Treatment of Beriberi
Immediate intravenous thiamine administration at 100-300 mg daily is the cornerstone of beriberi treatment, with wet beriberi requiring emergency IV dosing and close monitoring for cardiovascular stabilization. 1, 2, 3
Emergency Management of Wet Beriberi
Wet beriberi with myocardial failure must be treated as a medical emergency with slow IV thiamine administration. 3
Initial IV Therapy
- Administer 100 mg IV thiamine three times daily until clinical improvement occurs in patients with wet beriberi and myocardial failure 1
- For severe cases, doses of 100-300 mg/day IV are recommended 2, 4
- Critical: Give thiamine BEFORE any glucose-containing IV fluids to prevent precipitating acute heart failure 1, 2
- Administer 100 mg thiamine in each of the first few liters of IV fluid in patients receiving dextrose 3
Expected Response Timeline
- Hemodynamic improvement should occur within 12-48 hours of thiamine administration 5, 6
- Cardiovascular symptoms can resolve within hours of IV thiamine 7, 5
- Clinical improvement in hypotension and cardiac output typically occurs rapidly, often within the first day 6
Treatment of Dry Beriberi
Dosing Regimen
- Give 10-20 mg IM thiamine three times daily for up to two weeks 3
- For neurological manifestations including Wernicke encephalopathy: 500 mg IV three times daily 2
- Alternative dosing: 100-300 mg/day IV for acute presentations 2, 4
Neurological Recovery
- Neurological symptoms (ophthalmoplegia, ataxia, confusion) can improve dramatically within 24-48 hours of thiamine administration 7, 8
- Complete recovery may take weeks to months depending on severity and duration of deficiency 7
Maintenance and Transition to Oral Therapy
After Acute Phase
- Maintenance dose: 50-100 mg/day orally after initial IV treatment and clinical stabilization 1, 2
- For mild deficiency: 10 mg/day orally for one week, followed by 3-5 mg/day for at least 6 weeks 2
- An oral therapeutic multivitamin containing 5-10 mg thiamine daily for one month is recommended to achieve tissue saturation 3
Route of Administration Decision Algorithm
Use IV route when:
- Acute cardiovascular collapse or wet beriberi 1, 3
- Neurological symptoms (Wernicke encephalopathy, encephalopathy) 2, 7
- Severe gastrointestinal symptoms with vomiting or malabsorption 2, 7
- Hospitalized/critically ill patients 2
- Alcohol-related gastritis (poor oral absorption) 2
Use oral route when:
- Mild deficiency without acute symptoms 2
- Maintenance therapy after IV stabilization 1, 3
- Prophylaxis in at-risk populations 2
Special Clinical Scenarios
Infantile Beriberi
Pregnancy-Related Neuritis
- 5-10 mg IM daily when vomiting precludes oral therapy 3
Post-Bariatric Surgery
- 200-300 mg daily IV for prolonged vomiting or poor intake 2
- Prophylactic supplementation: 50 mg once or twice daily from B-complex supplement for first 3-4 months postoperatively 2
Alcohol-Related Deficiency
- 100-300 mg/day for 2-3 months following resolution of withdrawal symptoms 2
- For established Wernicke's: 500 mg IV three times daily 2
Critical Pitfalls to Avoid
Never administer glucose before thiamine - this can precipitate acute heart failure and worsen thiamine deficiency 1, 2, 3
Do not rely on oral supplementation alone in acute presentations - malabsorption is common in beriberi patients, particularly those with alcohol use, gastrointestinal disease, or critical illness 2, 7
Do not delay treatment waiting for laboratory confirmation - thiamine levels take time to result, and clinical improvement with therapeutic trial confirms diagnosis 1, 4
Beware of misdiagnosis as Guillain-Barré syndrome - dry beriberi can mimic GBS, but thiamine repletion leads to rapid improvement unlike GBS 8
Monitoring Parameters
- Daily monitoring of cardiac output, systemic vascular resistance, and parasitemia percentage until improvement in severe wet beriberi 1
- Blood pressure and urine output should improve within hours to days 6
- Neurological examination should show improvement within 24-48 hours 7, 8
- Lactic acidosis should resolve with thiamine administration 5, 6