Thiamine deficiency

Last revised by Dr Daniel J Bell on 02 Aug 2021

Thiamine deficiency is caused by a low level of thiamine (vitamin B1) in the body, and when severe, a deficiency may manifest in adults as beriberi.
There are two main forms:

  • wet beriberi: high-output cardiac failure predominates
  • dry beriberi: neurological dysfunction predominates

In practice patients may present with mixed beriberi, i.e. with elements of both the wet and dry forms.

  • confusion
  • altered mentation
  • ataxia
  • visual disturbance
  • sensory and/or motor deficits

Laboratory testing of the serum thiamine level can confirm the diagnosis.

In general, those individuals with a poor diet are most likely to develop thiamine deficiency. However due to low body stores of this vitamin, as little as two weeks without thiamine in the diet can lead to beriberi.

The imaging features of beriberi reflect its underlying manifestations, and therefore in dry beriberi, cardiomegaly, pulmonary edema, dilated cardiomyopathy may be seen; however there are no pathognomonic cardiac imaging findings 5.

In wet beriberi the classic MRI features of Wernicke encephalopathy may be seen.

In general radiology is a corroborative tool in beriberi. The diagnosis is usually clinical with response to supplemental thiamine confirmatory.

Optimal treatment of beriberi relies upon a two-pronged approach:

  • thiamine supplementation
  • supportive therapies e.g. cardiac support

Recovery is often rapid once thiamine supplements are started. 

Beriberi derives from the Sinhalese for "weak, weak", a deliberate duplication of the same word to emphasize how poorly a patient with the condition feels 2.

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