Deficiência de vitamina B1
Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- anormalidades oculares (encefalopatia de Wernicke)
- confusão (encefalopatia de Wernicke)
- ataxia (encefalopatia de Wernicke)
Other diagnostic factors
- fadiga
- dores musculares
- choro incessante (beribéri infantil)
- anorexia (beribéri infantil)
- fontanela abaulada (beribéri infantil)
- dispneia e ortopneia (beribéri úmido)
- taquicardia (beribéri úmido)
- cianose periférica (beribéri de Shoshin)
- edema periférico ou dependente (beribéri úmido)
- sensibilidade diminuída (beribéri seco)
- reflexos tendinosos reduzidos (beribéri seco)
- fraqueza e atrofia muscular (beribéri seco)
- dor abdominal (beribéri gastrointestinal)
Risk factors
- excesso crônico de álcool
- desnutrição
- alimento básico de arroz polido
- idade <1 ano em região endêmica para deficiência de tiamina
- Síndrome de reintrodução da alimentação
- Hiperêmese gravídica
- vômitos/diarreia crônica recorrentes
- cirurgia gastrointestinal
- terapia renal substitutiva
- obesidade
- deficiência de magnésio
- Infecção por vírus da imunodeficiência humana (HIV)/síndrome de imunodeficiência adquirida (AIDS)
- câncer e quimioterapia
- dieta contendo tiaminase e antagonistas da tiamina
- mutação genética
- uso de diuréticos
Diagnostic tests
1st tests to order
- pirofosfato de tiamina no sangue total
- dosagem de pirofosfato de tiamina em eritrócito
- gasometria arterial
- lactato
- testes da função tireoidiana
Tests to consider
- ressonância nuclear magnética (RNM) cranioencefálica
- ecocardiografia
Treatment algorithm
adultos hospitalizados assintomáticos em risco
adultos não hospitalizados em processo de desintoxicação alcoólica
adultos sintomáticos
crianças e bebês sintomáticos
Contributors
Authors
Krishnan Sriram, MB, BS, FRCS(C), FACS, FCCM
Intensivist
U.S. TeleCritical Care West
Hines/Chicago
IL
Disclosures
KS declares that he has no competing interests.
Chitra Mahesh, MSc RD
Head Dietitian
Department of Nutrition
Chennai Meenakshi Multispeciality Hospital Ltd.
Chennai
Tamilnadu
India
Disclosures
CM declares that she has no competing interests.
Saritha Purushothaman, MBBS, MD Pediatrics, MRCPCH (UK)
Associate Professor of Pediatrics
Sri Madhusudan Sai Institute of Medical Science and Research
Chikkaballapur
Karnataka
India
Disclosures
SP declares that she has no competing interests.
Acknowledgements
Dr Krishnan Sriram, Chitra Mahesh, and Dr Saritha Purushothaman would like to gratefully acknowledge Dr Jennifer Logue and Dr Mike Lean, previous contributors to this topic.
Disclosures
JL and ML declare that they have 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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Berger MM, Shenkin A, Schweinlin A, et al. ESPEN micronutrient guideline. Clin Nutr. 2022 Jun;41(6):1357-424.Full text Abstract
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.Full text Abstract
Galvin R, Bråthen G, Ivashynka A, et al. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur J Neurol. 2010 Dec;17(12):1408-18.Full text Abstract
da Silva JSV, Seres DS, Sabino K, et al. ASPEN consensus recommendations for refeeding syndrome. Nutr Clin Pract. 2020 Apr;35(2):178-95.Full text Abstract
Day E, Bentham PW, Callaghan R, et al. Thiamine for prevention and treatment of Wernicke-Korsakoff Syndrome in people who abuse alcohol. Cochrane Database Syst Rev. 2013 Jul 1;(7):CD004033.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Neuropatia periférica
- Encefalite aguda
- Meningite
More DifferentialsGuidelines
- Immigrant and refugee health: nutrition and growth
- ESPEN practical and partially revised guideline: clinical nutrition in the intensive care unit
More Guidelines
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