From the Guidelines
Beriberi should be treated with immediate thiamine supplementation, typically 100mg intravenously for severe cases, followed by 10-30mg daily oral supplements until symptoms resolve, as recommended by the most recent guidelines 1, 2, 3.
Diagnosis and Treatment
Beriberi is a disease caused by thiamine (vitamin B1) deficiency, which affects the nervous and cardiovascular systems. It presents in two main forms: dry beriberi, which primarily affects the nervous system causing numbness, weakness, and pain in the limbs; and wet beriberi, which affects the cardiovascular system leading to heart failure, edema, and breathing difficulties.
Prevention and Maintenance
For prevention and maintenance, a daily intake of 1.1-1.2mg of thiamine is recommended. Beriberi commonly occurs in populations with diets heavily dependent on polished white rice, chronic alcoholism, or conditions that impair thiamine absorption.
Key Considerations
Some key considerations for treatment include:
- Using the IV route for severe cases, providing 3 x 100-300 mg per day, as it is the most efficient way to address acute deficiency symptoms 3.
- Oral supplementation can be used for mild cases or for maintenance, with a dose of 10 mg/day thiamin for a week, followed by 3-5 mg/daily for at least 6 weeks 2.
- A balanced diet including whole grains, legumes, nuts, and meat helps prevent thiamine deficiency and beriberi.
Clinical Situations
The dose of thiamine supplementation may vary depending on the clinical situation, such as:
- Mild deficiency: 10 mg/day thiamin for a week, followed by 3-5 mg/daily for at least 6 weeks 2.
- Chronic diuretic therapy: 50 mg a day, by mouth 2.
- At risk for deficiency: 100 mg, 3 times a day, IV 2.
- High suspicion or proven deficiency: 200 mg, 3 times a day, IV 2.
From the FDA Drug Label
Indications and Usage Thiamine hydrochloride injection is effective for the treatment of thiamine deficiency or beriberi whether of the dry (major symptoms related to the nervous system) or wet (major symptoms related to the cardiovascular system) variety
- Thiamine hydrochloride injection is used to treat beriberi, which can be of the dry or wet variety.
- The treatment is indicated for thiamine deficiency and is effective for rapid restoration of thiamine in certain conditions, including Wernicke’s encephalopathy and infantile beriberi 4.
From the Research
Definition and Causes of Beri Beri
- Beri beri is a disease caused by thiamine deficiency (TD) [(5, 6, 7, 8, 9)].
- Thiamine deficiency can lead to heart problems, including heart failure 6.
- The diagnosis of gastrointestinal beriberi in the clinical setting is uncommon, especially in nonalcoholic patients 5.
Symptoms and Diagnosis
- Symptoms of beriberi can include abdominal pain, lethargy, hypotension, lactic acidosis, and cardiac hypokinesis [(5, 7)].
- Diagnosing the presence of TD based on both electrocardiogram and echocardiogram exams is particularly challenging because of its non-specific symptoms 6.
- Diagnosis is confirmed on a positive response to treatment 8.
Treatment and Prevention
- Timely treatment with thiamine can result in rapid improvement in a patient's clinical status [(5, 7, 8)].
- Thiamine supplementation should be started as early as possible in patients suspected to have thiamin deficiency 8.
- Dietary education post surgery and long-term follow-up to determine nutritional status, including vitamin and mineral assessment, is recommended for patients who undergo gastric surgery 9.
Risk Factors
- Risk factors for developing thiamin deficiency include malnutrition, refeeding syndrome, gastrointestinal surgery, and alcoholism [(8, 9)].
- Patients who undergo gastric surgery may have subclinical thiamine deficiency, and thus beriberi may be precipitated by acute illness such as sepsis or poor dietary intake 9.