Beri beri

Beri beri

1. BERIBERI
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Beriberi is a disease caused by a vitamin B1 (thiamine) deficiency.
There are two types of the disease: wet beriberi and dry beriberi. Wet
beriberi affects the heart and circulatory system. In extreme cases,
wet beriberi can cause heart failure. Dry beriberi damages the nerves
and can lead to a loss of muscle strength and eventually, muscle
paralysis. Beriberi can be life-threatening if it isn’t treated.
If you have access to foods rich in thiamine, such as beans,
vegetables, meat, and whole grains, your chances of developing
beriberi are low. Today, beriberi mostly occurs in people with an
alcohol use disorder (alcoholism)
WHAT IS BERIBERI?

3. WHAT CAUSES BERIBERI? WHO IS AT RISK?
The main cause of beriberi is a diet low in thiamine. The disease is very rare
in regions with access to vitamin-enriched foods (e.g., breakfast cereals and
breads). Beriberi is most common in regions of the world where the diet
includes a lot of unenriched white rice, which only has a tenth of the amount
of thiamine as brown rice.
•Alcohol abuse can make it hard for your body to absorb and store thiamine.
•Genetic beriberi is a rare condition that prevents the body from absorbing
thiamine.
•Pregnant women, breast-feeding mothers, and anyone with hyperthyroidism
(over-active thyroid gland) need extra thiamine.
•Prolonged diarrhea or use of diuretics (medication that makes you urinate
more) can lead to depletion of thiamine.
•Infants drinking breast milk or formula low in thiamine are at risk for thiamine
deficiency.
•Kidney dialysis can increase your risk of beriberi by depleting your body’s
stores of thiamine more quickly.
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4. WHAT ARE THE SYMPTOMS OF BERIBERI?
The symptoms of beriberi vary depending on the type (wet
or dry). The following are symptoms of wet beriberi:
•shortness of breath during physical activity
•waking up short of breath
•rapid heart rate
•swollen lower legs
The symptoms of dry beriberi include:
•decreased muscle function, particularly in the lower legs
•tingling or loss of feeling in the feet and hands
•pain
•mental confusion
•difficulty speaking
•vomiting
•involuntary eye movement
•paralysis
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5. ETIOLOGY
Risk factors (non-modifiable)
Female gender
Increasing age
Family history
White or Asian ethnicity
Small stature
Early menopause
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6. ETIOLOGY
Risk factors (cont’d)
Excess alcohol intake
Cigarette smoking
Anorexia
Oophorectomy
Sedentary lifestyle
Insufficient calcium intake
Low testosterone levels (hypogonadism in men)
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7. ETIOLOGY AND PATHOPHYSIOLOGY
Peak bone mass is achieved before
age 20

Bone loss after midlife is inevitable
but rate of loss is variable
Bone resorption exceeds bone
deposition
Bones become weakened and prone to
fracture, loss of height, and kyphosis.
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8. ETIOLOGY AND PATHOPHYSIOLOGY
Diseases associated with osteoporosis
Intestinal malabsorption
Kidney disease
Rheumatoid arthritis
Hyperthyroidism
Chronic alcoholism
Cirrhosis of the liver
Hypergonadism
Diabetes mellitus
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9. OSTEOPOROSIS
DIAGNOSTIC STUDIES
Clinical Manifestations
Known as silent disease
Diagnosis
Bone Mineral Density (BMD)
Dual-energy x-ray absorptiometry (DEXA)
History and physical
Quantitative ultrasound
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10. OSTEOPOROSIS
Can the disease be
prevented?
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11. TREATMENT AND NURSING CARE
Diet Therapy

