Beriberi

BeriberiBeriberi (from Sinhala beri - weakness; synonym: alimentary polyneuritis, polyneuritis endemica, B1-deficiency) is a disease characterized by polinevrita, disorders of the cardiovascular system, swelling or cachexia (Fig. 1 and 2). Species is spread in Europe in a few cases. The emergence of beriberi is due to a deficiency of vitamins complex Century Predisposing factors: pregnancy, lactation, high ambient temperature, acute and chronic lesions of the small intestine, thyrotoxicosis, peptic ulcer disease.
The clinical picture is from disorders of the peripheral nervous system disorder of sensitivity, paresis, paralysis extensor hands and feet), of cardiomyopathy right part of heart with subsequent development of right ventricular failure and the severity of the oedema syndrome. There is a source, polyneuritises, or "dry" (vasotecno), and cardiac (edema) forms of beriberi; for there are acute and chronic, gravity is easy and malignant. Forecast in a timely started treatment is good. Without treatment, the prognosis hard: the death from heart failure.
Treatment inpatient bed, large doses of vitamin B1 (see Thiamine), and other b vitamins Century, the diet should contain large amounts of protein.
Prevention: a balanced diet, rich in vitamins, especially B1. In the human intake of vitamin B1 in the gastrointestinal tract - injection solutions of vitamin B1. Cm. also Vitamin deficiency.

Beriberi is a disease caused by lack of food vitamin (thiamine), and characterized by a common disorder of the peripheral nerves (polyneuritis) of the limbs, disorders of the cardiovascular system and edema.
Beriberi is mainly distributed in East and South-East Asia, South America, Africa; in Europe there are isolated cases of the disease.
The disease develops in the absence in the diet of vitamin B1 (main etiological factor) along with the absence of other b vitamins, so it should be considered as comprehensive In-deficiency disease. Are also important predisposing factors: pregnancy, lactation, excessive physical labour, alcoholism, diseases of the stomach and intestines, associated with the violation of suction (prolonged diarrhea, vomiting, infection, febrile disease, thyrotoxicosis).
There are extreme total exhaustion, common or part edema. Heart increased mainly due to the expansion of the right-wing its departments, dramatically expanded the conus arteriosus. The adrenal, pituitary, and thyroid gland is enlarged. Muscle fibers of the heart are separated by a large number of serous fluid, celebrated fat and Vodianova degeneration of myocardium; degenerative changes in the peripheral nervous system - the collapse of the axons of nerve fibers and their myelin sheaths.
The clinical picture and over. There are four forms of beriberi, often passing each other: 1) not quite pronounced, rudimentary; 2) atrophic, or "dry", paralytic; 3) "wet"or swollen; 4) acute pernicious, or cardiac.
When rudimentary form beriberi first, fatigue, headache, insomnia, loss of appetite, weight and a sense of fullness in the epigastric region, palpitations, heart failures and shortness of breath during movement. Then joins the main symptom is weakness and various painful and unpleasant sensations in the extremities: "not my feet, legs, as in rubber, legs in tight stockings." When pressed calf muscles painful. Changes in the functions of internal organs, with the exception of slightly unclean tones heart, not celebrated.
Atrophic, "dry"form of beriberi characterized by severe cachexia (type of patient is reminiscent of a skeleton covered with skin), lesions of the nervous system with the development of a kind of polyneuritis. The first symptoms - parestesia in limbs, mainly in the shins and feet; the calf muscles become rigid. Then are developed paresis, mainly extensor stop; gait patient reminds gait sheep: the patient enters the fingers, on the outer edge of the foot, sparing the heel (Fig. 1). Such motor and sensory disorders can develop in the upper extremities, and sometimes a patient is not able to fasten the clothes to raise small items, unable to feed himself.
When edematous form beriberi main symptom become edema (Fig. 2);
along with the phenomena polinevrita typical cardio-vascular disorders. A mild form of cardiovascular disorders in beriberi is expressed only in heart rate and shortness of breath. When forms moderate and severe characterized by disorders of the cardiovascular system, develop progressive circulatory insufficiency on the type of right heart failure.
Acute patients beriberi (terminology Japanese authors, "chosen" - cardiac jolt) is the most severe, often fatal form; flows with strong and fast-growing signs of heart failure.

Beriberi in children. The disease is observed in children of the first months of life of mothers who have beriberi (no breast-milk vitamin B1). The child appears anorexia, he refuses to take the chest; abdomen is distended, due to pain and cramps child is forced stationary position. It is coupled with cardio-vascular disorders common to beriberi, complicating aphonia and meningismus. Within 1-2 days from the onset of the disease comes drowsiness, changing coma, and death.
The diagnosis of beriberi in apparent cases is simple and is based primarily on the anamnesis (diet, presence of diseases, affecting absorption of vitamins B1, and so on). The differential diagnosis should be carried out with infectious and alcohol polinevrita, lead poisoning. Edematous form beriberi should be distinguished from heart disease, kidney infections.
In disputable cases, appoint B1-vitamin therapy.
The forecast. If untreated, the disease progresses and death can occur from heart failure or intercurrent infections. With timely, correct treatment, the prognosis is good.
Treatment. Bed rest, especially with heart disease or if symptoms polyneuritis; parenteral 20-50 mg of vitamin L, daily before the pronounced improvement, then 10-20 mg per day for a long time (2-3 months). It simultaneously with vitamin B1 assign nicotinic acid and its amide (25 and 50 mg), Riboflavin (10-20 mg), vitamin B6 (10 - 50 mg). Food should be high-calorie and contain a large number of proteins.
Prevention. Food rich in b vitamins, especially vitamin B1. During pregnancy, lactation, physical work should be encouraged accept larger than usual doses of vitamin B1. Preventive importance and treatment of all diseases that violate the absorption of vitamin B1. Cm. also Vitamin deficiency.