Dry beriberi
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Understanding Dry Beriberi: Causes, Symptoms, and Treatment
Introduction to Dry Beriberi and Thiamine Deficiency
Dry beriberi is a condition resulting from a deficiency of thiamine (vitamin B1), which is essential for the proper functioning of the nervous system. Thiamine deficiency can lead to two main types of beriberi: dry beriberi, which primarily affects the nervous system, and wet beriberi, which affects the cardiovascular system 3. This article focuses on dry beriberi, its causes, symptoms, and treatment options.
Causes of Dry Beriberi
Alcohol Use Disorder and Poor Diet
One of the primary causes of dry beriberi is chronic alcohol use, which impairs thiamine absorption and utilization. Additionally, poor dietary intake, particularly diets high in unenriched carbohydrates and low in essential nutrients, can lead to thiamine deficiency 19. A case study highlighted a 20-year-old female with alcohol use disorder and a limited diet who developed dry beriberi, presenting with severe ascending paralysis 1.
Prolonged Parenteral Nutrition
Patients receiving prolonged total parenteral nutrition (TPN) without adequate thiamine supplementation are also at risk. For instance, a patient with Crohn's disease on TPN for eight months developed peripheral neuropathy and ataxia, which were promptly resolved with intravenous thiamine 4.
Malnutrition and Chronic Illnesses
Malnutrition due to chronic illnesses such as cancer, prolonged hyperemesis gravidarum, and conditions requiring bariatric surgery can also lead to thiamine deficiency. A case of dry beriberi was reported in a patient with acute fatty liver of pregnancy, successfully treated with intravenous thiamine 7.
Symptoms of Dry Beriberi
Neuropathy and Ascending Paralysis
Dry beriberi is characterized by symmetrical peripheral neuropathy, affecting both sensory and motor functions, primarily in the distal extremities. Patients may present with symptoms such as paresthesia, muscle weakness, and ascending paralysis, which can mimic conditions like Guillain-Barré syndrome (GBS) 36. In one case, a 56-year-old woman initially diagnosed with GBS was later found to have dry beriberi and Wernicke's encephalopathy, which improved rapidly with thiamine treatment 3.
Cognitive and Motor Impairments
In severe cases, thiamine deficiency can lead to Wernicke's encephalopathy, characterized by cognitive impairment, oculomotor abnormalities, and cerebellar dysfunction. If untreated, this can progress to Korsakoff syndrome, causing irreversible neurological damage 610.
Treatment and Management
Thiamine Replacement Therapy
The primary treatment for dry beriberi is thiamine replacement therapy. High-dose intravenous thiamine can lead to rapid clinical improvement, often within 48 hours, as seen in several case reports 347. Early recognition and treatment are crucial to prevent irreversible neurological damage.
Addressing Underlying Causes
In addition to thiamine supplementation, addressing the underlying causes of thiamine deficiency is essential. This includes improving dietary intake, managing alcohol use disorder, and ensuring adequate thiamine supplementation in patients receiving TPN or those with chronic illnesses 19.
Conclusion
Dry beriberi is a serious condition resulting from thiamine deficiency, often associated with alcohol use disorder, poor diet, and chronic illnesses. Early recognition and prompt thiamine replacement therapy are critical for preventing irreversible neurological damage. Clinicians should consider thiamine deficiency in patients presenting with symptoms of peripheral neuropathy or conditions mimicking GBS, especially in those with known risk factors.
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Most relevant research papers on this topic
A Case of Dry Beriberi from Alcohol Use Disorder and Disordered Eating
Dry beriberi can cause ascending paralysis without albuminocytologic dissociation in young, healthy adults with alcohol use disorder and poor diet.
Case Report
Rigorous JournalJohn Blackall's observations on the relation between nutritional deprivation and wet beriberi.
John Blackall's observations on the relation between nutritional deprivation and wet beriberi suggest that nutritional deprivation may be a contributing factor in the development of wet beriberi.
Dry Beriberi Due to Thiamine Deficiency Associated with Peripheral Neuropathy and Wernicke’s Encephalopathy Mimicking Guillain-Barré syndrome: A Case Report and Review of the Literature
Dry beriberi due to thiamine deficiency can mimic acute or chronic GBS, but rapid thiamine repletion leads to rapid clinical improvement and can prevent irreversible neurologic sequelae.
Case ReportDry beriberi: unusual complication of prolonged parenteral nutrition.
Chronic dry beriberi in a patient on total parenteral nutrition is an unusual complication, with a prompt response to intravenous thiamine treatment.
Case ReportBeriberi in a well-nourished Amazonian population.
Beriberi is an endemic disease among the Naporuna indigenous people of Ecuador, with no clear cause or risk factors identified.
Observational StudyDry beriberi mimicking Guillain–Barre syndrome as the first presenting sign of thiamine deficiency
Dry beriberi can be the first presenting sign of thiamine deficiency, and early recognition is crucial for preventing Wernicke's encephalopathy.
Case ReportRigorous JournalDry beriberi in a patient of acute fatty liver of pregnancy
Intravenous thiamine effectively treated dry beriberi caused by protracted vomiting in a patient with acute fatty liver of pregnancy.
Case ReportWas it really beriberi?
Dry beriberi may mimic Guillain-Barre syndrome, but the case highlights the need for awareness and caution in diagnosing GBS.
Case ReportDry Beriberi Manifesting as Acute Inflammatory Demyelinating Polyneuropathy in a Patient With Decompensated Alcohol-Induced Cirrhosis
Dry beriberi, a reversible cause of sensorimotor dysfunction, is a common and potentially under-recognized cause of lower extremity weakness in patients with alcohol-induced cirrhosis.
Case ReportRigorous Journal[Wernicke encephalopathy and dry beriberi; late complications after bariatric surgery performed on a patient with a psychiatric history].
Bariatric surgery increases the risk of thiamine deficiency, which can lead to memory impairments and Korsakoff's syndrome, particularly when combined with excessive alcohol consumption and poor vitamin supplementation compliance.
Case Report