Brocadello F, Manara R, Santelli L, Laroni A, Caregaro L. Wernicke's syndrome during parenteral feeding: not an unusual complication. Nutrition. February 2009. 25:142-6. [Medline].
Braverman LE, Utiger RD. Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text. 7th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1996. 694, 864.
Sriram K, Manzanares W, Joseph K. Thiamine in nutrition therapy. Nutr Clin Pract. 2012 Feb. 27(1):41-50. [Medline].
Al-Attas OS, Al-Daghri NM, Alfadda A, Abd Al-Rahman SH, Sabico S. Blood Thiamine and Derivatives as measured by High-Performance Liquid Chromatography: Levels and Associations in DM Patients with Varying Degrees of Microalbuminuria. J Endocrinol Invest. 2011 Nov 22. [Medline].
Wiesen P, Van Overmeire L, Delanaye P, Dubois B, Preiser JC. Nutrition disorders during acute renal failure and renal replacement therapy. J Parenter Enteral Nutr. March 2011. 35:217-22. [Medline].
Sica DA. Loop diuretic therapy, thiamine balance, and heart failure. Congest Heart Fail. 2007 Jul-Aug. 13(4):244-7. [Medline].
Hanninen SA, Darling PB, Sole MJ, et al. The prevalence of thiamin deficiency in hospitalized patients with congestive heart failure. J Am Coll Cardiol. 2006 Jan 17. 47(2):354-61. [Medline].
Aasheim ET, Bjorkman S, Sovik TT, et al. Vitamin status after bariatric surgery: a randomized study of gastric bypass and duodenal switch. Am J Clin Nutr. 2009 Jul. 90(1):15-22. [Medline].
Fattal-Valevski A, Azouri-Fattal I, Greenstein YJ, et al. Delayed language development due to infantile thiamine deficiency. Dev Med Child Neurol. 2009 Aug. 51(8):629-34. [Medline].
Nath A, Tran T, Shope TR, Koch TR. Prevalence of clinical thiamine deficiency in individuals with medically complicated obesity. Nutr Res. 2017 Jan. 37:29-36. [Medline].
Weise Prinzo Z, de Benoist B. Meeting the challenges of micronutrient deficiencies in emergency-affected populations. Proc Nutr Soc. 2002 May. 61(2):251-7. [Medline].
Whitfield KC, Smith G, Chamnan C, et al. High prevalence of thiamine (vitamin B1) deficiency in early childhood among a nationally representative sample of Cambodian women of childbearing age and their children. PLoS Negl Trop Dis. 2017 Sep. 11 (9):e0005814. [Medline]. [Full Text].
Harel Y, Zuk L, Guindy M, Nakar O, Lotan D, Fattal-Valevski A. The effect of subclinical infantile thiamine deficiency on motor function in preschool children. Matern Child Nutr. 2017 Oct. 13 (4):[Medline].
Saini M, Lin W, Kang C, Umapathi T. Acute flaccid paralysis: Do not forget beriberi neuropathy. J Peripher Nerv Syst. 2019 Mar. 24 (1):145-9. [Medline]. [Full Text].
Isenberg-Grzeda E, Shen MJ, Alici Y, Wills J, Nelson C, Breitbart W. High rate of thiamine deficiency among inpatients with cancer referred for psychiatric consultation: results of a single site prevalence study. Psychooncology. 2016 May 26. [Medline].
Jain A, Mehta R, Al-Ani M, Hill JA, Winchester DE. Determining the Role of Thiamine Deficiency in Systolic Heart Failure: A Meta-Analysis and Systematic Review. J Card Fail. 2015 Dec. 21 (12):1000-7. [Medline].
Angstadt JD, Bodziner RA. Peripheral polyneuropathy from thiamine deficiency following laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2005 Jun-Jul. 15(6):890-2. [Medline].
Koike H, Iijima M, Mori K, et al. Postgastrectomy polyneuropathy with thiamine deficiency is identical to beriberi neuropathy. Nutrition. 2004 Nov-Dec. 20(11-12):961-6. [Medline].
Edwards KA, Tu-Maung N, Cheng K, Wang B, Baeumner AJ, Kraft CE. Thiamine Assays-Advances, Challenges, and Caveats. ChemistryOpen. 2017 Apr. 6 (2):178-91. [Medline].
Tran HA. Increased troponin I in "wet" beriberi. J Clin Pathol. 2006 May. 59(5):555. [Medline].
Falder S, Silla R, Phillips M, Rea S, Gurfinkel R, Baur E, et al. Thiamine supplementation increases serum thiamine and reduces pyruvate and lactate levels in burn patients. Burns. 2010 Mar. 36(2):261-9. [Medline].
Donnino M. Gastrointestinal beriberi: a previously unrecognized syndrome. Ann Intern Med. 2004 Dec 7. 141(11):898-9. [Medline].
Wani NA, Qureshi UA, Ahmad K, Choh NA. Cranial Ultrasonography in Infantile Encephalitic Beriberi: A Useful First-Line Imaging Tool for Screening and Diagnosis in Suspected Cases. AJNR Am J Neuroradiol. 2016 Aug. 37 (8):1535-40. [Medline].

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Beriberi in an adult patient.

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Author

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

Disclosure: Nothing to disclose.

Coauthor(s)

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, Michigan State Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Romesh Khardori, MD, PhD, FACP Professor of Endocrinology, Director of Training Program, Division of Endocrinology, Diabetes and Metabolism, Strelitz Diabetes and Endocrine Disorders Institute, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

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, Society of General Internal Medicine

Disclosure: Nothing to disclose.

Acknowledgements

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.

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