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Key Features

  • Most common cause: alcoholism

  • Other causes

    • Malabsorption

    • Dialysis

    • Chronic protein-calorie undernutrition

  • In patients with marginal thiamine stores, symptoms and signs can be precipitated by intravenous dextrose solutions

Clinical Findings

  • Early manifestations

    • Anorexia

    • Muscle cramps

    • Paresthesias

    • Irritability

  • Advanced deficiency chiefly affects cardiovascular system (wet beriberi) or nervous system (dry beriberi)

  • Wet beriberi

    • Occurs with severe physical exertion and high carbohydrate intake

    • Characterized by marked peripheral vasodilation resulting in high-output heart failure with dyspnea, tachycardia, cardiomegaly, pulmonary and peripheral edema, and warm extremities

  • Dry beriberi

    • Occurs with inactivity and low-calorie intake

    • Involves both peripheral and central nervous systems

    • Peripheral nerve involvement includes symmetric motor and sensory neuropathy with pain, paresthesias, and loss of reflexes in legs more than the arms

    • Central nervous system involvement includes Wernicke encephalopathy and Korsakoff syndrome

Diagnosis

  • Clinical response to empiric thiamine therapy

  • Biochemical tests: erythrocyte transketolase activity and urinary thiamine excretion; transketolase activity coefficient > 15–20% suggest thiamine deficiency

Treatment

  • Thiamine, 50–100 mg intravenously for the first few days, followed by 5–10 mg once daily orally

  • Therapeutic doses of other water-soluble vitamins

  • Treatment results in complete resolution of symptoms and signs in 50% of patients (one-fourth immediately and one-fourth over days); the remaining 50% obtain only partial resolution or no benefit

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