(Singhalese: beri = extreme weakness.) Formerly a major health problem in many Asian countries, beriberi is a nutritional deﬁciency disease resulting from prolonged deﬁciency of the water-soluble vitamin, THIAMINE (vitamin B1). It is often associated with deﬁciencies of other members of the the vitamin B complex (see APPENDIX 5: VITAMINS). A major public-health problem in countries where highly polished rice constitutes the staple diet, beriberi also occurs sporadically in alcoholics (see WERNICKE’S ENCEPHALOPATHY) and in people suﬀering from chronic malabsorptive states. Clinical symptoms include weakness, paralysis – involving especially the hands and feet (associated with sensory loss, particularly in the legs) – and ‘burning sensations’ in the feet (dry beriberi). Alternatively, it is accompanied by oedema, palpitations and a dilated heart (wet beriberi). Death usually results from cardiac failure. Thiamine deﬁciency can be conﬁrmed by estimating erythrocyte transketolase concentration; blood and urine thiamine levels can be measured by high-pressure liquid chromatography.
Treatment consists of large doses of vitamin B1 – orally or intramuscularly; a diet containing other vitamins of the B group; and rest.
Infantile beriberi This is the result of maternal thiamine deﬁciency; although the mother is not necessarily aﬀected, the breast-fed baby may develop typical signs (see above). Optic and third cranial, and recurrent laryngeal nerves may be aﬀected; encephalopathy can result in convulsions, coma and death.