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Thiamine Deficiency

There are 2 types of thiamine deficiency: primary and secondary. Primary thiamine deficiency is caused by inadequate intake of the said vitamins. It can naturally found in foods like high refined sugar, white flour and polished rice. It can also be caused by insufficient amount of other B vitamins.

Secondary thiamine deficiency, on the other hand, is caused by the body’s increased demands for thiamine. This includes certain medical conditions like pregnancy, fever, excessive exercise, lactation, chronic diarrhea, hepatic insufficiency and other impaired metabolism. It can also be caused by long term alcoholism which greatly affects thiamine’s uptake and utilization.

Thiamine deficiency can cause degeneration of the thalamus, peripheral nerves, mammillary bodies and cerebellum. Vascular resistance may increase while the cerebral blood flow may significantly reduce. Moreover, thiamine deficiency can also cause the dilatation of the heart causing the cardiac muscles to swell, vacuolize and fragment. The vasodilatation in turn can lead to the edema of both the legs and feet. Arteriovenous shunting of the blood may increase and eventually can cause increased cardiac output.

Signs and Symptoms

Early signs and symptoms of thiamine deficiency include:

Sleep disturbances,

Fatigue

Abdominal discomfort

Anorexia

Poor memory

Irritability

Precordial pain

Diagnosis

The diagnosis is basically based on the clinical presentation and the patient’s favorable response to thiamine treatment. Supporting laboratory results can also be helpful. Electrolytes, particularly magnesium should be measured to rule out other differential diagnoses. In equivocal cases, a 24-hour urinary thiamine excretion and the activity of the erythrocyte transketolase should be measured as well.

Treatment

A high dose of thiamine is the main treatment approach for this case. It is important that the body is receiving sufficient amounts of thiamine regardless the symptoms. Usually, the patient is given 100mg of thiamine (IV).

Mild neuropathy - 10 to 20mg thiamine once a day, orally for 2 weeks

Moderate to advanced neuropathy – 20 to 30mg a day until symptoms resolve

Edema and cardiovascular congestion – 100mg once a day, IV for several days

 

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