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Thiamine (Vitamins B1)

  1. Breast milk cow's milk, vegetable, cereable, fruits and eggs are source of thiamine
  2. Daily need decrease when fat form a large part of the diet and increase as carbohydrate intake increase Stored in body mainly as thiamine pyrophosphate (TPP) 


  1. TPP or carboxylase function as a coenzyme in carbohydrate metabolism
  2. Thiamine is required for synthesis of acetylcholine and deficiency results in impaired nerve conduction
  3. It act as a coenenzyme in tranketolation and in decarboxylation of α-ketoaid  

Clinical deficiency [Beriberi]


Deficiency mainly occur in - Alcoholic

  1. Chronic peritoneal dialysis
  2. Hemodialysis
  3. Refeeding after starvation
  4. After administration of glucose to asymptomatic but thiamine dependent patient  

Wet Beriberi CVs involve


Three major physiologic derangements

  1. Peripheral vasodilatation leading to high cardiac out put state
  2. Retention of sodium and water leading to edema
  3. Biventricular myocardial failure

So there is tachycardia, cyanosis, dyspnea, enlargement of liver arterial bruit, neck vein distension.


Dry beriberi Nervous system involve


Three type nervous system involvement occur

  1. Peripheral neuropathy
  2. Wernicke’s encephalopathy
  3. Korsakoff syndrome 

Peripheral neuropathy - impairment of motor, sensory and reflex function that affect predominantly the distal segment of limbs. There is tingling, burning and paresthesias of the toes and feet decreased tendon reflex, loss of vibration sense and Hoarseness or aphonia due to paralysis of the laryngeal nerve is a characteristic sign.


Wernicke’s encephalopathy- in orderly sequence consist of vomiting, Nystagmus, lateral rectus palsies leading to U/L or B/L ophthalmoplegia, fever, ataxia, progressive mental deterioration that lead to confessional state and may progress to death.


Treatment - Daily dose for adult is 50 mg and for children 10 mg. Oral administration is effective unless gastroinstinal disturbances prevent absorption.

Thiamine Responsive condition
  1. Thiamine responsive megaloblastic anemia
  2. Maple syrup urine disease
  3. Leigh's encephalomyelopathy

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