What is beriberi? Who gets it?

Beriberi is a thiamine deficiency which is relatively uncommon in the United States. In the Middle East and Asia, it is seen among people who wash their rice before they eat it. They develop a thiamine deficiency while replete in other vitamin status (wet beriberi). It is characterized by malaise and fatigue, an increased cardiac output secondary to decreased systemic vascular resistance and increased venous return, and edema with enlarged cardiac silhouettes and pulmonary effusions. They respond very well to thiamine replacement.

Dry beriberi is thiamine deficiency in generalized protein calorie malnutrition and is more commonly seen in the United States. Individuals with poor caloric intake which is relatively high in carbohydrates, e.g., alcoholics, are at risk. The usual clinical picture is an elevated heart rate with warm hands (representing the decreased systemic vascular resistance), and a generalized neuropathy (including motor deficits and decreased reflexes). This can be associated with a nutritional cirrhosis or paresthesias of the extremities. Treatment is with thiamine replacement but may include early digitalis and diuretics.

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