Pediatric Beriberi Follow-up

Updated: Oct 04, 2018
  • Author: Simon S Rabinowitz, MD, PhD, FAAP; Chief Editor: Jatinder Bhatia, MBBS, FAAP  more...
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Follow-up

Further Outpatient Care

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  • Preventive therapy should be used in patients with malabsorption problems, patients with decreased intake, patients on long-term TPN, [25] 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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Further Inpatient Care

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  • 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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Inpatient & Outpatient Medications

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  • 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

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  • 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

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  • 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

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  • 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

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  • 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

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  • 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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