Beriberi

Background

• Dry Beriberi: neuro sx caused by thiamine deficiency
• Wet Beriberi: cardiac sx caused by thiamine deficiency
• Infantile Beriberi: neuro/cardiac sx caused by thiamine deficiency in <1 year old infant

Causes

• Anything that causes thiamine (vitamin B1) deficiency: poor dietary intake, malabsorption, increased metabolic requirement
  • Chronic alcoholism, dieting/fasting/starvation, anorexia, vomiting/diarrhea, unbalanced TPN, GI surgery, malignancy, dialysis, AIDS, IBD, pancreatitis, liver disease, thyrotoxicosis

Clinical Features

Dry Beriberi

• Symmetrical peripheral neuropathy (motor and sensory) mostly distal extremities

Wet Beriberi

• CHF, high output heart failure, cardiomegaly, peripheral edema, tachycardia, DOE/PND/orthopnea
• Can include neuropathy seen in Dry Beriberi

Infantile Beriberi

• CHF, cardiomegaly, tachycardia, cyanosis, dyspnea, weight loss, marasmus, vomiting, loud cry, nystagmus, seizure

Diagnosis

Beriberi = clinical diagnosis

Treatment

If you suspect Beriberi then treat it! Diagnosis is clinical and difficult to confirm, treatment is simple/inexpensive/effective, there is little risk to treatment, and the risk of morbidity/mortality from not treating is high

• Thiamine 50-100 mg IV/IM q day x 7-14 days, then 10 mg PO q day until complete recovery
• Magnesium; hypomagnesemic state may be resistant to thiamine administration
• Multivitamin (at risk for other vitamin deficiencies)
• For chronic alcoholics always consider banana bag: thiamine 100 mg + magnesium 2-4 g + folate 1 mg + multivitamin; all in 1L NS or D5W
• Remember to give thiamine BEFORE glucose in pts requiring glucose who are at risk for thiamine deficiency; glucose without thiamine can precipitate/worsen WE by driving thiamine intracellularly

See Also

• Wernicke's Encephalopathy
• Korsakoff's Psychosis
• Wernicke-Korsakoff Syndrome
• Thiamine deficiency