Last reviewed: 5 Nov 2021
Last updated: 03 Sep 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • ocular abnormalities (Wernicke encephalopathy)

Other diagnostic factors

  • confusion (Wernicke encephalopathy)
  • ataxia (Wernicke encephalopathy)
  • fatigue
  • muscle aches
  • incessant crying (infantile beri-beri)
  • anorexia (infantile beri-beri)
  • bulging fontanelle (infantile beri-beri)
  • dyspnea (wet beriberi)
  • orthopnea (wet beriberi)
  • tachycardia (wet beriberi)
  • peripheral cyanosis (wet beriberi)
  • peripheral edema (wet beriberi)
  • decreased sensation (dry beriberi)
  • reduced tendon reflexes (dry beriberi)
  • muscle weakness (dry beriberi)
  • muscle wasting (dry beriberi)

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

Diagnostic investigations

1st investigations to order

  • erythrocyte thiamine pyrophosphate
  • arterial blood gas
  • lactate
  • thyroid function tests

Treatment algorithm

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.

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