What is the treatment for Gastrointestinal (GI) Beriberi?

Treatment of Gastrointestinal (GI) Beriberi

Immediate intravenous thiamine administration at 100 mg daily is the definitive treatment for GI beriberi, with clinical improvement expected within 12-48 hours. 1, 2

Immediate Management

Thiamine must be administered without delay when GI beriberi is suspected, as waiting for laboratory confirmation can result in irreversible neurologic damage or death. 1, 3

Initial Thiamine Dosing

• For acute GI beriberi with cardiovascular involvement ("wet beriberi"): Administer 100 mg thiamine intravenously as initial dose, followed by 50-100 mg intramuscularly daily until the patient can consume a regular, balanced diet 1, 2
• For GI beriberi without cardiac failure: Give 10-20 mg thiamine intramuscularly three times daily for up to two weeks 1
• If Wernicke's encephalopathy is present or suspected: Start with 100 mg thiamine intravenously, then continue with 50-100 mg intramuscularly daily 1, 3

Route of Administration Considerations

• Intravenous administration is mandatory in emergency situations with myocardial failure or severe encephalopathy, but must be given slowly to avoid adverse reactions 1, 2
• Intramuscular route is preferred for non-emergency cases to minimize risk of hypersensitivity reactions 1

Expected Clinical Response

Hemodynamic improvement occurs within 12 hours of thiamine administration in wet beriberi, with normalization of cardiac function within hours to days. 2, 4

• Neurological symptoms improve within 48 hours in dry beriberi and Wernicke's encephalopathy 3
• Mental status changes resolve rapidly, often allowing extubation within 2-3 days in severe cases 3
• Echocardiographic normalization occurs within days to one month 2

Maintenance Therapy

After acute treatment, continue oral thiamine 50 mg daily until adequate oral intake is established, followed by a therapeutic multivitamin containing 5-10 mg thiamine daily for one month to achieve tissue saturation. 1

Prevention in At-Risk Patients

Patients receiving dextrose infusions who have marginal thiamine status should receive 100 mg thiamine hydrochloride in each of the first few liters of IV fluid to prevent precipitating heart failure. 1

• This is particularly critical in malnourished patients, those with chronic alcohol use, prisoners with dietary deficiency, patients on total parenteral nutrition, and those with gastrointestinal disorders causing malabsorption 3, 2, 5

Critical Pitfalls to Avoid

Never delay thiamine administration while waiting for laboratory confirmation of deficiency, as the therapeutic test is both diagnostic and life-saving. 6, 3

• Do not mistake GI beriberi for Guillain-Barré syndrome: Dry beriberi can mimic acute inflammatory demyelinating polyradiculoneuropathy with similar CSF and MRI findings, but unlike GBS, beriberi responds dramatically to thiamine within 48 hours rather than requiring weeks of IVIG therapy 3
• Recognize high-output cardiac failure with low systemic vascular resistance as a pattern suggesting thiamine deficiency rather than typical heart failure or septic shock 2
• Avoid administering furosemide alone for cardiac symptoms without thiamine, as this can worsen the clinical picture 5
• Consider folate deficiency as a comorbid condition that worsens thiamine malabsorption and clinical presentation 5

Diagnostic Considerations

The diagnosis is clinical and should be based on history (malnutrition, alcohol abuse, gastrointestinal disorders, imprisonment), physical examination findings (peripheral neuropathy, high-output heart failure, encephalopathy), and therapeutic response to thiamine. 6, 3, 2

• Serum thiamine measurement is costly, has limitations, and should not delay treatment 6
• Right heart catheterization showing high cardiac output and low systemic vascular resistance supports the diagnosis of wet beriberi 2
• Brain MRI showing typical Wernicke's encephalopathy changes confirms thiamine deficiency 3, 5