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

Differential Diagnosis

Thiamine deficiency types

Diagnosis

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 consider banana bag: thiamine 100 mg + magnesium 2-4 g + folate 1 mg + multivitamin; all in 1L NS or D5W
Give thiamine BEFORE glucose in patients requiring glucose who are at risk for thiamine deficiency; glucose without thiamine can precipitate/worsen WE by driving thiamine intracellularly