Resumen
Definición
病史和体格检查
关键诊断因素
- presença de fatores de risco
- anormalidades oculares (encefalopatia de Wernicke)
- confusão (encefalopatia de Wernicke)
- ataxia (encefalopatia de Wernicke)
其他诊断因素
- 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)
危险因素
- 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
诊断性检查
首要检查
- pirofosfato de tiamina no sangue total
- dosagem de pirofosfato de tiamina em eritrócito
- gasometria arterial
- lactato
- testes da função tireoidiana
需考虑的检查
- ressonância nuclear magnética (RNM) cranioencefálica
- ecocardiografia
治疗流程
adultos hospitalizados assintomáticos em risco
adultos não hospitalizados em processo de desintoxicação alcoólica
adultos sintomáticos
crianças e bebês sintomáticos
撰稿人
作者
Krishnan Sriram, MB, BS, FRCS(C), FACS, FCCM
Intensivist
U.S. TeleCritical Care West
Hines/Chicago
IL
利益声明
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
利益声明
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
利益声明
SP declares that she has no competing interests.
鸣谢
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.
利益声明
JL and ML declare that they have no competing interests.
同行评议者
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
利益声明
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
利益声明
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
利益声明
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.
参考文献
关键文献
Berger MM, Shenkin A, Schweinlin A, et al. ESPEN micronutrient guideline. Clin Nutr. 2022 Jun;41(6):1357-424.全文 摘要
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.全文 摘要
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.全文 摘要
da Silva JSV, Seres DS, Sabino K, et al. ASPEN consensus recommendations for refeeding syndrome. Nutr Clin Pract. 2020 Apr;35(2):178-95.全文 摘要
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.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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