* - THREE TYPES ARE RECOGNISED : 1. DRY BERIBERI, 2. WET BERIBERI & 3. ACUTE FULMINANT CARDIOVASCULAR BERIBERI OR SHOSHIN BERIBERI
In suspected cases, prompt administration of parenteral thiamine is indicated. The recommended dose is 50 mg intramuscularly for several days. The duration of therapy depends on the symptoms, and therapy is indicated until all symptoms have disappeared. Maintenance is recommended at 2.5-5 mg per day orally, unless a malabsorption syndrome is suspected.
Support for other cardiac function is necessary in cases of wet beriberi because lack of cardiac function support leads to low output cardiac failure when the thiamine deficiency is corrected.
Thiamine, even at high concentrations, is not toxic in a person with normal renal function. No cases of thiamine toxicity have been reported from its use at the dosages indicated even in patients in critical condition.
Diet
" Thiamine-containing foods include all vegetables and the outer layer of grains. Thiamine is not present in fats or highly refined sugars and is present sparingly in cassava. Factors in the diet that decrease absorption are the presence of foods containing thiaminases, such as milled rice, shrimp, mussels, clams, fresh fish, and raw animal tissues.
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" Cassava is a staple in many developing countries and has been used in a variety of high-energy diets. Although it contains thiamine (0.05-0.225 mg of thiamine per 100 g of cassava, depending on the crop), the high carbohydrate load of a diet rich in cassava actually consumes more thiamine than it offers the body and can result in thiamine deficiency from the same mechanism as administering dextrose to a person with limited supplies of the vitamin.
Activity
The level of activity and high energy consumption states (eg, hyperthyroidism, pregnancy, lactation, severe disease) increase the daily requirements of thiamine.