Acute cardiac beriberi

While peripheral neuritis and acute cardiac beriberi with lactic acidosis occur in thiamin deficiency associated with alcohol abuse, the more usual presentation is as the Wernicke—Korsakoff syndrome, due to central nervous system lesions. Initially there is a confused state, Korsakoff s psychosis, which is characterized by confabulation and loss of recent memory, although memory for past events may be unimpaired. Later, clear neurological signs develop — Wernicke s encephalopathy. This is characterized by nystagmus and extraocular palsy. Post-mortem examination shows characteristic brain lesions. 

Citreoviridin is a potent inhibitor of soluble mitochondrial ATPase. In experimental animals it has caused a disease called acute cardiac beriberi, whose symptoms are similar to the symptoms of classic beriberi (convulsions and paralysis), but the disease is not curable with thiamine. 

Beriberi is caused by a deficiency of thiamin (also called thiamine, aneurin(e), and vitamin Bj). Classic overt thiamin deficiency causes cardiovascular, cerebral, and peripheral neurological impairment and lactic acidosis. The disease emerged in epidemic proportions at the end of the nineteenth century in Asian and Southeast Asian countries. Its appearance coincided with the introduction of the roller mills that enabled white rice to be produced at a price that poor people could afford. Unfortunately, milled rice is particularly poor in thiamin thus, for people for whom food was almost entirely rice, there was a high risk of deficiency and mortality from beriberi. Outbreaks of acute cardiac beriberi still occur, but usually among people who live under restricted conditions. The major concern today is subclinical deficiencies in patients with trauma or among the elderly. There is also a particular form of clinical beriberi that occurs in patients who abuse alcohol, known as the Wer-nicke-Korsakoff syndrome. Subclinical deficiency may be revealed by reduced blood and urinary thiamin levels, elevated blood pyruvate/lactate concentrations and a-ketoglutarate activity, and decreased erythrocyte transketolase (ETKL) activity. Currently, the in vitro stimulation of ETKL activity by thiamin diphosphate (TDP) is the most useful functional test of thiamin status where an acute deficiency state may have occurred. The stimulation is measured as the TDP effect. 

Acute infantile beriberi in infants breast-fed by deficient mothers may involve high-output cardiac failure, as in shoshin beriberi, as well as signs of central nervous system involvement similar to those seen in Wernicke s encephalopathy (Section 6.4.4). 

Heart failure without increased cardiac output, and no peripheral edema, may also occur acutely, associated with severe lactic acidosis. This was a common presentation of deficiency in Japan, where it was called shoshin (= acute) beriberi in the 1920s, nearly 26,000 deaths a year were recorded. 

Indications Cold rheum internally amassed. Chronic tracheitis, acute and chronic bronchitis, bronchial asthma, pulmonary emphysema, chronic pulmonary obstructive disease, edema, ascites, chronic nephritis, atrophic kidney, pleurisy, beriberi, and cardiac asthma... 

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