Beriberi — the disease caused by insufficient inclusion of thiamine (B1 vitamin) in metabolic processes. Most often arises at deficiency of receipt of B1 with foodstuff, violation of absorption in bodies of a GIT. Clinically avitaminosis is shown by a bilateral polyneuropathy, a kakheksiya, cardiovascular frustration. Development of sharp encephalopathy with a twilight condition of consciousness is possible. The basis of diagnosis of beriberi is made by blood test on the maintenance of B1. Treatment is carried out by the raised thiamine dosages, knocking over of warm, digestive violations is carried out, the all-strengthening therapy is appointed.
Beriberi is translated with Sinhalese as "big weakness". The disease was widely adopted at the end of the 19th century in the countries where rice was the main food product. Incidence had character of epidemic, the reason was unknown. In 1897 the Dutch doctor H. Eykman observing similar symptomatology at poultry established that pathology develops when feeding birds the purified rice and regresses at introduction to a diet of the black crude grain. The researcher made the assumption of existence in rice bran of substance, vital for an organism. In 1911 the Polish scientist K. Funk managed to emit B1 vitamin in a crystal look. As the amino group is the chemical composition of vitamin, K. Funk called it thiamine. In the modern world avitaminosis of B1 meets seldom, mainly in developing countries of South America, Africa, Southeast Asia.
The daily need for thiamine makes at adult 1,3-2,5 mg, children depending on age have 0,5-1,7 mg. The need for vitamin decreases at advanced age, increases at the increased physical activities, in a frigid climate, at psychoemotional pressure, at pregnant women and the feeding women. Avitaminosis of B1 is observed at insufficient receipt of B1 in an organism. The main etiofaktor are:
- Lack of B1 in a diet. Monotonous food the products which are not containing thiamine (white rice, bread from white wheat flour) results in chronic deficiency of vitamin. The exchange processes happening to its participation are broken. As a result avitaminosis develops.
- The raised B1 expenditure. It is noted at long fever, a thyrotoxicosis, excessive physical activity, a chronic stress, at women during pregnancy and a lactation. Avitaminosis arises when the increased needs for vitamin are not compensated by its increased receipt with food.
- Maldigestiya syndrome. Chronic pancreatitis, fermental insufficiency of a pancreas, the lowered secretion of bilious acids at a liver failure cause deficiency of enzymes, necessary for splitting of food. At a gastroduodenita, stomach ulcer of a stomach and 12 perstny guts there is a decrease of the activity of digestive enzymes. Insufficient splitting of products in a GIT leads to the reduced receipt of B1.
- Malabsorption syndrome. Long enteritis, Whipple's disease, chronic enterokolit, a disease the Krone, enteropatiya, dysbacteriosis are followed by violation of adequate absorption of nutrients in intestines. Insufficient digestion, removal of the most part of thiamine and other nutrients with a stake is result.
- Metabolic violations. The lack of transport proteins, violation of release of B1 after transportation, its wrong interaction with cellular receptors is possible. The listed deviations complicate vitamin K transfer to fabrics, its inclusion in biochemical reactions. Avitaminosis develops against the background of the sufficient maintenance of B1 in a diet.
- Alcoholism. Alcoholic dependence is characterized by a food irregularity, anorexia in the period of hard drinking, disorder of absorption in intestines, damage of a liver. The specified factors lead to critical decrease in receipt of B1. Avitaminosis demonstrates in the third stage of alcoholism.
Thiamine plays an important role in carbohydrate and fatty exchange. Its insufficiency provokes biochemical shifts with accumulation of pyrogrape acid in fabrics. Surplus of a piruvat becomes the reason of damage and a demiyelinization of nervous fibers. In a GIT production of gastric juice decreases that leads to appetite loss, digestion violation. Thiamine is necessary for synthesis of the tiamindifosfat participating in power biochemical reactions. Insufficient power supply of a myocardium causes reduction of force of warm reductions, the expressed weakness of skeletal muscles. In TsNS participates in ensuring full functioning of the mechanism of synoptic transfer of nervous impulses.
