eMedicine Specialties > Endocrinology > Metabolic Disorders

Beriberi (Thiamine Deficiency): Treatment & Medication

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

Treatment

Medical Care

In suspected cases, prompt administration of parenteral thiamine is indicated. The recommended dose is 50 mg intramuscularly for several days. The duration of therapy depends on the symptoms, and therapy is indicated until all symptoms have disappeared. Maintenance is recommended at 2.5-5 mg per day orally unless a malabsorption syndrome is suspected.

Support for other cardiac function is necessary in cases of wet beriberi, because lack of cardiac function support leads to low-output cardiac failure when the thiamine deficiency is corrected.

Thiamine, even at high concentrations, is not toxic in a person with normal renal function. No cases of thiamine toxicity have been reported from the use of thiamine at the dosages indicated, even in patients in critical condition.

Diet

Thiamine-containing foods include all vegetables and the outer layer of grains. Thiamine is not present in fats or highly refined sugars and is present sparingly in cassava. Foods containing thiaminases, such as milled rice, shrimp, mussels, clams, fresh fish, and raw animal tissues, decrease absorption.25

Cassava is a staple in many developing countries and has been used in a variety of high-energy diets. Although it contains thiamine (0.05-0.225 mg of thiamine per 100 g of cassava, depending on the crop), the high carbohydrate load of a diet rich in cassava actually consumes more thiamine than it offers the body. This can produce a thiamine deficiency through the same mechanism observed when dextrose is administered to a person with limited supplies of the vitamin.

Table. Nutritional Needs for Specific Age Groups

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Table
Population Age Allowance, mg/d
Recommended Dietary Allowances (RDAs)
Boys9-13 y0.9
Men>14 y0.9
Girls9-13 y0.9
Women14-18 y1.0
Women>19 y1.1
Pregnant/Lactating Women. . .1.4
Children1-3 y0.5
Children4-8 y0.6
Adequate Intakes (AIs)
Infant0-6 mo0.2
Infant7-12 mo0.4
Population Age Allowance, mg/d
Recommended Dietary Allowances (RDAs)
Boys9-13 y0.9
Men>14 y0.9
Girls9-13 y0.9
Women14-18 y1.0
Women>19 y1.1
Pregnant/Lactating Women. . .1.4
Children1-3 y0.5
Children4-8 y0.6
Adequate Intakes (AIs)
Infant0-6 mo0.2
Infant7-12 mo0.4

Activity

The level of activity and the presence of a high energy consumption state (eg, hyperthyroidism, pregnancy, lactation, severe disease) increase the daily requirements of thiamine.

Medication

The goals of pharmacotherapy are to correct the vitamin deficiency, reduce morbidity, and prevent complications.

Vitamins

Vitamins are essential for normal deoxyribonucleic acid (DNA) synthesis.


Thiamine (Thiamilate)

Used to replenish the body's stores of coenzyme thiamine pyrophosphate.

Adult

Mild neuropathy: 10-20 mg/d IM divided bid for 2 wk
Mild to advanced neuropathy: 20-30 mg/d IM divided bid for several wk after symptoms resolve
Shoshin: 100 mg IV qd for several d, followed by 50-100 mg IV/IM bid for several d, then 10-20 mg IM qd until full response

Pediatric

Not established

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

Precautions

Sensitivity reactions can occur (intradermal test dose recommended in patients with suspected sensitivity); deaths have resulted from IV use; sudden onset or worsening of Wernicke encephalopathy following glucose may occur in thiamine-deficient patients; administer before or together with dextrose-containing fluids in suspected thiamine deficiency
Parenteral doses >400 mg of thiamine can cause nausea, anorexia, lethargy, mild ataxia, and decrease in gut tone

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].

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  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].

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  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].

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  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].

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  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].

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  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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