Vitamin B₁/Thiamine deficiency (Wernicke encephalopathy and beriberi)

E51.1-2/E51.8-9

• Description
• General Measures
• Medicine Treatment
• Referral

DESCRIPTION

Clinical features include:

• confusion
• short-term memory loss
• paralysis of one or more of the ocular muscles or ophthalmoplegia
• nystagmus
• ataxia
• peripheral neuropathy
• cardiac failure

Alcoholics may present with Wernicke encephalopathy, neuropathies or cardiac failure associated with multiple vitamin deficiencies.

GENERAL MEASURES

• Lifestyle adjustment including discouraging alcohol abuse.
• Dietary advice to increase intake of thiamine rich foods such as: wholewheat breads, oatmeal pulses, nuts, yeast fortified cereals, pork, bacon, marmite and potatoes and peas

MEDICINE TREATMENT

Peripheral neuropathy and cardiac failure

• Thiamine, oral, 100 mg daily.

In susceptible patients, administration of intravenous glucose precipitates Wernicke encephalopathy if administered before thiamine supplementation. Thiamine should be given first in all patients treated with intravenous glucose who are at risk of thiamine deficiency, e.g. alcoholics.

REFERRAL

All patients with encephalopathy, eye muscle paralysis or cardiac failure.