Increase and puffiness of internals is macroscopically noted. Heart extends mainly in the right departments, there is myocardium dystrophy. Adrenal glands, a thyroid gland, a hypophysis increase. In nervous tissue disintegration of a myelin cover of nervous trunks, destruction of axons is observed.
Developing of beriberi is caused by external factors (the lowered content of vitamin B a diet, the increased requirement) and the internal violations leading to insufficient participation of thiamine in necessary biochemical reactions. Taking into account an etiology two main forms of a disease are allocated:
- Primary. It is directly connected with insufficient receipt of B1 with food. Arises at any age at change of character of food, increase in level of loadings (physical, mental). Seasonal nature of symptomatology, a long latent current is possible.
- Secondary. It is caused by various diseases. Develops owing to dysfunction of a gastrointestinal tract, violation of transportation of B1 in body tissues, metabolic changes. Secondary avitaminosis is possible at intestines pathology, severe damage of a liver, alcoholism, diabetes, a gipertireoza.
Clinical classification of beriberi is based on variability of symptomatology of a disease. According to prevalence of defeat of TsNS, cardiovascular system, peripheral nervous trunks distinguish the following forms:
- Cerebral (Gayet-Vernique's syndrome) — proceeds with primary defeat of brain fabrics as sharp encephalopathy. Usually demonstrates because of alcoholism.
- Cardiovascular (a "damp" form) — to the forefront there is a damage of a myocardium with development of a miokardiodistrofiya. Hypostases of extremities are characteristic. Heart failure is possible.
- Peripheral (a "dry" form) — is followed by multiple damage of peripheral nerves. The polyneuropathy differs in symmetry, bigger expressiveness in the lower extremities. At avitaminosis of this form the expressed kakheksiya is observed.
In a phase of moderate hypovitaminosis the general malaise, headaches, a loss of appetite, sleep disorders is noted (difficulties of falling asleep, an insomniya, night awakenings). There are cardiovascular changes: patients complain of the speeded-up heartbeat, interruptions of warm activity. Short wind when walking is characteristic. In process of progressing of vitamin deficiency weakness in legs, morbidity of gastrocnemius muscles appears. The further current depends on a clinical form.
The peripheral form proceeds with the expressed polyneuritis. In the beginning paresteziya and weakness in disteel departments of the lower extremities develop, consolidation of gastrocnemius muscles is noted. Patients describe the feelings in legs as "wattage", constant feeling of the put-on stockings. In the subsequent paresis joins sensitive violations. The first foot muscles-razgibateli are surprised. Typical "sheep" gait with a support on fingers and lateral edge of foot without load of a heel is formed.
Similar motor and touch violations can arise in the top extremities. In similar cases the patient experiences difficulties when performing small work as hands (a footwear shnurovaniye, fastening of buttons), cannot hold objects, including tableware in hard cases. Distinctive feature of "dry" option of beriberi is the expressed kakheksiya. The body weight of patients is so reduced that skin in literal sense fits bones.
Avitaminosis of a "damp" form is characterized by the accruing hypostases, arterial hypertension, tachycardia. The right departments of heart extend, there is a short wind accompanying any movements of the patient. Cerebral beriberi differs in a sharp demonstration of symptomatology. Confusion of consciousness, a disorientation in surrounding, agnosia, apraxia comes to light. The patient does not understand the events, incoherent cannot concentrate attention, thinking. The mixed ataxy including vestibular, sensitive and cerebellar components is observed. Is defined , , glazodvigatelny frustration: squint, full oftalmoplegiya.
At the babies eating milk of sick beriberis of mothers, avitaminosis debuts gastrointestinal symptomatology. There is anorexia (refusal of a breast), an abdominal distension, intestinal gripes. Owing to belly-aches the child adopts the bent antalgichesky provision. Warm and vascular frustration join. The aphonia — lack of a voice, loss of tendinous reflexes, emergence of meningealny symptoms is characteristic. The symptomatology progresses within 1-2 days from the outcome in a sopor and a coma.
