What is the treatment for beriberi?

Treatment of Beriberi

The treatment for beriberi requires immediate thiamine administration, with dosing regimens of 10-20 mg thiamine hydrochloride intramuscularly three times daily for up to two weeks for standard beriberi, followed by oral maintenance therapy of 5-10 mg daily for one month. 1

Types of Beriberi and Clinical Presentation

Beriberi is a nutritional disorder caused by thiamine (vitamin B1) deficiency that presents in two primary forms:

• Dry Beriberi: Characterized by peripheral neuropathy with symptoms including numbness, tingling of limbs, disrupted coordination, and in severe cases, paralysis 2, 3
• Wet Beriberi: Presents with cardiovascular manifestations including heart failure, tachycardia, and respiratory symptoms 2, 4
• Wernicke's Encephalopathy: Severe thiamine deficiency affecting the central nervous system, characterized by ophthalmoplegia, ataxia, and mental confusion 5, 6

Treatment Protocol

Emergency Treatment

For severe cases requiring immediate intervention:

• Wet beriberi with myocardial failure: Must be treated as an emergency cardiac condition with thiamine administered slowly by IV route 1
• Wernicke-Korsakoff syndrome: Initial dose of 100 mg IV, followed by IM doses of 50-100 mg daily until the patient is consuming a regular diet 1
• Severe cases with hypotension or encephalopathy: 100-300 mg IV thiamine daily 3, 7

Standard Treatment Regimen

1. Acute phase:

   • 10-20 mg thiamine hydrochloride IM three times daily for up to two weeks 1
   • For infantile beriberi with collapse: 25 mg IV (administered cautiously) 1

2. Maintenance phase:

   • Oral therapeutic multivitamin containing 5-10 mg thiamine daily for one month 1
   • Correction of poor dietary habits and prescription of a well-balanced diet 1

Special Populations

• Pregnancy with severe vomiting: 5-10 mg thiamine hydrochloride IM daily 1
• Patients receiving dextrose infusions: 100 mg thiamine hydrochloride in each of the first few liters of IV fluid to prevent precipitating heart failure 1
• Post-bariatric surgery patients: Prophylactic oral thiamine 15 mg daily; increase to 200-300 mg daily if symptomatic 4

Clinical Response to Treatment

Treatment with thiamine typically results in rapid clinical improvement:

• Cardiovascular symptoms (hypotension, tachycardia) often resolve within hours of thiamine administration 8, 7
• Neurological symptoms (diplopia, ophthalmoplegia) may improve dramatically within 24 hours 5
• Complete recovery of mental and neurological status may take up to 2 months 5

Monitoring and Prevention

• Monitor thiamine status by measuring RBC or whole blood thiamine diphosphate (ThDP) 4
• For patients at risk (chronic alcoholism, malnutrition, bariatric surgery, prolonged vomiting), provide prophylactic thiamine supplementation 4
• Educate patients about the importance of adequate thiamine intake and early medical advice if symptoms develop 4

Important Considerations

• Diagnosis is often clinical, based on symptoms and response to thiamine administration 3
• Delay in treatment can lead to irreversible neurological damage or death 5, 6
• Consider thiamine deficiency in all patients with unexplained heart failure, lactic acidosis, or multiple organ failure, especially those with risk factors 7
• Even in well-nourished patients, gastrointestinal beriberi can mimic surgical emergencies 8

Early recognition and prompt thiamine administration are crucial for preventing long-term complications and mortality in patients with beriberi.