Dry athlete's foot

Introduction The beriberi disease is divided into dry beriberi and wet beriberi, the central and peripheral nervous system damage, called dry beriberi. Peripheral nervous system lesions caused by vitamin B1 deficiency typically show a feeling of rising symmetry, impaired motor and reflex function. The onset starts from the distal end of the limb, and the lower extremity is more common in the upper limb. It may have burning or abnormal feeling. It is distributed in the sock type and gradually develops to the proximal end of the limb. It turns out that the allergic area is gradually dull, even painful, warm and vibrating. The feeling disappears in turn.

Cause

Beriberi is a deficiency of vitamin B1 or thiamine. In the absence of thiamine, increased pyruvate inhibits the activity of choline acetylase and reduces acetylcholine synthesis. Moreover, due to the reduced production of thiamine pyrophosphate, the activity of cholinesterase is enhanced, and the hydrolysis of acetylcholine is also accelerated, which affects nerve conduction. Therefore, gastrointestinal fatigue and peristalsis slow down, and digestive juice secretion is reduced. The disorder of glucose metabolism causes cell function to decline, and various gastrointestinal symptoms appear. Pathological findings showed intestinal inflation, mucosal hemorrhage, follicular swelling, and mesenteric lymphadenopathy. In addition, the liver and kidneys have blood stasis and steatosis.

an examination

Related inspection

Skin smear microscopy skin microscopy

Clinical manifestation

The onset starts from the distal end of the limb, and the lower extremity is more common in the upper limb. It may have burning or abnormal feeling. It is distributed in the sock type and gradually develops to the proximal end of the limb. It turns out that the allergic area is gradually dull, even painful, warm and vibrating. The feeling disappears in turn. With muscle strength decline, muscle soreness, with gastrocnemius muscles, difficult to get up and down stairs. Then the feet, the toes droop, the muscles contract, and bedridden. The reflex function of the ankle, knee, etc. is initially hyperactive, but generally decreases or disappears later, and some patients still cannot recover completely after healing. Central nervous system damage can involve the vagus nerve, optic nerve, oculomotor nerve, abductor nerve, auditory nerve, recurrent laryngeal nerve, and phrenic nerve. Expressed as Wenicke-Korsakoff syndrome. Symptoms include vomiting, nystagmus (more than vertical tremor), ophthalmoplegia, fever, ataxia, changes in consciousness, and coma, accompanied by memory loss, decreased learning ability, and fiction.

Differential diagnosis

Identification:

Vitamin B1 deficiency in peripheral neuritis manifestations must be differentiated from lead poisoning arsenic poisoning and infection caused by diphtheria and leprosy. Patients with edema must be differentiated from nephritis, malnutrition and physiological edema. Urine routine examination, plasma protein determination, and examination of the presence or absence of concomitant symptoms of peripheral neuropathy are helpful for diagnosis. Patients with heart failure should be identified with other high-output heart disease with heart failure (such as hyperthyroid heart disease with hyperthyroidism) and toxic viral myocarditis.

Vitamin B1 deficiency in alcoholics can be accompanied by liver poisoning. Sometimes it is difficult to distinguish and need to be carefully observed for diagnosis.

diagnosis:

The onset starts from the distal end of the limb, and the lower extremity is more common in the upper limb. It may have burning or abnormal feeling. It is distributed in the sock type and gradually develops to the proximal end of the limb. It turns out that the allergic area is gradually dull, even painful, warm and vibrating. The feeling disappears in turn. With muscle strength decline, muscle soreness, with gastrocnemius muscles, difficult to get up and down stairs. Then the feet, the toes droop, the muscles contract, and bedridden. The reflex function of the ankle, knee, etc. is initially hyperactive, but generally decreases or disappears later, and some patients still cannot recover completely after healing. Central nervous system damage can involve the vagus nerve, optic nerve, oculomotor nerve, abductor nerve, auditory nerve, recurrent laryngeal nerve, and phrenic nerve. Expressed as Wenicke-Korsakoff syndrome. Symptoms include vomiting, nystagmus (more than vertical tremor), ophthalmoplegia, fever, ataxia, changes in consciousness, and coma, accompanied by memory loss, decreased learning ability, and fiction.

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