Vitamin B1 deficiency

Vitamin B1 (thiamine) deficiency is the underlying cause of several clinical syndromes, including Wernicke encephalopathy, wet beriberi, and dry beriberi, rather than a single clinical condition or diagnosis.

Clinical presentation depends on the chronicity of the deficiency.

As signs and symptoms are nonspecific, the presence of risk factors raises suspicion of the diagnosis.

Risk factors include alcohol dependence, malabsorption, and a diet low in thiamine (e.g., based on polished rice).

As there is no rapid diagnostic test for the condition, presumptive treatment should be commenced immediately if vitamin B1 deficiency is suspected.

Untreated vitamin B1 deficiency in the form of Wernicke encephalopathy can result in the need for institutional care, or in death.

Vitamin B1, also known as thiamine, is an essential micronutrient.[1]Whitfield KC, Bourassa MW, Adamolekun B, et al. Thiamine deficiency disorders: diagnosis, prevalence, and a roadmap for global control programs. Ann N Y Acad Sci. 2018 Oct;1430(1):3-43. https://www.doi.org/10.1111/nyas.13919 http://www.ncbi.nlm.nih.gov/pubmed/30151974?tool=bestpractice.com Deficiency can result in distinct clinical presentations. Acute deficiency can present as Wernicke encephalopathy, with ocular abnormalities, mental state changes, and ataxia. Acute or chronic deficiency can also lead to wet beriberi (which presents as high-output cardiac failure with edema and orthopnea), or low-output cardiac failure with lactic acidosis and peripheral cyanosis (also known as Shoshin beriberi). Dry beriberi occurs with chronic deficiency and is characterized by a distal peripheral polyneuropathy.