Vitamin B1 deficiency

Last reviewed: 23 Apr 2022
Last updated: 03 Sep 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • ocular abnormalities (Wernicke's encephalopathy)
More key diagnostic factors

Other diagnostic factors

  • confusion (Wernicke's encephalopathy)
  • ataxia (Wernicke's encephalopathy)
  • fatigue
  • muscle aches
  • incessant crying (infantile beri-beri)
  • anorexia (infantile beri-beri)
  • bulging fontanelle (infantile beri-beri)
  • dyspnoea (wet beriberi)
  • orthopnoea (wet beriberi)
  • tachycardia (wet beriberi)
  • peripheral cyanosis (wet beriberi)
  • peripheral oedema (wet beriberi)
  • decreased sensation (dry beriberi)
  • reduced tendon reflexes (dry beriberi)
  • muscle weakness (dry beriberi)
  • muscle wasting (dry beriberi)
Other diagnostic factors

Risk factors

  • chronic alcohol excess
  • malnutrition
  • staple diet of polished rice
  • age <1 year in endemic thiamine deficient region
  • refeeding/total parenteral nutrition
  • hyperemesis gravidarum
  • obesity
  • recurrent vomiting/chronic diarrhoea
  • gastrointestinal surgery
  • magnesium deficiency
  • HIV infection/AIDS
  • cancer and chemotherapy
  • thiaminase- and thiamine antagonist-containing diet
  • genetic mutation
More risk factors

Diagnostic investigations

1st investigations to order

  • erythrocyte thiamine pyrophosphate
  • ABG
  • lactate
  • thyroid function tests
More 1st investigations to order

Investigations to consider

  • MRI brain
More investigations to consider

Treatment algorithm

INITIAL

at-risk asymptomatic hospitalised adults

adults on community alcohol withdrawal

ACUTE

symptomatic adults

symptomatic children and infants

Contributors

Authors

Jennifer Logue, MBChB, MRCP, MD, FRCPath
Jennifer Logue

Reader and Honorary Consultant in Metabolic Medicine

Lancaster University Medical School

Lancaster University

Lancaster

UK

Disclosures

JL declares that she has no competing interests.

Mike Lean, MA, MB, BChir, MD, MRCP, FRCPS, FRCP
Mike Lean

Professor of Human Nutrition

University of Glasgow

Glasgow

Scotland

UK

Disclosures

ML declares that he has no competing interests.

Peer reviewers

William Marshall, MA, MB, BS, PhD, MSc, FRCP, FRCPath, FRCPEdin, FSB

Emeritus Reader in Clinical Biochemistry

King's College London

Clinical Director of Pathology

The London Clinic

London

UK

Disclosures

WM declares that he has no competing interests.

Linda Edwards, MD

Chief and Associate Professor of Medicine

Division of General Internal Medicine

Associate Chairman

Department of Medicine

University of Florida College of Medicine

Jacksonville

FL

Disclosures

LE declares that she has no competing interests.

Martin Crook, BSc, MB, BS, MA, PhD, FRCPath, FRCPI, FRCP

Consultant Chemical Pathologist

Guy's Hospital

London

UK

Disclosures

MC declares that he has no competing interests.

  • Differentials

    • Peripheral neuropathy
    • Acute encephalitis
    • Graves' disease
    More Differentials
  • Guidelines

    • ESPEN guideline on clinical nutrition in the intensive care unit
    • Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update
    More Guidelines
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