1. Dry Beriberi Presented By: Allister Liu Jennifer Ng Jessica Ng

2. What is Dry Beriberi?  A vitamin deficiency disease caused by inadequate bodily stores of thiamine.  It can damage the heart and nervous system.

3. What is Thiamine?  Also called Vitamin B1  Found in both plants and animals  Mainly lean pork, beef, liver, peas, beans, whole or enriched grains and breads  Assists in metabolism and processing of food taken in by the body  Required to form an important coenzyme known as Thiamine Pyrophosphate (TPP)

4. Thiamine Pyrophosphate http://stud.eao.chups.jussieu.fr/polys/biochimie/OCbioch/POLY.Chp.5.2.html

5. http://elmhcx9.elmhurst.edu/~chm/vchembook/613acetylcoa.html

6. http://www.uic.edu/classes/phar/phar332/Clinical_Cases/vitamin%20cases/thiamin/thiamin_pyropho sphate.html Citric Acid Cycle

7. Pentose Phosphate Pathway http://www.uic.edu/classes/phar/phar332/Clinical_Cases/vitamin%20cases/thiamin/thiamin_pyropho sphate.html

8. Overview  Two major manifestations: 1) wet beriberi: a cardiovascular disease 2) dry beriberi: a nervous system disease  Both types caused by a deficiency in thiamine (vitamin B1), which can be precipitated by excessive alcohol consumption or a diet high in white rice.  Nervous system symptoms caused by the degeneration of nerve fibers and their insulation  Heart failure is the most common cause of death in people with beriberi.

9. Photo provided by Allister Liu

10. Signs and Symptoms 1)Early neurologic symptoms :  Complaints of symmetric tingling or burning pain in the extremities  Numbness in the extremities  Vomiting  Strange eye movements (nystagmus) 2)Later neurologic symptoms:  Mental confusion/speech difficulties  Difficulty walking  Coma  Death 3)Heart Failure Symptoms:  Shortness of breath with exertion  Symmetric swelling of the lower legs  Awakening at night short of breath 4) GI Symptoms:  Loss of appetite  Indigestion  Severe constipation  Lack of hydrochloric acid in the stomach

11. Signs and Symptoms http://www.nutriweb.org.br/n0201/beriberi2.jpg http://www.mca-marines.org/Leatherneck/SecCam.htm

12. Complications 1)Psychosis 2)Coma 3)Congestive heart failure 4)Death

13. Diagnosis and Tests  Tests include: 1)Measurement of blood thiamine and whole-blood or erythrocyte transketolase activity 2)Measurement of urinary thiamine excretion 3)Clinical response to administered thiamine  person with late-stage beriberi may be confused or have memory loss and delusions.  A physical examination may show signs of congestive heart failure  Neurological examination may show a loss of vibratory sensation, decreased reflexes, loss of coordination, gait changes, nystagmus, ptosis, and opthalmoplegia

14. Cardiac enlargement in a pig. On the left, the heart of a normal pig. On the right, the heart of a thiamin deficient pig. http://www.ansci.cornell.edu/plants/toxicagents/thiaminase/thiaminase.html http://www.ansci.cornell.edu/plants/toxicagents/thiaminase/thiaminase.html

15. Treatment 1)Administration of thiamine by injection and with pills. 2)Patients should also receive therapeutic doses of other water-soluble vitamins. http://www.neogen.com/thiamine.htm http://www.healthmart2000.com/item50.htm

16. Prognosis  Cardiac damage usually reversible  Full recovery is expected after treatment  However in conjunction with acute heart failure recovery rate is greatly reduced  Nervous system damage also reversible, if caught early.  If not, symptoms such as memory loss may not be completely recovered with treatment.  Untreated beriberi is often fatal.

17. Prevention  Adequate intake of thiamine, particularly by pregnant or breast-feeding women  Heavy drinkers should try to cut down or quit and supplement diets with B-vitamins to ensure appropriate intake of thiamine.

18. References (1) “Beriberi.” AllRefer Health. 2005.. Ericson, Karen., RN. “Beriberi.” Health AtoZ – Your Family Health Site. 2006. <http://www.healthatoz.com/healthatoz/Atoz/ency/beriberi.jsp>. Hart, Jacqueline A., M.D. “Beriberi.” MedlinePlus Medical Encyclopedia. 06 January 2006. Hart, Jacqueline A., M.D. “Beriberi.” MedlinePlus Medical Encyclopedia. 06 January 2006. Kirk, Terence S. “The Secret POW Camera.” Photo. Leatherneck – Magazine of the Marines. 2004.. Ophardt, Charles, E. “Formation of Acetyl CoA from Pyruvic Acid.” Photo. Virtual Chembook Elmhurst College. 2003. <http://elmhcx9.elmhurst.edu/~chm/vchembook/613acetylcoa.html>. Sewell, R Andrew., MD and Lawrence D Recht, MD. “Nutritional Neuropathy.” eMedicine. 15 September 2005..

19. References (2) “Thiaminases.” Cornell University. 4 October 2001. <http://www.ansci.cornell.edu/plants/toxicagents/thiaminase/thiaminase.html> “Thiamine Hydrochloride.” Photo. Neogen Corporation. 13 February 2006.. “Thiamine Pyrophosphate.” Photo. Chups. <http://stud.eao.chups.jussieu.fr/polys/biochimie/OCbioch/POLY.Chp.5.2.html> “Vitamin B1, Thiamine.” Photo. Healthmart2000. 13 February 2006. <http://www.healthmart2000.com/item50.htm>. “Vitamin B1 (Thiamine).” University of Maryland Medical Center. 2004. <http://www.umm.edu/altmed/ConsSupplements/VitaminB1Thiaminecs.html>. Woodbury, Charles. “Thiamine Pyrophosphate.” University of Illinois at Chicago. 05 January 2005. 05 January 2005.

20. “Lucky Charms?” http://www.suburbangarbage.com/Leprechaun-2004.jpg

21. Summary Slide  A vitamin deficiency disease caused by inadequate bodily stores of thiamine.  Thiamine:  Vitamin B1  Found in both plants and animals  Mainly lean pork, beef, liver, peas, beans, whole or enriched grains and breads  Assists in metabolism and processing of food taken in by the body  Required to form an important coenzyme known as Thiamine Pyrophosphate (TPP)  made up of pyrimidine + thiazole + 2 phosphates  TPP is required in the Krebs Cycle to convert pyruvic acid into Acetyl CoA, generating NADH for the electron transport chain  Signs and Symptoms 1) Early neurologic symptoms : tingling/pain and numbness in extremities, vomiting, nystagmus 2)Later neurologic symptoms: mental confusion, speech difficulties, difficulty walking, coma, death 3)Heart Failure Symptoms: SOB (leading to disturbed sleep), symmetric swelling of lower legs 4)GI Symptoms: loss of appetite, indigestion, severe constipation, lack of HCl in stomach  Complications: Psychosis, Coma, Congestive Heart Failure, Death  Diagnosis  person with late-stage beriberi may be confused or have memory loss and delusions.  A physical examination may show signs of congestive heart failure  Neurological examination may show a loss of vibratory sensation, decreased reflexes, loss of coordination, gait changes, nystagmus, ptosis, and opthalmoplegia  Tests 1)Measurement of blood thiamine and whole-blood or erythrocyte transketolase activity 2)Measurement of urinary thiamine excretion 3)Clinical response to administered thiamine  Treatment 1)Administration of thiamine by injection and with pills. 2)Patients should also receive therapeutic doses of other water-soluble vitamins.