Vitamin B1/thiamine deficiency (Wernicke encephalopathy and beriberi) *New*
ICD-10 codes: E51.1 , E51.2 / E51.8 , E51.9 Description General measures Medicine treatment Referral DESCRIPTION Clinical features include: confusion. short-term memory loss. paralysis of one or more of the ocular muscles or ophthalmoplegia. nystagmus. ataxia. peripheral neuropathy. cardiac failure. Alcoholics may present with Wernicke encephalopathy, neuropathies or cardiac failure associated wi
ICD-10 codes: E51.1, E51.2 / E51.8, E51.9
Description
General measures
Medicine treatment
Referral
DESCRIPTION
Clinical features include:
- confusion.
- short-term memory loss.
- paralysis of one or more of the ocular muscles or ophthalmoplegia.
- nystagmus.
- ataxia.
- peripheral neuropathy.
- cardiac failure.
Alcoholics may present with Wernicke encephalopathy, neuropathies or cardiac failure associated with multiple vitamin deficiencies.
GENERAL MEASURES
- Lifestyle adjustment including discouraging alcohol abuse.
- Dietary advice to increase intake of thiamine rich foods such as: wholewheat breads, oatmeal, pulses, nuts, yeast, fortified cereals, pork, bacon, marmite and potatoes and peas.
MEDICINE TREATMENT
Peripheral neuropathy and cardiac failure
- Thiamine, oral, 100 mg daily.
| In susceptible patients, administration of intravenous glucose precipitates Wernicke encephalopathy if administered before thiamine supplementation. Thiamine should be given first in all patients treated with intravenous glucose who are at risk of thiamine deficiency, e.g. alcoholics. |
REFERRAL
All patients with encephalopathy, eye muscle paralysis or cardiac failure.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, Updated for the 2023 Edition