- 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
- Anything that causes thiamine (vitamin B1) deficiency: poor dietary intake, malabsorption, increased metabolic requirement
- 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.
Thiamine deficiency types
- CHF, high output heart failure, cardiomegaly, peripheral edema, tachycardia, DOE/PND/orthopnea
- Can include neuropathy seen in Dry Beriberi
- CHF, cardiomegaly, tachycardia, cyanosis, dyspnea, weight loss, marasmus, vomiting, loud cry, nystagmus, seizure
- Occurs 1-3 months post-bariatric surgery
- Causes are multifactorial, including low nutritional intake, poor baseline nutrition, persistent vomiting, malabsorption
- Vitamin A deficiency
- Vitamin B deficiencies
- Vitamin C deficiency (Scurvy)
- Vitamin D deficiency (Rickets)
- Vitamin E deficiency
- Vitamin K deficiency
- High-output heart failure from AV fistula
- Paget disease
- 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
- Thiamine 50-100mg IV/IM q day x 7-14 days, then 10mg PO q day until complete recovery
- Magnesium; hypomagnesemic state may be resistant to thiamine administration
- 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
- Thiamine 100mg IV
- Folate 1mg IV (cheaper PO)
- Multivitamin 1 tab IV (cheaper PO)
- Magnesium sulfate 2mg IV
- Normal saline as needed for hydration
- 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.
- 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
- Krishel, S, et al. Intravenous Vitamins for Alcoholics in the Emergency Department: A Review. The Journal of Emergency Medicine. 1998; 16(3):419–424.
- Li, SF, et al. Vitamin deficiencies in acutely intoxicated patients in the ED. The American Journal of Emergency Medicine. 2008; 26(7):792–795.