(vitamin B1 deficiency, beri-beri, avitaminosis B1)

Vitamin B1 is needed for the metabolism of carbohydrates including the transformation of pyruvate by pyruvate kinase. Daily needs: 0.5 to 1 mg. Vitamin B1 is mainly located in the germ and pericarp of the seeds of cereals: industrial or "polished" rice and  "iced" rice (such as consumed in the Far East) do not contain thiamine anymore.The term 'beri-beri' is of Sri Lankan origin and means weakness. 

Vitamin B1 deficiency may present in different ways:

*         neurological form of adulthood (dry beri-beri ): sensory-motor polyneuropathy,  bilateral and symmetrical paralysis; for alcoholic people deficient in vitamin B1: Garcia-Wernicke encephalopathy (confusion, oculomotor paralysis) and Korsakoff syndrome (anterograde amnesia, confabulation)

*         cardiac form of the adult (wet beri-beri ): dilated cardiomyopathy with heart failure - shoshin beri-beri: cardiogenic shock associated with alcoholism

*   acute cardiac form of the infant: heart failure

*   aphonic form of the infant: gradual emergence of dysphonia evolving to a voice loss (paralysis of the vocal cords)

*         pseudomeningeal form of the infant: drowsiness, stiffness of neck, nystagmus, CSF under pressure 

*         a less known clinical presentation is hyperlactatemia 2 or type B : as thiamine deficiency decreases the activity of pyruvate dehydrogenase, pyruvate is converted into lactate instead of entering the Krebs cycle. Patients at risk for this clinical state of lactic acidosis are those with hepatic failure, the malnourished patients in critical condition whose parenteral nutrition is devoid of thiamine or those whose stock of thiamine is consumed by a carbohydrate-rich nutrition, also some cancers. Type A lactic acidosis is the best known and most frequent: it is caused by tissue hypoxemia.

Anesthetic implications: 

consider vitamin B1 deficiency in malnourished children and in the alcoholic patient: vitamin supplements can lead to a dramatic improvement of symptoms.

References :  

-        Moulin P, Cinq-Frais C, Gangloff C, Peyre M et al. 
Béri-béri du nourrisson : à propos d’un cas. 
Arch Pédiatr 2014 ; 21 : 392-5.

-         Simalti AK, Joshi R, Aggarwal N et al. 
An unusual cause of persisting hyperlactatemia in a neonate undergoing open heart surgery. W
orld J Pediatr Cong Heart Surg 2015; 6: 103-4.

-         Shah S, Wald E. 
Type B lactic acidosis secondary to thiamine deficiency of a child with malignancy. 
Pediatrics 2015; 135: e221-4.

Updated: August 2019