eMedicine Specialties > Pediatrics: General Medicine > Nutrition

Beriberi: Treatment & Medication

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

Treatment

Medical Care

  • Monitor patients with cardiac failure in an intensive care unit.
  • Because beriberi often presents with other vitamin B deficiencies, administer a complete vitamin B complex.
  • After the high-output state has been addressed with thiamine, patients can go into standard congestive heart failure and, thus, may require ongoing cardiology consultation, possibly remaining in an intensive care unit.

Consultations

  • Cardiologic evaluation with 2-dimensional echocardiography is necessary.
    • Essential for diagnosis and management of beriberi
    • Reveals congestive heart failure and the poor ventricular function observed in beriberi
    • Assists in cardiac dysfunction that remains after thiamine administration.
  • Neurologic and psychiatric consultations are usually necessary. If dry beriberi has progressed, ongoing care is required.
  • Nutritional consultation should be aimed at preventing a recurrence of the deficiency.
  • For psychosocial causes, support counseling is essential to avoid recurrence. Specialized multidisciplinary teams are advisable for patients with chronic alcoholism to monitor their future course. Comprehensive follow-up programs are necessary to minimize recidivism in most cases of nutritional beriberi.

Diet

  • Patients with lethargy, confusion, and severe heart failure need to be kept on a diet of nothing by mouth (NPO) to prevent aspiration.
  • Dietary sources of thiamine (see Pathophysiology) must be emphasized along with ongoing supplementation.

Activity

  • Patients who present with congestive heart failure should have activity restricted.

Medication

The treatment of choice is thiamine hydrochloride (ie, aneurine hydrochloride, vitamin B-1). In a prospective study of the safety of thiamine hydrochloride, Wrenn et al evaluated 989 patients (1070 doses of 100 mg).20 A total of 12 adverse reactions (1.1%) were reported. Minor reactions consisting of transient local irritation were observed in 11 patients (1.02%), and only one major reaction occurred (0.093%), consisting of generalized pruritus.

Several thiamine derivatives (eg, thiamine propyl disulfide [TPD], thiamine tetrahydrofurfuryl disulfide [TTFD]) have also been used to treat beriberi. These compounds are barely soluble in water. Even when orally administered, TPD and TTFD produce a higher thiamine level in the blood than thiamine hydrochloride.

If beriberi occurs in a breastfed infant, both the mother and child should be treated with thiamine. The physician should also be aware that thiamine deficiency can occur concurrently with other water soluble vitamin deficiencies.

Vitamins

These agents are organic substances required by the body in small amounts for various metabolic processes. Vitamins may be synthesized in small or insufficient amounts in the body or may not be synthesized at all, thus requiring supplementation.


Thiamine hydrochloride (Thiamilate)

Essential coenzyme that combines with ATP to form thiamine pyrophosphate. Dosage forms include a parenteral injection (100 mg/mL) and tablets.

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 syndrome (wet beriberi): 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

25-50 mg/dose slow IV, followed by 10 mg/d IV for 7 d, then 3-5 mg PO qd for at least 6 wk

Neuromuscular agents may enhance effects of thiamine; high carbohydrate diets or IV dextrose solutions may increase thiamine requirements; large doses may interfere with serum theophylline assay

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Pregnancy category A if <1.4 mg/d (RDI) and pregnancy category C >1.4 mg/d; avoid PO dosing in patients with GI disorders that prevent absorption; can be administered to breastfeeding mothers; administer before beginning a glucose infusion; sensitivity reactions can occur (intradermal test-dose recommended in suspected sensitivity); deaths have resulted from IV use; rash, angioedema, warmth, and tingling may occur

More on Beriberi

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

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  2. Institute of Medicine of the National Academies. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin and Choline. Washington DC: National Academy Press; 1998:[Full Text].

  3. World Health Organization. Thiamine Deficiency and its prevention and control in major emergencies. 1999. [Full Text].

  4. McCandless DW, Schenker S, Cook M. Encephalopathy of thiamine deficieny: studies of intracerebral mechanisms. J Clin Invest. Oct 1968;47(10):2268-80. [Medline].

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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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