[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Beriberi (thiamine deficiency) [Conditions](https://durgical.com/en/conditions/) · [Vitamins and minerals](https://durgical.com/en/conditions/) # Beriberi (thiamine deficiency) Beriberi is lack of vitamin B1 in nerves and heart: weak, numb legs, or heart failure with swelling. Updated 2026-11-01 ## Structures involved Tap one to see what it is and open it in 3D. - [Left ventricle](https://durgical.com/en/anatomy/left-ventricle/) - [Right ventricle](https://durgical.com/en/anatomy/right-ventricle/) - [Sciatic nerve](https://durgical.com/en/anatomy/sciatic-nerve/) - [Tibial nerve](https://durgical.com/en/anatomy/tibial-nerve/) - [Common fibular nerve](https://durgical.com/en/anatomy/common-fibular-nerve/) ## In biochemistry - [Thiamine (vitamin B1)](https://durgical.com/en/biochemistry/molecules/thiamine/) ## In physiology - [Vitamins and minerals: a physiological overview](https://durgical.com/en/physiology/vitamins-and-minerals-a-physiological-overview/) ## Why it happens - [Vitamin deficiencies: what each one does to tissue](https://durgical.com/en/general-pathology/vitamin-deficiencies-what-each-one-does-to-tissue/) ## What it is A thiamine deficiency disease with two main forms: dry (peripheral neuropathy) and wet (high-output heart failure). The brain form is Wernicke encephalopathy, which has its own page. ## Who gets it Classic in populations eating polished rice; today it occurs with alcoholism, bariatric surgery, hyperemesis of pregnancy, dialysis and diuretics. Infantile beriberi affects babies breastfed by deficient mothers in Southeast Asia. ## Causes - Diet based on polished rice or unfortified refined flour - Alcoholism - Prolonged vomiting, bariatric surgery, malnutrition - Diuretics and dialysis (urinary loss) - Breastfeeding by a deficient mother (infantile beriberi) ## Risk factors - Alcoholism - Hyperemesis gravidarum - Parenteral nutrition without vitamins - Heart failure treated with loop diuretics ## Pathophysiology Without thiamine pyrophosphate, pyruvate dehydrogenase and α-ketoglutarate dehydrogenase fail: ATP falls and lactate rises. Long axons, which need much energy, degenerate (distal neuropathy). In the heart energy runs short, and accumulating metabolites dilate peripheral arterioles: vascular resistance falls, cardiac output rises and salt and water are retained, until the heart dilates and fails. ## Classification - Dry: sensorimotor polyneuropathy - Wet: high-output heart failure with oedema - Shoshin: fulminant wet form with shock and lactic acidosis - Infantile: in babies aged 2 to 6 months (aphonia, heart failure) ## Symptoms and signs - Tingling, burning and numbness of the feet and legs - Muscle weakness, foot drop, cramps, difficulty rising - Leg swelling, breathlessness, palpitations (wet form) - Infants: hoarse or absent cry, vomiting, fast heart rate ## Red flags - Hypotension, shock and lactic acidosis (shoshin) - Breathlessness at rest with oedema - Confusion, ataxia or abnormal eye movements (Wernicke) ## Diagnosis **Clinical** A clinical diagnosis in someone at risk; a quick response to thiamine (especially in the wet form) confirms it. Treatment is not delayed for tests. **Tests** Whole-blood thiamine or TPP, red-cell transketolase activity; raised lactate; electrolytes and magnesium; ECG and natriuretic peptides in the wet form. **Imaging** [Chest](https://durgical.com/en/anatomy/region/chest/) X-ray with cardiomegaly and congestion; echocardiogram showing a dilated, high-output heart. ## Treatment **Acute** Immediate parenteral thiamine in wet beriberi or in infants; then orally **Medical** Manage heart failure and correct magnesium and other deficiencies **Rehabilitation** Physical rehabilitation for the neuropathy **Lifestyle** Diet with whole or fortified grains, legumes and meat; support to stop alcohol ## Complications - Heart failure and sudden death - Residual neuropathy - Wernicke encephalopathy and Korsakoff syndrome ## Prognosis The wet form responds within hours to days; the neuropathy improves slowly and may leave deficits. ## Prevention - Fortification of flour and rice - Thiamine for people at risk, especially before intravenous glucose - Vitamins in parenteral nutrition ## Test yourself Think of the answer, then tap the question to see it. ## What is the difference between dry and wet beriberi? Dry is a peripheral polyneuropathy; wet is high-output heart failure with oedema. ## Why is wet beriberi a high-output state? Energy failure and accumulated metabolites dilate arterioles, vascular resistance falls and the heart pumps harder until it fails. ## What is shoshin beriberi? The fulminant wet form, with shock, severe lactic acidosis and cardiovascular collapse. ## Why does polished rice cause beriberi? Thiamine is in the husk and germ, which are removed by polishing. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/beriberi/) ## Related conditions - [Pellagra (niacin deficiency)](https://durgical.com/en/conditions/pellagra/) - [Wernicke encephalopathy (thiamine deficiency)](https://durgical.com/en/conditions/wernicke-encephalopathy/) - [Heart failure](https://durgical.com/en/conditions/heart-failure/) - [Lactic acidosis](https://durgical.com/en/conditions/lactic-acidosis/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [Beriberi: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000339.htm) (MedlinePlus, US National Library of Medicine, 2026); [Thiamin: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/002401.htm) (MedlinePlus, US National Library of Medicine, 2026); [SLC19A2 gene: MedlinePlus Genetics](https://medlineplus.gov/genetics/gene/slc19a2/) (MedlinePlus, US National Library of Medicine, 2026); Textbook of Biochemistry for Medical Students, 6th ed. (Jaypee Brothers Medical Publishers (Vasudevan DM, Sreekumari S, Vaidyanathan K), 2011). [← All conditions](https://durgical.com/en/conditions/) ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/conditions/beriberi/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/beriberi/