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Cardiac beriberi (shoshin beriberi) caused by excessive intake of isotonic drink.

A 21 month old female had voluntarily ingested 0.5-1.51 of isotonic sports drink daily from 10 months of age. She developed hyponatremia and beriberi heart disease, which resulted in metabolic acidosis and cardiogenic shock (shoshin beriberi). Mechanical ventilation was applied for pulmonary edema. Right heart failure was improved after administering vitamin B1. However, 5 days after the shock, hypoxemia and diffuse radiographic infiltrates progressed, and a diagnosis of adult respiratory distress syndrome (ARDS) was made. After the occurrence of an air leak, the patient died of respiratory failure. The cardiogenic shock and pulmonary edema due to cardiac beriberi may have triggered the ARDS.

Beriberi↗

Blood vitamin B1, transketolase and thiamine pyrophosphate (TPP) effect in beriberi patients, with studies employing discriminant analysis.

In recent years, many cases of beriberi have been reported throughout Japan. One may assume that a great many healthy subjects suffer from a subclinical thiamine deficiency. The present study was carried out in order to examine thiamine status in 21 beriberi patients and 674 apparently normal subjects. In the beriberi patients the total vitamin B1 in whole blood and transketolase activity in the hemolysate were significantly lower, and the thiamine pyrophosphate effect was significantly higher, compared to normal subjects. However, these two groups could not be clearly separated by these biochemical parameters because of significant overlap. On analyzing the results of these biochemical parameters by discriminant analysis, beriberi could be diagnosed with an accuracy of 87,7%. Thus, vitamin B1 levels in blood, transketolase activity and the thiamine pyrophosphate effect in the hemolysate are useful biochemical indices for the diagnosis of beriberi. Above all, the thiamine pyrophosphate effect proved to be the most effective parameter in distinguishing the beriberi group from normal subjects.

Adolescent↗

Cardiac beriberi among illegal mainland Chinese immigrants.

The most common symptoms of chronic beriberi due to thiamine deficiency include dyspnoea, fatigue, leg oedema, lower extremity weakness and numbness. When collapsed peripheral circulation, metabolic acidosis, or shock are present, the disease has advanced from chronic beriberi to pernicious or fulminating beriberi heart failure (Shoshin beriberi). We report two patients with fulminating beriberi; both of whom had been incarcerated at a detention centre for 5 months before hospitalization. A prolonged monotonous diet, low in thiamine, was a major risk factor in both patients. Thiamine deficiency should be considered for any patient with symptoms and signs compatible with beriberi.

Adult↗

Beriberi cardiomyopathy.

In Indonesia beriberi is still endemic, but subclinical cases are not uncommon. Three patients suffering from beriberi presented with different clinical manifestations. One had the classical features of Shoshin beriberi and the other two had the non-alcoholic cardiac beriberi (chronic type). The cardiac symptoms of all three patients responded dramatically to thiamine tetrahydrofurfuryl disulfide; there was also some improvement of their polyneuropathy, consistent with the neurophysiologic findings and somatosensory evoked potentials (SSEPs). We conclude that SSEPs provide additional clinical information on beriberi polyneuropathy. The mortality of untreated cardiovascular beriberi is high. In view of the harmless nature of the treatment, a good case could be made for routine administration of thiamine to all patients in whom heart failure is present without clear evidence of the cause.

Adult↗

Cardiac beriberi. A report of 4 cases.

Four cases of beriberi were diagnosed on clinical grounds and 3 were confirmed biochemically. The cases cover a spectrum of beriberi heart disease ranging from a hyperdynamic circulation to circulatory shock. They are Shoshin beriberi, beriberi with high output failure, beriberi with signs of a hyperdynamic circulation alone and beriberi with underlying cardiomyopathy.

Adult↗

TPN-induced fulminant beriberi: a report on our experience and a review of the literature.

Fulminant beriberi, once considered a rare disease, is now being encountered more frequently, yet little is known about its clinical features. This study was undertaken to determine the clinical features of total parenteral nutrition (TPN)-induced fulminant beriberi by reviewing the clinical data on 10 of our own patients who developed this complication, and 33 cases documented in the literature. TPN-induced fulminant beriberi became evident 4-40 days after the initiation of TPN, and was more likely to develop in patients with malignancies, ulcerative colitis, and short bowel syndrome, as well as in those receiving chemotherapy. Although the patients manifested various symptoms, very few developed the classical signs of beriberi or the constant findings seen in alcoholic patients. The severity of metabolic acidosis was extremely high and refractory to bicarbonate administration, but it responded quickly to intravenous (i.v.) thiamine. Thus, rapid i.v. administration of at least 100 mg of thiamine is imperative, and the patient must be transferred to the intensive care unit when TPN-induced fulminant beriberi develops.

Acidosis↗

The beriberi analogy to myocardial infarction.

