Pediatric Beriberi Follow-up

  • Author: Simon S Rabinowitz, MD, PhD; Chief Editor: Jatinder Bhatia, MBBS   more...
 
Updated: Sep 18, 2009
 

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.
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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.
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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.
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Transfer

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

Specialty Editor Board

Maria Rebello Mascarenhas, MBBS  Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Section Chief Nutrition, 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.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

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.

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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