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Deficiência de vitamina B1

  • Visão geral
  • Teoria
  • Diagnóstico
  • Tratamento
  • ACOMPANHAMENTO
  • Recursos
Última revisão: 24 Sep 2025
Última atualização: 22 May 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • presença de fatores de risco
  • anormalidades oculares (encefalopatia de Wernicke)
  • confusão (encefalopatia de Wernicke)
  • ataxia (encefalopatia de Wernicke)
Detalhes completos

Outros fatores diagnósticos

  • 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)
Detalhes completos

Fatores de risco

  • 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
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • pirofosfato de tiamina no sangue total
  • dosagem de pirofosfato de tiamina em eritrócito
  • gasometria arterial
  • lactato
  • testes da função tireoidiana
Detalhes completos

Investigações a serem consideradas

  • ressonância nuclear magnética (RNM) cranioencefálica
  • ecocardiografia
Detalhes completos

Algoritmo de tratamento

Inicial

adultos hospitalizados assintomáticos em risco

adultos não hospitalizados em processo de desintoxicação alcoólica

AGUDA

adultos sintomáticos

crianças e bebês sintomáticos

Colaboradores

Autores

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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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