Weight bearing Exercises

Decrease Risk Factors
Quit smoking and decrease consumption of alcohol
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12. DRUG TREATMENT OF
OSTEOPOROSIS
Estrogen Replacement Therapy
Calcium & Vitamin D supplements
Calcitonin
Biphosphonates (Fosamax, Didronel,
Actonel, Boniva, Aredia, Bonefos, Skelid)
Selective Estrogen receptor modulator –
Evista
Teriparatide (Forteo)
Portion of parathyroid hormone
First drug to stimulate new bone formation
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13. MEDICATIONS USED IN
TREATMENT OF
OSTEOPOROSISHormone Replacement Therapy – Estrogen
Controversy over use. Should discuss with health care provider
Calcium
There are a variety of calcium supplements available
(See Table 64-16, p. 1689).
They should be taken with _______ _ to aid in absorption.
Also if taking large doses i.e. 1000 mg. / day – take in divided
doses of 500mg BID for better absorption
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14. MEDICATIONS USED IN
TREATMENT OF
OSTEOPOROSISCalcitonin
If calcitonin inhibits bone resorption by opposing the effects of parathyroid
hormone, how does that affect serum calcium levels?
What is needed to counter that effect?
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15. MEDICATIONS USED IN
TREATMENT OF
OSTEOPOROSIS
Bisphosphenates – (Fosamax)
Inhibit osteoclast-mediated bone resorption thereby increasing BMD
and total bone mass.
Side effects – anorexia, weight loss, gastritis
Patient Teaching



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16. MEDICATIONS USED IN
TREATMENT OF
OSTEOPOROSISSelective Estrogen Receptor
Modulators
Mimic effect of estrogen on bone by reducing bone resorption without stimulating
the breasts or uterus.
Side effects
Leg cramps
Hot flashes
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18. OSTEOMALACIA
Decalcification and softening of the bone
Caused mainly by: vitamin D deficiency
**Vitamin D is required for the absorption of
calcium from the intestine and calcium is
responsible for mineralization of bone
Etiology
Lack of exposure to __________ ____
GI malabsorption, extensive burns, chronic diarrhea, pregnancy, drugs
such as Dilantin.
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19. OSTEOMALACIA
SIGNS & SYMPTOMS
Most Common
____ ____
Difficulty rising from a chair
Difficulty walking
Additional Signs and Symptoms
Low back pain, muscle weakness
Weight loss, progressive deformities
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20. DIAGNOSIS
Blood work
Decreased serum calcium or phosphorus
Decreased serum 25-hydroxyvitamin D
Elevated alkaline phosphatase
X-Rays
Show loose’rs transformation zone –
ribbons of decalcification in bone
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21. OSTEOMALACIA
TREATMENT AND NURSING CARE
Drug Therapy


Diet Therapy
Milk, yogurt, cheese
Dark green leafy vegetables, okra, broccoli
Fish and seafood
Almonds


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23. PAGET’S DISEASE
Excessive bone resorption followed by
replacement of normal marrow by
vascular, fibrous connective tissue.
The new bone is ______, ____________,
___ ______
Most often affect the pelvis,
long bones, spine,
ribs, sternum, and cranium
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24. CLINICAL MANIFESTATIONS
In milder form, none
Common early symptom--
Fatigue
Waddling gait
Loss of height
Increased head size
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25. COMPLICATIONS
Pathological fractures (may be a first sign of disease)
Bone tumors
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26. PAGET’S DISEASE
Diagnosis
Elevated serum alkaline phosphatase
X-ray will show increase in bone size
Bone scan shows increased uptake in affected bones
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27. DRUG TREATMENT FOR PAGET’S
Drug Therapy
Calcitonin-salmon (Miacalcin)
Bone is in a constant state of remodeling, whereby old
bone is removed by osteoclasts, and new bone is laid
down by osteoblasts. Calcitonin inhibits bone removal
by osteoclasts, and promotes bone formation by
osteoblasts.
NSAIDS
Bisphosphonates
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28. PAGET’S DISEASE
Other treatments and Nursing Care
Back support by firm mattress
Teaching about use of splints or braces to support bones and joints and help
prevent weakened bones - skin care, circulation, etc.
Teach how to correctly use canes or walkers
Physical therapy
Diet high in…what?
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