Edema, thiamin deficiency

Thiamin deficiency can result in three distinct syndromes a chronic peripheral neuritis, beriberi, which may or may not be associated with heart ilure and edema acute pernicious (fulminating) beriberi (shoshin beriberi), in which heart failure and metabolic abnormalities predominate, without peripheral neuritis and Wernicke s encephalopathy with KorsakofPs psychosis, which is associated especially with alcohol and dmg abuse. The central role of thiamin diphosphate in... 

Diseases and disorders resulting from a deficiency of thiamine include beriben, opisthotonos (in birds), polyneuritis, hyperesthesia, bradycardia, and edema. Rather than a specific disease, beriberi may be described as a clinical state resulting from a thiamine deficiency. In body cells, thiamine pyrophosphate is required for removing carbon dioxide from various substances, including pyruvic acid. Actually, this is accomplished by a decarboxylase of which thiamine pyrophosphate is a part. Where... 

Thiamine deficiency resulting in beriberi usually occurs because of excessive alcohol intake, which interferes with thiamine absorption. In the early stages, the person tires easily and the limbs feel heavy and weak. In an advanced stage of wet beriberi,.symptoms include neuromuscular problems enlarged heart (with tachycardia), peripheral edema, and weakness and malaise. These symptoms usually respond to thiamine administration. 

Beriberi occurs whenever thiamine intake is less than 0.4 mg/d for an extended period of time. It occurs where polished rice is a dietary staple, and, in Western society, in poor and elderly populations and alcoholics. Beriberi has wet, dry, and cardiac types, and an individual may have more than one type. Wet refers to pleural and peritoneal effusions and edema dry refers to polyneuropathy without effusions. Cardiomyopathy is the principal feature of the cardiac type. An infantile form occurs in breast-fed infants, usually 2-5 months of age, nursing from thiamine-deficient mothers. The symptoms of beriberi remit completely upon thiamine supplementation. A subclinical deficiency of thiamine occurs in hospital patients and the elderly. Deficiency of thiamine and other vitamins may contribute to a generally reduced state of health in these populations. 

A syndrome called beriberi, characterized by edema and polyneuritis, has been known for a long time. Although beriberi is a multifactor deficiency, thiamine deficiency is mainly responsible for the disease. 

Considerable evidence for blood-brain barrier (BBB) damage in thiamine deficiency and WE has been described, with disturbances localized to brain regions vulnerable to thiamine deficiency, including the presence of hemorrhagic lesions (Torvik 1985 Vortmeyer and Colmant 1988). Such a process may also contribute to previous reports of brain edema identified in both thiamine deficiency and in cases of WE. 

Clinical Effects of Thiamin Deficiency. If a deficiency of thiamin is not corrected (if thiamin is not present in sufficient amounts to provide the key energizing coenzyme factor in the cells), the clinical effects will be reflected in the gastrointestinal system, the nervous system, and the cardiovascular system. Severe thiamin deficiency of long duration will culminate in beriberi, the symptoms of which are polyneuritis (inflammation of the nerves), emaciation and/or edema, and disturbances of heart function. 

Classic beri-beri, rarely seen in the United States and Europe, except in alcoholism (P4), is endemic in the Far East because of the prevalent diet of decorticated rice (F6). It occurs in two forms wet beri-beri, characterized by edema and cardiovascular symptoms (G6), and dry beri-beri with peripheral neuritis, paralysis, and atrophy of the muscles. Conditions which may predispose to deficiency by increasing thiamine requirements are pregnancy (see section 2.4), and lactation, hyperthyroidism, malignant disease, febrile conditions, increased muscular activity, high carbohydrate diets, and parenteral administration of glucose solutions. A constant supply of thiamine is required for optimal nutrition because storage in the liver and elsewhere is limited. Thiamine is synthesized by bacteria in the intestinal tract of various animals, but this is not a dependable source for man. 

Severe thiamine vitamin Bf) deficiency results in beriberi. The symptoms can include growth retardation, muscular weakness, apathy, edema, and heart failure. Neurological symptoms, such as personality changes and mental deterioration, also may be present in severe cases. Because of the role played by thiamine in metabolic processes in all cells, a mild deficiency may occur when energy needs are increased. Since thiamine is widely distributed in food, beriberi is rare except in communities existing on a single staple cereal food. The disease does occur with some frequency in alcoholics, whose poor diet may lead to an inadequate daily intake of thiamine. 

Answer The symptoms resemble those you remember from medical school for beriberi, but you fail to see the coimection. Then a light clicks on. If the patient were consuming most of his calories as alcohol, he may have a nutritional deficiency, a beriberi-Uke syndrome, as a result of insufficient intake of thiamine. You prescribe a daily vitamin tablet and admonish the patient to cut back on alcohol intake. At the next appointment, the edema is much better and the cardiac stress tests results are normal. He has joined Alcohohcs Anonymous and indicates that he is doing better. 

Vision loss may occur in deficiency states (thiamine or vitamin B12) or as a toxic response to certain drugs or substances (Box 22-5). In most cases one can establish that the patient has been exposed to toxins or has had some dietary deficiency. The precise pathogenesis of the atrophic process is somewhat obscure, although adenosine triphosphate formation appears to undergo a change. This change leads to a stasis of axoplasmic flow with subsequent optic disc edema, eventually resulting in axonal death. 

When we have used beverages and salt-containing food to excess, tissues react by swelling with water (edema). Edema may result from deficiencies of protein, thiamine, and/or vitamin Bf,. It also can be caused by kidney problems, congestive heart failure, pregnancy, standing too long, muscle injury, oral... 

Fig B-25 Beriberi, a deficiency disease due to a lack of vitamin B-1 (thiamin) in the diet. Note the cracked skin and swollen l s (edema). In the Far East, beriberi is largely due to the almost exclusive use of polished rice. (Courtesy, FAO, Rome, Italy.)... 

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