eMedicine Specialties > Endocrinology > Metabolic Disorders

Beriberi (Thiamine Deficiency): Follow-up

Author: Dieu-Thu Nguyen-Khoa, MD, Assistant Professor, University of California Los Angeles Residency Program; Physician Specialist, Valley Care-Olive View Medical Center
Coauthor(s): Dennis W Cope, MD, FACP, Emeritus Professor of Clinical Medicine, University of California Los Angeles School of Medicine; Chief, Department of Internal Medicine, Olive View-University of California Los Angeles Medical Center; Ginette V Busschots, MD, Staff Physician, Assistant Professor, University of Michigan, Department of Emergency Medicine, Foote Hospital; Phyllis A Vallee, MD, Associate Program Director, Department of Emergency Medicine, Henry Ford Hospital
Contributor Information and Disclosures

Updated: Sep 9, 2009

Follow-up

Further Inpatient Care

  • Depending on the cause of the vitamin deficiency, a referral to an alcohol dependency clinic may be needed.
  • Follow-up care until delivery of current pregnancy, intensive care of advanced cardiomyopathy, definitive care for hyperthyroidism, or further workup of intestinal derangement may be warranted.
  • An optimal method for delivering the needed thiamine in a bioavailable form must be determined for long-term treatment of each patient.

Further Outpatient Care

  • Most outpatient care is targeted at delivering thiamine in a bioavailable form to rehabilitated patients. Clinical follow-up with measurement of thiamine diphosphate activity may be warranted if relapse or noncompliance is suspected.

Prognosis

  • The patient prognosis for beriberi is usually good, unless patients have established Korsakoff syndrome. When patients have progressed to this stage, the degree of damage is only minimally reversible.

Patient Education

  • Include education regarding Korsakoff syndrome for patients being treated for alcohol dependency. As with any substance abuse treatment program, education needs to be combined with a serious, multidisciplinary team approach to have any chance of success.
  • With other causes of beriberi, once the primary problem has been addressed, an appropriate diet providing more-than-adequate thiamine levels should be adopted by the patient.

Miscellaneous

Medicolegal Pitfalls

  • Thiamine deficiency is an easily treatable condition, and adverse effects of treatment are minimal. Failure to recognize and treat thiamine deficiency can result in litigation.

Special Concerns

  • Observation of a patient's clinical response to thiamine administration remains the easiest, least expensive form of testing; however, clinicians usually miss the subclinical forms of beriberi.
 


More on Beriberi (Thiamine Deficiency)

Overview: Beriberi (Thiamine Deficiency)
Differential Diagnoses & Workup: Beriberi (Thiamine Deficiency)
Treatment & Medication: Beriberi (Thiamine Deficiency)
Follow-up: Beriberi (Thiamine Deficiency)
References
Further Reading
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References

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  2. Cole PD, Kamen BA. "Beriberi" interesting!. J Pediatr Hematol Oncol. Dec 2003;25(12):924-6. [Medline].

  3. Isselbacher KJ, Braunwald E, Wilson JD. Harrison's Principles of Internal Medicine. 13th ed. New York, NY: McGraw-Hill; 1994:474-475.

  4. McCormick DB. Shils ME, Young VR, eds. Modern Nutrition in Health and Disease. Philadelphia, Pa: Lea and Febiger; 1988:355-61.

  5. Rosen P, Barkin R. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St. Louis, Mo: Mosby Year Book; 1998:2138-40.

  6. Thiamine. Monograph. Altern Med Rev. Feb 2003;8(1):59-62. [Medline].

  7. Karuppagounder SS, Xu H, Pechman D, et al. Translocation of amyloid precursor protein C-terminal fragment(s) to the nucleus precedes neuronal death due to thiamine deficiency-induced mild impairment of oxidative metabolism. Neurochem Res. Mar 4 2008;[Medline].

  8. Indraccolo U, Gentile G, Pomili G, et al. Thiamine deficiency and beriberi features in a patient with hyperemesis gravidarum. Nutrition. Sep 2005;21(9):967-8. [Medline].

  9. Zuccoli G, Gallucci M, Capellades J, et al. Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients. AJNR Am J Neuroradiol. Aug 2007;28(7):1328-31. [Medline].

  10. Hazell AS. Astrocytes are a major target in thiamine deficiency and Wernicke's encephalopathy. Neurochem Int. Jul-Aug 2009;55(1-3):129-35. [Medline].

  11. Zuccoli G, Pipitone N. Neuroimaging findings in acute Wernicke's encephalopathy: review of the literature. AJR Am J Roentgenol. Feb 2009;192(2):501-8. [Medline].

  12. Weise Prinzo Z, de Benoist B. Meeting the challenges of micronutrient deficiencies in emergency-affected populations. Proc Nutr Soc. May 2002;61(2):251-7. [Medline].

  13. Masumoto K, Esumi G, Teshiba R, et al. Need for thiamine in peripheral parenteral nutrition after abdominal surgery in children. JPEN J Parenter Enteral Nutr. Jul-Aug 2009;33(4):417-22. [Medline].

