Vitamin B1 (Thiamine) Deficiency – USMLE Biochemistry Vitamins Case Based Discussion


Vitamin B1 (Thiamine) Deficiency - USMLE Biochemistry Vitamins Case Based Discussion

Thiamine deficiency can produce the following disorders:

Infant Beriberi – Presents at 2-3 months of age with cardiomegaly, tachycardia, cyanosis, dyspnoea, vomiting and a strong and penetrating cry with symptoms secondary to the formula that lacks thiamine.

Beriberi adult, dry – symmetrical peripheral neuropathy of the distal extremity characterized by both sensory and motor impairment.
Beriberi adult, wet – Neuropathy plus evidence of cardiac involvement with cardiomegaly, cardiomyopathy, congestive heart failure and peripheral edema.

Wernicke-Korsakoff syndrome – Wernicke's encephalopathy is a triad of nystagmus, ophthalmoplegia and ataxia associated with confusion often found in alcoholics with chronic thiamine deficiency. Korsakoff syndrome refers to the chronic neurological condition of short-term memory loss and constipation that is the result of Wernicke's encephalopathy.

Leigh Syndrome – Mitochondrial disorder of progressive subacute necrotizing childhood encephalomyopathy associated with thiamine deficiency.

Differential diagnosis and traps

Diagnosis for wet beriberi:

Hyperthyroidism / thyrotoxicosis
Cardiomyopathy secondary to diabetes, alcohol or other etiologies
Liver failure
Severe anemia
Other Causes of High Performance Heart Failure
Differential for Wernicke-Korsakoff syndrome:
Psychiatric illness (delusions, schizophrenia, schizophreniform disorder, etc.)
Delirium
Delirium tremens
Structural diseases in the medial thalamus, hippocampus or lower medial temporal lobes, such as topocular stroke, hypoxic-ischemic encephalopathy after cardiac arrest, herpes simplex virus encephalitis and third ventricular tumors

Diagnosis for beriberi seco:

Diabetic peripheral neuropathy
Differential for infant beriberi:
Infections such as meningitis
Pediatric forms of above diseases including hyperthyroidism, cardiomyopathy, hepatic failure, etc.

Video credits to Dr.G.Bhanu Prakash YouTube channel





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Vitamin B1 (Thiamine) Deficiency – USMLE Biochemistry Vitamins Case Based Discussion

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