Beriberi

Revision as of 16:15, 19 September 2013 by Mhankerson (talk | contribs) (new note)
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)

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

Diagnosis

Beriberi = clinical diagnosis


Dry Beriberi

  • Sx: symmetrical peripheral neuropathy (motor and sensory) mostly distal extremities


Wet Beriberi

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


Infantile Beriberi

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

Treatment

Thiamine 50-100 mg IV/IM q day x 7-14 days, then 10 mg PO q day until complete recovery


  • 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
  • Remember to give magnesium; hypomagnesemic state may be resistant to thiamine administration
  • Give multivitamin since pt 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