Diagnostic Considerations

Conditions to consider in the differential diagnosis of thiamine deficiency include the following:

Hepatic failure
Alcoholic cardiomyopathy
Cardiomyopathy in diabetic heart disease
Cardiomyopathy secondary to other etiologies
Delirium
Delirium tremens
Delusional disorder
Dementia due to human immunodeficiency virus (HIV) disease
Depression
Dermatomyositis
Diabetic ketoacidosis
Hepatic encephalopathy
Hypertensive encephalopathy
Uremic encephalopathy
Enterobacter infections
Enteroviruses
Folic acid deficiency
Hyperthyroidism
Ileus
Irritable bowel syndrome
Metabolic acidosis
Myocarditis
Nerve entrapment syndromes
Polymyositis
Schizophreniform disorder
Scurvy
Wernicke-Korsakoff syndrome

Hyperthyroidism and/or thyrotoxicosis

When examining a patient with high-output cardiac failure, thyrotoxicosis is an important differential diagnosis to consider and treat, although no definite clinical correlation has been found between thiamine and thyroid disease. Only animal studies suggest any benefit in administering thiamine to treat patients with thyrotoxicosis.

If thyrotoxicosis is suspected, the treatment must be directed at protecting the heart from the thyroid storm, as opposed to supporting the cardiac output while increasing the thiamine level. However, because no damage is expected from administering supplemental thiamine to patients with thyrotoxicosis, the use of thiamine in the treatment of these patients is innocuous and may be helpful.

Differential Diagnoses

Workup

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Media Gallery

Beriberi in an adult patient.

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Author

Dieu-Thu Nguyen-Khoa, MD, FACP Associate Clinical Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Physician Specialist, Department of Primary Care and Community Medicine, ValleyCare Olive View-UCLA Medical Center

Dieu-Thu Nguyen-Khoa, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Ginette V Busschots, MD Assistant Professor, Department of Emergency Medicine, Foote Hospital, University of Michigan Medical School

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, Michigan State Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Romesh Khardori, MD, PhD, FACP (Retired) Professor, Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

Dennis W Cope, MD, FACP Emeritus Professor of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Chief, Department of Internal Medicine, Olive View-UCLA Medical Center

Dennis W Cope, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, Society of General Internal Medicine

Disclosure: Nothing to disclose.

Acknowledgements

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.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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 College of Nutrition, 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.

Population	Age	Allowance, mg/day
Recommended Dietary Allowances (RDAs)
Boys	9-13 years	0.9
Men	>14 years	1.2
Girls	9-13 years	0.9
Women	14-18 years	1.0
Women	>19 years	1.1
Pregnant/lactating women	. . .	1.4
Children	1-3 years	0.5
Children	4-8 years	0.6
Adequate Intakes (AIs)
Infant	0-6 months	0.2
Infant	7-12 months	0.3

Beriberi (Thiamine Deficiency) Differential Diagnoses

Diagnostic Considerations

Hyperthyroidism and/or thyrotoxicosis

Differential Diagnoses

References

Tables

Contributor Information and Disclosures

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