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
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