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



  • Thiamine is a cofactor for enzymes required in:
    • Krebs cycle
    • Pentose phosphate pathway
    • Alpha-ketoglutarate dehydrogenase
    • Pyruvate dehydrogenase.
  • Because thiamine is an important cofactor in critical pathways for energy production, deficiency results in lactic acidosis and alteration of brain metabolism.
  • Thiamine is also important for lipid metabolism and may affect myelin sheath formation. This may explain peripheral neuropathy symptoms in dry beriberi.

Clinical Features

Dry Beriberi

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

Wet Beriberi

Infantile Beriberi

Bariatric Beriberi

Differential Diagnosis

Vitamin deficiencies


  • Clinical diagnosis


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

  1. Thiamine 50-100mg IV/IM q day x 7-14 days, then 10mg PO q day until complete recovery
  2. Magnesium; hypomagnesemic state may be resistant to thiamine administration
  3. Multivitamin (at risk for other vitamin deficiencies)
  • 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



Vitamin Prophylaxis for Chronic alcoholics

  • At risk for thiamine deficiency, but no symptoms: thiamine 100mg PO q day
  • Give multivitamin PO; patient at risk for other vitamin deficiencies

Banana bag

The majority of chronic alcoholics do NOT require a banana bag[1][2]


See Also


  1. Donnino, Michael, et al. “Myths and misconceptions of wernicke’s encephalopathy: what every emergency physician should know.” Annals of emergency medicine. 2007. Vol 50, no 6. Pages 715-721.
  2. Sechi, GianPietro; Serra, Alessandro. “Wernicke’s encephalopathy: new clnical settings and recent advances in diagnosis and management.” Neurology. Vol 6, May 2007. Pages 442-455
  1. Krishel, S, et al. Intravenous Vitamins for Alcoholics in the Emergency Department: A Review. The Journal of Emergency Medicine. 1998; 16(3):419–424.
  2. Li, SF, et al. Vitamin deficiencies in acutely intoxicated patients in the ED. The American Journal of Emergency Medicine. 2008; 26(7):792–795.