  14. Rao SN, Mani S, Madap K, et al. High prevalence of infantile encephalitic beriberi with overlapping features of Leigh's disease. J Trop Pediatr. May 8 2008;[Medline].

  15. Fattal-Valevski A, Azouri-Fattal I, Greenstein YJ, et al. Delayed language development due to infantile thiamine deficiency. Dev Med Child Neurol. Aug 2009;51(8):629-34. [Medline].

  16. Shenoy VV, Patil PV, Nagar VS, et al. Congestive cardiac failure and anemia in a 15-year-old boy. J Postgrad Med. Jul-Sep 2005;51(3):225-7. [Medline].

  17. Angstadt JD, Bodziner RA. Peripheral polyneuropathy from thiamine deficiency following laparoscopic Roux-en-Y gastric bypass. Obes Surg. Jun-Jul 2005;15(6):890-2. [Medline].

  18. Koike H, Iijima M, Mori K, et al. Postgastrectomy polyneuropathy with thiamine deficiency is identical to beriberi neuropathy. Nutrition. Nov-Dec 2004;20(11-12):961-6. [Medline].

  19. Aasheim ET, Bjorkman S, Sovik TT, et al. Vitamin status after bariatric surgery: a randomized study of gastric bypass and duodenal switch. Am J Clin Nutr. Jul 2009;90(1):15-22. [Medline].

  20. Braverman LE, Utiger RD. Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text. 7th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1996:694, 864.

  21. Sica DA. Loop diuretic therapy, thiamine balance, and heart failure. Congest Heart Fail. Jul-Aug 2007;13(4):244-7. [Medline].

  22. Hanninen SA, Darling PB, Sole MJ, et al. The prevalence of thiamin deficiency in hospitalized patients with congestive heart failure. J Am Coll Cardiol. Jan 17 2006;47(2):354-61. [Medline].

  23. Lu J, Frank EL. Rapid HPLC measurement of thiamine and its phosphate esters in whole blood. Clin Chem. May 2008;54(5):901-6. [Medline].

  24. Tran HA. Increased troponin I in "wet" beriberi. J Clin Pathol. May 2006;59(5):555. [Medline].

  25. National Academy of Sciences. Dietary Guidance: Dietary Reference Intake Reports. USDA National Agricultural Library. Available at http://fnic.nal.usda.gov/nal_display/index.php?info_center=4&tax_level=3&tax_subject=256&topic_id=1342&level3_id=5141.

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Further Reading

Related eMedicine topic:
 Alcohol-Related Psychosis
Beriberi [Pediatrics: General Medicine]
Cardiomyopathy, Alcoholic
Wernicke Encephalopathy
Wernicke-Korsakoff Syndrome

Clinical guidelines:
American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. American Association of Clinical Endocrinologists - Medical Specialty Society
American Society for Metabolic and Bariatric Surgery - Professional Association
The Obesity Society - Disease Specific Society.  2008 Jul-Aug.  83 pages.  NGC:006716

Expert panel on weight loss surgery. Massachusetts Department of Public Health - State/Local Government Agency [U.S.].  2004 Aug 4 (revised 2007 Dec 12).  106 pages.  NGC:006638

Clinical trials:
The Prevalence of Thiamin Deficiency in Ambulatory Patients With Heart Failure

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Keywords

beriberi, thiamine, thiamin, vitamin B, vitamin B1, vitamin B-1, thiamine deficiency, Wernicke's encephalopathy, Wernicke encephalopathy, Korsakoff syndrome, Korsakoff’s syndrome, vitamin B1 deficiency, vitamin B-1 deficiency, thiamin deficiency, wet beriberi, dry beriberi, Shoshin beriberi, acute fulminant cardiovascular beriberi, thiamine pyrophosphate, thiamin pyrophosphate

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Contributor Information and Disclosures

Author

Dieu-Thu Nguyen-Khoa, MD, Assistant Professor, University of California Los Angeles Residency Program; Physician Specialist, Valley Care-Olive View Medical Center
Dieu-Thu Nguyen-Khoa, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Dennis W Cope, MD, FACP, Emeritus Professor of Clinical Medicine, University of California Los Angeles School of Medicine; Chief, Department of Internal Medicine, Olive View-University of California Los Angeles Medical Center
Dennis W Cope, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Ginette V Busschots, MD, Staff Physician, Assistant Professor, University of Michigan, Department of Emergency Medicine, Foote Hospital
Disclosure: Nothing to disclose.

Phyllis A Vallee, MD, Associate Program Director, Department of Emergency Medicine, Henry Ford Hospital
Phyllis A Vallee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Stanley Wallach, MD, Executive Director, American College of Nutrition; Clinical Professor, Department of Medicine, New York University School of Medicine
Stanley Wallach, MD is a member of the following medical societies: American Society for Bone and Mineral Research, American Society for Clinical Investigation, American Society for Clinical Nutrition, American Society for Nutritional Sciences, Association of American Physicians, and Endocrine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Don S Schalch, MD, Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, University of Wisconsin Hospitals and Clinics
Don S Schalch, MD is a member of the following medical societies: American Diabetes Association, American Federation for Medical Research, Central Society for Clinical Research, and Endocrine Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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