The progressing polyneuropathy with increase of muscular weakness leads to loss of ability of independent movement, self-service. Kakheksiya is followed by decrease in immunity that is a favorable background for developing of interkurrentny infectious diseases, distribution of activators on all organism with development of sepsis. Cardiovascular frustration with the progressing right ventricular dysfunction, a miokardiodistrofiya cause progressing of heart failure. Death at beriberi comes owing to heavy infections, a kakheksiya, dekompensirovanny heart failure.
Careful collecting the anamnesis with inquiry about character of food, associated diseases, the operations undergone earlier on bodies of a GIT is necessary. For verification of the diagnosis of beriberi the thiamine level research in blood is conducted. For the purpose of search of the reason of vitamin deficiency, assessment of extent of damage of heart, nervous system the following diagnostic events are recommended:
- Gastroenterologichesky inspection: koprogramma, gastroduodenoskopiya, research of gastric juice, contrast X-ray analysis of intestines. Techniques allow to reveal violations of digestive, vsasyvatelny function, the morphological deviations which became the beriberi reason.
- Neurologic inspection. Defines the peripheral nature of paresis, oppression of tendinous reflexes of extremities, a disteel giperesteziya, the mixed ataxy. At a cerebral form glazodvigatelny frustration, consciousness violations are found.
- Cardiological inspection. It is carried out by means of the ECG, an echocardiography. Confirms violations of a rhythm, tachycardia, expansion of the right auricle and ventricle. Gives the chance to estimate degree of heart failure.
B1 avitaminosis with polyneuritis should be differentiated from a diabetic polyneuropathy, autoimmune defeats, a cardiovascular form — from heart diseases (myocarditis, a toxic miokardiodistrofiya, an infectious endocarditis). The cerebral form demands a differentiation with psychiatric pathology, tick-borne encephalitis, a brain tumor.
Treatment of beriberi
Therapy is directed to the fastest compensation of deficiency of B1. The correction of causal pathology, knocking over of cardiovascular violations all-strengthening actions is in parallel carried out. If necessary the neurologist, the cardiologist, the gastroenterologist are connected to treatment. The main components are:
- Therapy by thiamine. Treatment starts with parenteral introduction of B1 solution. After achievement of the expressed improvement of a state pass to medicine reception inside within 2-3 months. The diet with the increased content of vitamins and proteins is recommended.
- Treatment of GIT pathology. It is carried out by the gastroenterologist. According to indications antibacterial, fermental, hepatoprotective therapy, correction of gastric secretion, normalization of intestinal microflora is carried out.
- Symptomatic therapy. At polyneuritis the good effect gives intramuscular introduction of B6 vitamin, nicotinic acid, Riboflavinum. For restoration of neuromuscular transmission it is used . At "damp" beriberi is necessary purpose of diuretic pharmaceuticals, warm glycosides.
- The all-strengthening treatment. Promotes the fastest restoration of an organism, increase in immunity. Massage sessions, physiotherapy exercises, the general ultra-violet radiation are applied. The favorable effect is rendered by coniferous bathtubs. Complex rehabilitation under the leadership of the narcologist is recommended to alcohol-addicted patients.
Forecast and prevention
In due time begun treatment acts as pledge of a favorable outcome of beriberi. In the started cases with development of a heavy kakheksiya, heart failure, accession of interkurrentny infections the lethal outcome is possible. Avitaminosis allows to warn food rich with B1 vitamin. Products of plant origin are saturated with this vitamin: cabbage, asparagus, carrots, nuts, bean, bread of a rough grinding, crude rice, raisin, porridge. At the increased requirement additional reception of polyvitaminic complexes with thiamine is possible. Timely therapy of gastroenterologichesky diseases, treatment of alcoholism has preventive value.