Treatment for Wet Beriberi

Clinical Presentation and Diagnosis

The American College of Nutrition recommends diagnosis of wet beriberi by low serum thiamine levels or erythrocyte thiamine diphosphate (ThDP), with response to thiamine supplementation as a therapeutic trial, and other biomarkers such as elevated lactate, pyruvate, alpha-ketoglutarate, and glyoxylate concentrations in patients with cardiovascular manifestations including high cardiac output, low systemic vascular resistance, and congestive heart failure 1
Wet beriberi is characterized by cardiovascular manifestations including high cardiac output, low systemic vascular resistance, and congestive heart failure, as well as tachycardia and respiratory symptoms, according to the Obesity Reviews guidelines 2

The Clinical Nutrition guidelines recommend initial IV thiamine administration of 100 mg IV three times daily until clinical improvement occurs in patients with wet beriberi and myocardial failure, with a recommended maintenance dose of 50-100 mg/day orally 1
The Obesity Reviews guidelines suggest avoiding administration of glucose-containing fluids before thiamine repletion, as this can worsen thiamine deficiency, and administering 100 mg thiamine in each of the first few liters of IV fluid to prevent precipitating heart failure 3, 4

Patients with malnutrition or poor dietary intake, chronic alcohol consumption, and increased metabolic requirements are at higher risk of thiamine deficiency, according to the Clinical Nutrition guidelines 1
The Advances in Nutrition guidelines recommend paying special attention to patients with malabsorptive conditions, including bariatric surgery, and prolonged vomiting or rapid weight loss 5, 3, 2

The American Association for the Study of Liver Diseases recommends addressing underlying causes, such as alcohol cessation and nutritional rehabilitation, as part of the treatment for wet beriberi 6, 7
The European Association for the Study of the Liver suggests that B-complex vitamin supplementation is recommended for alcoholic patients, considering the potential risk of Wernicke's encephalopathy, and that alcohol abstinence is the cornerstone of long-term therapy 6, 7