Two pandemics of heart attack deaths have plagued the world's population during the past 130 years. The first pandemic, induced by beriberi, was caused by the industrial revolution altering the nutritional composition of rice. By 1892 a simple working knowledge, then at hand, could have terminated the beriberi plague; however, orthodox medicine being then enchanted with the false concept that all disease was caused by germs, permitted millions of Asians to die needlessly of beriberi by refusing to tell them to eat rice bran or to drink rice bran tea. A second pandemic of heart attack deaths, called myocardial infarction (MI), struck the developed nations of the Western World in full force after 1930. As a hypothesis, it is suggested that this MI pandemic, still raging today, was caused by a change in food processing that occurred after 1920, when the new oil seed industry introduced into our food three greatly harmful lipid substances. The unnatural trans-trans isomer of linoleic acid, which had never been in human food prior to 1920 and which entered our food in margarines and refined oils, blocked the conversion of natural cis-cis linoleic acid to prostaglandin E1, which tends to prevent MI, both by acting as a vasodilator and by minimizing platelet aggregation. Harmful lactones were also introduced into our food, increasing the risk of MI by decreasing the fibrinolytic activity of our blood. The oil seed industry also introduced into our diet free radical lipid peroxides that make the myocardium more vulnerable to infarction. It is suggested that except for the one in 500 of us who is afflicted by familial hypercholesterolemia, the cholesterol concept of MI is as false today as was the concept in 1900 that germs caused beriberi. It is further suggested that a working knowledge is at hand today that can make death from MI just as rare as death is now from a beriberi-induced heart attack.

Animals↗

Acute pernicious or fulminating beriberi heart disease. A report of 6 patients.

OBJECTIVE: To investigate the incidence and presentation of acute pernicious or fulminating beriberi in a general district hospital. METHODS: All patients with a diagnosis of acute pernicious or fulminating beriberi heart disease made between 1978 and 1994 were identified, and their medical records were retrospectively examined. RESULTS: Six cases of acute pernicious or fulminating beriberi heart disease were recognized. The disease was characterized by circulatory shock and peripheral cyanosis. All patients had severe lactic acidosis, in 5 of them without hypoxaemia. Four patients were alcoholics. The most important diagnostic criterion was the impressive improvement after thiamine administration. CONCLUSIONS: Acute pernicious or fulminating beriberi heart disease can be recognized occasionally. Thiamine should be administered as soon as possible in suspected cases.

Acute Disease↗

Beriberi in a well-nourished Amazonian population.

Beriberi is an endemic disease among the Naporuna indigenous people of Ecuadorean Amazonia (annual morbidity rate of 1.5%). A total of 47 patients with dry beriberi were seen at the Franklin Tello Hospital, Napo, during 1995-1996; a similar incidence was observed in previous years. No wet beriberi was found. Although the diagnosis of the disease was made clinically, an effective and quick response to thiamine treatment excluded other differential diagnoses, such as tropical ataxic neuropathy. Although indigenous people have several possible dietetic risk factors, none of them adequately explain the disease's high incidence. Some suggestions are made for the high incidence of beriberi among this Amazonian people but its cause remains unknown.

Adolescent↗

A case of beriberi accompanying short bowel.

A case of beriberi based on short bowel is reported. A 4 year old girl, who underwent a resection of the intestine when a neonate and has had a short bowel, manifested beriberi despite eating normal Japanese food. Considering that she has had no dislikes of foods, and her family members, who have eaten meals similar to hers have been healthy, beriberi is considered in this case to have developed mainly through hypoabsorption of vitamin B1. This patient has responded well to vitamin B1 therapy with a relatively slow recovery in neural functions. Although it has not been confirmed whether short bowel syndrome is prone to be accompanied by beriberi, special attention should be given to vitamin B1 in short bowel syndrome patients.

Beriberi↗

Fulminant beriberi heart disease with lactic acidosis: presentation of a case with evaluation of left ventricular function and review of pathophysiologic mechanisms.

Cardiac beriberi is considered a rare disease in western society. A patient with fulminant Shoshin-type beriberi was studied in the acute phase and found to have severe metabolic acidosis, high output biventricular failure, and markedly low systemic vascular resistance. Red blood cell transketolase activity was abnormally low. Following treatment with thiamine, diuretics, digitalis and oxygen, all abnormalities disappeared. The historical background of the disease is reviewed along with a discussion of pathophysiologic mechanisms responsible for the hemodynamic profile and lactic acidosis. Angiographic and hemodynamic data on the patient presented suggest relative depression of left ventricular function in the acute phase of beriberi. Since beriberi is uncommonly encountered, emphasis is placed on diagnostic and therapeutic implications of the disease which may not be widely appreciated.

Acidosis↗

[Nina Rodrigues, epidemiologist: historical study of beriberi outbreaks in a mental asylum in Bahia, Brasil (1897-1904)].

