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/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.