eMedicine Specialties > Pediatrics: General Medicine > Nutrition

Beriberi: Follow-up

Author: Simon S Rabinowitz, MD, PhD, Professor of Clinical Pediatrics, New York Medical College; Chairman, Chief and Medical Administrator, Department of Pediatrics, Chief, Pediatric Gastroenterology and Nutrition, Richmond University Medical Center
Coauthor(s): L Arturo Batres, MD, Assistant Professor, Department of Pediatrics, Division of Gastroenterology and Nutrition, The Children's Hospital of the King's Daughters; Sheela Moorthy, MD, Staff Physician, Department of Pediatrics, Richmond University Medical Center
Contributor Information and Disclosures

Updated: Sep 18, 2009

Follow-up

Further Inpatient Care

  • In the course of treatment for high-output cardiac failure, care must be taken that other supportive cardiac medications are continued in parallel with thiamine infusion. Failure to do so could precipitate low-output cardiac failure.
  • Physicians must be able to elucidate risk factors surrounding the presenting patient in order to prevent recurrence.

Further Outpatient Care

  • Preventive therapy should be used in patients with malabsorption problems, patients with decreased intake, patients on long-term TPN,21 and patients with increasing demand that lasts for more than 2 weeks.
  • In specific cohorts (eg, patients with alcoholism), rehabilitation and support therapy must be incorporated into the treatment regimen.
  • Recent work (see Frequency) suggests that infants with beriberi should be monitored throughout childhood for future neurodevelopmental delays.

Inpatient & Outpatient Medications

  • In mild deficiency states, including a breast-feeding mother, a daily oral dose of 10 mg of thiamine during the first week, followed by 3-5 mg daily orally for 6 weeks, helps prevent deficiency.
  • After infantile thiamine deficiency with acute heart failure is treated with parenteral therapy, the patient is then placed on oral thiamine, 3-5 mg daily for at least 6 weeks.

Transfer

  • Patients with chronic alcoholism should be transferred to a facility with structured programs in place for treating substance abuse.

Deterrence/Prevention

  • Physicians in the United States, especially those caring for Asian immigrants, must be able to recognize the various cultural and dietary customs that surround their particular patient population that place them at high risk.
  • Internationally, subtle thiamine deficiency should be identified early, especially when dealing with populations at risk (eg, refugees, institutionalized persons, breastfed infants whose mothers are thiamine deficient).

Complications

  • GI complaints, including constipation and colicky abdominal pain
  • Muscle wasting
  • Vision or hearing impairment
  • Complete paralysis
  • Ataxia
  • Profound loss of recent memory with active imagination
  • Delirium
  • Death

Prognosis

  • In patients with wet beriberi, improvement is observed in the first 6-24 hours after thiamine administration.
    • Cyanosis disappears.
    • The heart rate reduces.
    • The respiratory rate reduces.
    • Diuresis and reduction in heart size may be apparent within 1-2 days.
  • In patients with dry beriberi, the complete resolution of the peripheral neurologic symptoms can take weeks to months.
  • In patients with Wernicke encephalopathy, the ocular symptoms resolve within hours to days, and the confusional state subsides in days to weeks.
  • Korsakoff syndrome resolves over months, and residual deficits are often reported.
  • Infantile beriberi may lead to learning deficits in childhood and beyond.

Patient Education

  • Population at risk must be educated regarding the diversification of diet, the incorporation of foods high in thiamine, proper food preparation (shorter cooking time for vegetables, reduction in amount of rice washing prior to cooking), the value of whole grains, avoidance of alcohol, and thiamine supplementation, if that is necessary to maintain thiamine status.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider the diagnosis may lead to severe congestive heart failure and death or permanent neurologic disability.
  • Failure to recognize that patients with high-output states relieved by intravenous thiamine may remain in cardiac failure that can lead to morbidity.
  • Failure to recognize early manifestations of Korsakoff syndrome often leads to residual impairments.
 
Acknowledgments

The authors gratefully acknowledge Dori Harasek for her assistance in the preparation of this chapter.



More on Beriberi

Overview: Beriberi
Differential Diagnoses & Workup: Beriberi
Treatment & Medication: Beriberi
Follow-up: Beriberi
Multimedia: Beriberi
References
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Further Reading

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Keywords

thiamine deficiency, vitamin B-1 deficiency, vitamin B1, aneurin deficiency, Shoshin syndrome, occidental beriberi, endemic neuritis, kakké, panneuritis endemica, beriberi, wet beriberi, edematous cardiovascular dysfunction, dry beriberi, multifocal peripheral neurologic dysfunction, dietary thiamine deficiency, thiamine pyrophosphate, TPP, myocardial tissue edema, malnutrition, malabsorption syndromes, hyperemesis gravidarum, lymphoma, congestive heart failure, milled rice, mitochondrial myopathy, infantile beriberi, tachycardia, low diastolic pressure, cardiomegaly, pulmonary edema, cyanosis, peripheral edema, pulmonary effusions, polyneuritis, paralysis, encephalopathy, Korsakoff syndrome, Wernicke-Korsakoff syndrome, sudden infant death syndrome, SIDS, hepatomegaly, ataxia, nystagmus, ptosis, ophthalmoplegia, delirium, retrograde amnesia

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Contributor Information and Disclosures

Author

Simon S Rabinowitz, MD, PhD, Professor of Clinical Pediatrics, New York Medical College; Chairman, Chief and Medical Administrator, Department of Pediatrics, Chief, Pediatric Gastroenterology and Nutrition, Richmond University Medical Center
Simon S Rabinowitz, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American College of Gastroenterology, American Gastroenterological Association, American Medical Association, New York Academy of Sciences, North American Society for Pediatric Gastroenterology and Nutrition, Phi Beta Kappa, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

L Arturo Batres, MD, Assistant Professor, Department of Pediatrics, Division of Gastroenterology and Nutrition, The Children's Hospital of the King's Daughters
L Arturo Batres, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Study of Liver Diseases, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Sheela Moorthy, MD, Staff Physician, Department of Pediatrics, Richmond University Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Maria Rebello Mascarenhas, MBBS, Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Section Chief, Division of Gastroenterology and Nutrition, Director, Nutrition Support Service, Children's Hospital of Philadelphia
Maria Rebello Mascarenhas, MBBS is a member of the following medical societies: American Gastroenterological Association, American Society for Parenteral and Enteral Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jatinder Bhatia, MBBS, Professor of Pediatrics, Chief, Section of Neonatology, Department of Pediatrics, Medical College of Georgia
Jatinder Bhatia, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Dietetic Association, American Pediatric Society, American Society for Clinical Nutrition, American Society for Parenteral and Enteral Nutrition, Society for Pediatric Research, and Southern Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Jatinder Bhatia, MBBS, Professor of Pediatrics, Chief, Section of Neonatology, Department of Pediatrics, Medical College of Georgia
Jatinder Bhatia, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Dietetic Association, American Pediatric Society, American Society for Clinical Nutrition, American Society for Parenteral and Enteral Nutrition, Society for Pediatric Research, and Southern Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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