Beriberi outbreaks in the São João de Deus Asylum, 1897-1904, are presented, focusing on studies by legist physician Nina Rodrigues. The goals were: to trace the steps of the original investigation of an unknown disease; to understand the purpose of excluding mentally ills in an asylum institution. Methodology encompassed occurence narration and qualitative analytical procedures for the documental interpretation of voluntary and involuntary testimonies, combined with statistical treatment of measurable data. Frequent and progressive outbreaks of beriberi have caused two-thirds of the asylum deaths in 1904. The research method included domiciliary visits and interviews with dwellers in the asylum surroundings. Beriberi occurence was frequent among the insane and practically inexistent among the asylum staff, who presented close and long lasting contact with the ills. Nina Rodrigues refuted the declining miasmatic conception which emphasized external conditions, the emergent conception of contagion, and raised the hypothesis of a carential etiology for beriberi. Nina Rodrigues' study is a good historical example of "epidemiological reasoning," with question formulation, building of data bulk guided by working hypothesis, obtained by means of simple and efficient techniques.

Beriberi↗

[An elderly patient with beriberi].

An 82-year-old man was admitted to the hospital in the summer of 1995 due to dyspnea, peripheral edema, and a tingling sensation and muscle weakness in all extremities. Physical examination showed heart failure and polyneuropathy. Laboratory data showed a low concentration of vitamin B1 (10 ng/ml normal 23.8-45.9 ng/ml) and a low level of erythrocyte transketolase activity (0.58 IU/gHb normal 0.75-1.30 IU/gHb). A chest X-ray film revealed cardiomegaly (cardiothoracic ratio 57.1%) and ultrasonic cardiography revealed increased motion of the left ventricle. A diagnosis of beriberi was made. The disease in this case may have been caused by hard work in the summer heat. The patient was treated with thiamine and his symptoms and signs resolved within a few weeks. A search of the literature revealed no previous report of beriberi in a patient of this age, but reports of beriberi in older patients in Japan are more common now than in previous years. Beriberi should be included in the differential diagnosis of polyneuropathy in elderly patients.

Age of Onset↗

[Right heart failure caused by thiamine deficiency (cardiac beriberi)].

BACKGROUND: Vitamin B1 deficiency (beriberi) is very uncommon in France. It leads to high output cardiac failure totally different from the situation observed in alcoholic patients. We report a typical case of cardiac beriberi. CASE REPORT: The patient was referred for dyspnea with high output cardiac failure. Echocardiography evidenced severe pulmonary hypertension and high cardiac output. The more common causes of heart failure were ruled out. The dietary habits of the patient (suggested beriberi which was confirmed by the low serum thiamin and therapeutic test with vitamin B1. DISCUSSION: High output cardiac failure should suggest possible Shoshin beriberi, particularly in subjects with imported dietary habits living in a precarious socioeconomic situation.

Beriberi↗

Clinical diagnosis of cardiac beriberi.

The clinical features of 28 patients with biochemically proven cardiac beriberi were prospectively studied. Patients recruited over a 2-year-period fell into two groups: (i) those with signs of hyperdynamic circulation; and (ii) those presenting with heart failure and circulatory shock with or without metabolic acidosis. All patients showed a dramatic response to intravenous thiamine; in group 1 the hyperdynamic state resolved within hours and in group 2 there was an immediate rise in the blood pressure with gradual resolution of the acidosis in 6-8 hours. Two patients in whom the diagnosis was missed died soon after admission to hospital. A notable finding was that even in the presence of peripheral circulatory shock, patients with beriberi had preservation of the femoral pulses often with 'pistol shots' and femoral bruit; this finding has clinical value in the diagnosis of acute cardiovascular beriberi (shoshin beriberi).

Acidosis, Respiratory↗

Subclinical beriberi polyneuropathy in the low income group: an investigation with special tools on possible patients with suspected complaints.

OBJECTIVE: To determine the prevalence rate of subclinical beriberi polyneuropathy (PNP) in the low income group and to present new methods for early detection. DESIGN: We conducted a prospective, randomized observational study on all patients from family members of non-PNP patients presenting to the outpatient neurologic clinic of the Dr Soetomo Hospital in 1989 in Surabaya, Indonesia. MATERIAL AND METHODS: The 53 group I patients belonged to the low income series, whereas the 56 group II patients were from the mid- and high-income groups. We analyzed their diets and determined their blood thiamine levels. Neurologic, internal, psychiatric as well as neurophysiologic examinations were performed on all patients. RESULTS: The prevalence rate of subclinical beriberi PNP of the apparently healthy subjects of the low income group was 66% compared with 12.5% among the mid and high income groups. The exposure odds ratio was 13.6 (95% Cl, 2.78 to 8.04) indicating that the low income group ran a greater risk of developing beriberi PNP than the mid and high income groups. CONCLUSION: Most of our low income group patients had an inadequate diet, especially concerning deficient thiamine intake. Analysis of the diets revealed, that they were usually rich in carbohydrate especially steamed milled rice, whereas intake of fat and thiamine was low, protein was just sufficient. The calorie intake was marginal. Carbohydrate rich and non fat calories in the diet with low thiamine intake may provoke beriberi.

Adolescent↗