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Dry Beriberi

Dry Beriberi. Presented By: Allister Liu Jennifer Ng Jessica Ng. What is Dry Beriberi?. A vitamin deficiency disease caused by inadequate bodily stores of thiamine. It can damage the heart and nervous system. What is Thiamine?. Also called Vitamin B1 Found in both plants and animals

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Dry Beriberi

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  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/OCbioch/POLY.Chp.5.2.html

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

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

  7. Pentose Phosphate Pathway http://www.uic.edu/classes/phar/phar332/Clinical_Cases/vitamin%20cases/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. 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 Signs and Symptoms

  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. 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 Diagnosis and Tests

  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.healthmart2000.com/item50.htm http://www.neogen.com/thiamine.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. <http://health.allrefer.com/health/beriberi.html>. Ericson, Karen., RN. “Beriberi.” Health AtoZ – Your Family Health Site. 2006. <http://www.healthatoz.com/healthatoz/Atoz/ency/beriberi.jsp>. Hart, Jacqueline A., M.D. “Beriberi.” MedlinePlus Medical Encyclopedia.06 January 2006. <http://www.nlm.nih.gov/medlineplus/ency/article/000339.htm> Kirk, Terence S. “The Secret POW Camera.” Photo. Leatherneck – Magazine of the Marines. 2004. <http://www.mca-marines.org/Leatherneck/SecCam.htm>. Ophardt, Charles, E. “Formation of Acetyl CoA from Pyruvic Acid.” Photo. Virtual Chembook Elmhurst College. 2003. <http://elmhcx9.elmhurst.edu/~chm/vchembook/613acetylcoa.html>. Sewell, R Andrew., MD and Lawrence D Recht, MD. “Nutritional Neuropathy.” eMedicine. 15 September 2005. <http://www.emedicine.com/NEURO/topic278.htm>.

  19. References (2) “Thiaminases.” Cornell University. 4 October 2001. <http://www.ansci.cornell.edu/plants/toxicagents/thiaminase/thiaminase.html> “Thiamine Hydrochloride.” Photo. Neogen Corporation. 13 February 2006. <http://www.neogen.com/thiamine.htm>. “Thiamine Pyrophosphate.” Photo. Chups. <http://stud.eao.chups.jussieu.fr/polys/biochimie/OCbioch/POLY.Chp.5.2.html> “Vitamin B1, Thiamine.” Photo. Healthmart2000. 13 February 2006. <http://www.healthmart2000.com/item50.htm>. “Vitamin B1 (Thiamine).” University of Maryland Medical Center. 2004. <http://www.umm.edu/altmed/ConsSupplements/VitaminB1Thiaminecs.html>. Woodbury, Charles. “Thiamine Pyrophosphate.” University of Illinois at Chicago. 05 January 2005. <http://www.uic.edu/classes/phar/phar332/Clinical_Cases/vitamin%20cases/thiamin/thiamin_pyrophosphate.htm>

  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 • Tests • Measurement of blood thiamine and whole-blood or erythrocyte transketolase activity • Measurement of urinary thiamine excretion • Clinical response to administered thiamine • Treatment • Administration of thiamine by injection and with pills. • Patients should also receive therapeutic doses of other water-soluble vitamins.

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