Chapter: Medicine and surgery: Nutritional and metabolic disorders

Vitamin B1 (thiamine) deficiency

Deficiency of thiamine (vitamin B1). - Definition, Incidence, Aetiology, Pathophysiology, Clinical features, Complications, Investigations, Management, Prognosis.

Vitamin B1 (thiamine) deficiency




Deficiency of thiamine (vitamin B1).




Insufficient intake of thiamine, which is present in for-tified wheat flour (the natural thiamine is removed by milling, so it is replaced in most countries), fortified breakfast cereals, milk, eggs, yeast extract and fruit. Alcoholics are most commonly affected in the United Kingdom, because of malnutrition.




Thiamine is an essential factor for the maintenance of the peripheral nervous system and the heart. It is also involved in glycolytic pathways, mediating carbohydrate metabolism.


Clinical features


Dry beriberi is an endemic form of polyneuritis resulting from a diet consisting of polished rice deficient in thiamine. The neuropathy predominantly affects the legs with weakness, parasthesia and loss of ankle jerks. Cerebral involvement causes Wernicke–Korsakoff ’s syndrome. Wet beriberi is the high output heart failure caused by thiamine deficiency resulting in oedema. Wet beriberi is rare in alcoholics.




Diagnosis is usually clinical and on response to thiamine. Erythrocyte transketolase activity and blood pyruvate are increased.




Thiamine is replaced orally, intravenously or intramuscularly. The cardiac failure usually responds rapidly, but neuropathies may only partially resolve if they are long-standing.

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