Clinical Presentation of Dry Beriberi Patients and Therapeutic Response to Thiamine Supplementation: A Hospital-Based Study in Bangladesh

Abstract

Background: Thiamine deficiency-related disorders are increasingly being reported in Bangladesh, as polished rice is the primary dietary constituent and the diet lacks balance in calorie, protein, and micronutrient content. Thiamine (vitamin B1) deficiency is often associated with sensory-motor neuropathy (dry beriberi) without Wernicke’s encephalopathy and cardiac dysfunction.

Objectives: The objective of our study was to observe the clinical presentation of suspected dry beriberi and to evaluate the therapeutic response to thiamine replacement.

Methods: This study was a prospective, open-label, clinical trial (quasi-experimental study) carried out in the Neurology Ward of Chittagong Medical College Hospital from July 2018 to June 2019. Fifty-five (55) patients of suspected dry beriberi were recruited by convenience sampling. All patients were given 200mg IV Thiamine HCl daily for 1 week, then switched to oral Tablets. Thiamine 100mg twice daily for the remaining 11 weeks. They were evaluated clinically before treatment and followed up at the end of 1 week, 6 weeks and 12 weeks after treatment. The assessment was done by clinical parameters like leg swelling, muscle cramps, muscle power, squat test, sensory impairments, deep tendon reflexes and by Overall Neuropathy Limitations Scale (ONLS) Score.

Results: There was a significant improvement in leg swelling (p<0.001), muscle cramp (p<0.001), muscle power (p<0.001), total score of Overall Neuropathy Limitation Scale (ONLS) (p<0.001) within 1 week of thiamine replacement. The treatment also successfully reduced individual components of sensory impairment (i.e. pain, touch, position, vibration) from baseline to 12 weeks (p<0.001). Only deep tendon reflexes did not return to normal in all patients within 12 weeks. Long time follow-up was needed for this.

Conclusion: Thiamine replacement improved most clinical features of deficiency neuropathy (leg swelling, cramps, muscle power, sensory impairment, functional status). Clinicians should recognize varied presentations of neuritic beriberi and provide early supplementation.