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Consider In High Risk Patients

  • Alcoholics
  • GI disorders
  • Eating disorders
  • Starvation/poor diet
  • Extremes of age

Thiamine (B1) deficiency

  • Causes damage to neurons and cardiac myocytes
  • Manifestations
    • Dry beriberi
      • Neuropathy
      • Paresthesias
    • Wernicke’s encephalopathy
      • Ophthalmoplegia
      • Ataxia
      • Altered mental status
    • Korsakoff syndrome
      • Ophthalmoplegia, ataxia, altered mental status
      • PLUS
      • Confabulation
      • Memory loss
    • Wet beriberi
      • Heart failure from cardiac damage
  • Treatment
    • High dose thiamine

Niacin (B3) Deficiency

  • “Pellagra”
  • Clinical Triad
    • Diarrhea
    • Dementia
    • Dermatitis
      • Scaly rash
        • Neck
        • Dorsum of hands
  • Treatment
    • Vitamin B3

Folate (B9) Deficiency

  • Megaloblastic anemia
  • Treatment
    • Folate

B12 Deficiency

  • Classically occurs in vegans (in addition to the previous high risk groups)
  • Manifestations
    • Megaloblastic anemia
    • PLUS
    • Neurologic complaints
      • Subacute combined (posterior and lateral column) degeneration of spinal cord
        • Posterior columns
          • Impaired vibratory sensation and propioception
        • Lateral columns
          • Sensory loss
          • Motor weakness

Additional Reading

  • Thiamine Deficiency: Pearls and Pitfalls (emDOCs)