Last reviewed:October 2019
Last updated:September  2017

Summary

Definition

History and exam

Key diagnostic factors

  • ocular abnormalities (Wernicke encephalopathy)

Other diagnostic factors

  • confusion (Wernicke encephalopathy)
  • ataxia (Wernicke encephalopathy)
  • fatigue
  • muscle aches
  • 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
  • refeeding/total parenteral nutrition
  • GI surgery
  • magnesium deficiency
  • recurrent vomiting/chronic diarrhea
  • AIDS
  • cancer and chemotherapy
  • thiaminase- and thiamine antagonist-containing diet

Diagnostic investigations

1st investigations to order

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

Treatment algorithm

Contributors

Jennifer Logue

Reader and Honorary Consultant in Metabolic Medicine

Lancaster University Medical School

Lancaster University

Lancaster

UK

Disclosures

JL led a joint working project in weight management with Astra Zeneca, MSD, and NHS Greater Glasgow and Clyde, which had unrestricted grant support from Janssen. JL received support from Novo Nordisk in Oct 2016 for attending a conference.

Mike Lean

Professor of Human Nutrition

University of Glasgow

Glasgow

Scotland

UK

Disclosures

ML declares that he has no competing interests.

Peer reviewersVIEW ALL

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.

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.

Consultant Chemical Pathologist

Guy's Hospital

London

UK

Disclosures

MC declares that he has no competing interests.

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