What is the treatment for wet beriberi?

Treatment of Wet Beriberi

Immediate intravenous thiamine administration is the definitive treatment for wet beriberi, with 100 mg IV thiamine initially followed by 50-100 mg daily until the patient is consuming a regular diet. 1

Clinical Presentation and Diagnosis

Wet beriberi is a cardiovascular manifestation of thiamine (vitamin B1) deficiency characterized by:

• High-output heart failure
• Peripheral edema
• Low systemic vascular resistance
• Tachycardia
• Respiratory distress
• Lactic acidosis

Diagnosis should be considered in patients with:

• Unexplained heart failure with low systemic vascular resistance
• History of malnutrition, alcoholism, prolonged vomiting, or bariatric surgery
• Rapid response to thiamine administration

Treatment Algorithm

Emergency Treatment (Acute Wet Beriberi/Shoshin Beriberi)

1. Initial Management:

   • Administer thiamine 100 mg IV immediately 1
   • Treat as an emergency cardiac condition 1
   • CAUTION: Do not administer glucose before thiamine as it can worsen the condition 2

2. Continued Inpatient Treatment:

   • Continue with 50-100 mg thiamine daily (IV or IM) until the patient can consume a regular balanced diet 1
   • Monitor hemodynamic parameters - improvement typically occurs within 12-48 hours 3

3. Supportive Care:

   • Manage heart failure symptoms with careful fluid management
   • Monitor for other organ dysfunction as multiple organ failure can occur 3

Non-Emergency Treatment

1. For Less Severe Cases:

   • Thiamine 10-20 mg IM three times daily for up to two weeks 1
   • Transition to oral therapy when possible

2. Maintenance Therapy:

   • Oral therapeutic multivitamin containing 5-10 mg thiamine daily for at least one month to achieve tissue saturation 1
   • Correct poor dietary habits and prescribe a balanced diet

Special Considerations

Patients at High Risk

Particular attention should be paid to:

• Alcoholics
• Malnourished individuals
• Patients with prolonged vomiting
• Post-bariatric surgery patients 2
• Patients on chronic diuretic therapy 4
• Prisoners with poor nutrition 3

Associated Conditions

Monitor for and treat concurrent conditions:

• Wernicke's encephalopathy (neurological manifestations of thiamine deficiency) 2
• Other vitamin deficiencies, particularly folate 5
• Peripheral neuropathy (dry beriberi) which may coexist with wet beriberi 6

Monitoring and Follow-up

• Echocardiographic examinations to assess cardiac function improvement
• Hemodynamic monitoring in severe cases
• Thiamine levels if available (though treatment should not be delayed waiting for results) 2
• Clinical response - typically rapid improvement within hours to days with proper treatment 3

Prevention

• Prophylactic thiamine supplementation for high-risk patients
• Multivitamin supplementation for patients with malabsorption disorders 5
• Particular attention to patients receiving parenteral nutrition or dextrose solutions 1

Wet beriberi is a potentially fatal but readily reversible condition when diagnosed and treated promptly with thiamine. The dramatic response to thiamine administration is both diagnostic and therapeutic.