Beriberi (Thiamine Deficiency) Treatment & Management

Updated: Mar 08, 2018
  • Author: Dieu-Thu Nguyen-Khoa, MD, FACP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Treatment

Approach Considerations

In suspected cases of thiamine deficiency, prompt administration of parenteral thiamine is indicated. The recommended dose is 50 mg given 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.

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.

An optimal method for delivering the needed thiamine in a bioavailable form must be determined for the long-term treatment of each patient. Depending on the cause of the vitamin deficiency, a referral to an alcohol dependency clinic may be needed.

Most outpatient care is targeted at delivering thiamine in a bioavailable form to rehabilitated patients. Clinical follow-up with measurement of thiamine diphosphate activity may be warranted if relapse or noncompliance is suspected.

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

Follow-up care until delivery of current pregnancy, intensive care for advanced cardiomyopathy, definitive care for hyperthyroidism, or further workup of intestinal derangement may be warranted in patients with thiamine deficiency.

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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.

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