Thiamine deficiency in tachypnoeic Cambodian infants

Abstract

Background:

Beriberi is endemic in South-east Asia. Diagnosis is based on clinical findings, but correlation of clinical features with blood thiamine concentrations is uncertain.

Objectives:

To investigate in tachypnoeic Cambodian infants the correlation between whole blood thiamine diphosphate (TDP) concentrations, clinical findings and blood TDP levels after therapy.

Methods:

Infants hospitalised with tachypnoea were enrolled from October 2011 to January 2012. Initial clinical features, diagnostic test results and final diagnoses were recorded. Blood for TDP determination was collected prior to treatment and at discharge. Matched infants from the general outpatient clinic with minor complaints were enrolled as controls. Thiamine was administered at the discretion of the treating paediatrician.

Results:

Of the 47 tachypnoeic and 47 control infants, median initial blood TDP concentrations were 83 and 93 nmol/L, respectively (P = 0·69), and were below the estimated limit of normal (<70 nmol/L) in 43% vs 34% (P = 0·40). Median initial TDP levels were 72 and 91 nmol/L in tachypnoeic infants who did or did not receive thiamine, respectively (P = 0·56); at hospital discharge, median TDP concentration had increased by 107 and 3·5 nmol/L in these two subgroups (P<0·001). Classical findings of beriberi such as dysphonia, tachycardia and hepatomegaly did not correlate with low initial TDP concentrations, but infant age, Tiger Balm use, absence of wheezing and low blood CRP levels were associated with low initial TDP levels. Use of infant formula was associated with higher initial TDP levels.

Conclusions:

Thiamine deficiency is common in tachypnoeic Cambodian infants, but routine clinical assessments do not accurately identify those with low blood TDP concentrations. Parenteral thiamine administration markedly increases TDP levels. Empirical thiamine treatment should be considered for tachypnoeic infants in regions with endemic thiamine deficiency.

Keywords:

• Beriberi
• Thiamine deficiency
• South-east Asia
• Vitamin B₁
• Tachypnoea
• Cambodian infants
• Blood thiamine diphosphate
• Parenteral thiamine supplementation
• Pneumonia

Acknowledgment

The study was supported by the Alpha Omega Alpha Carolyn L. Kuckein Student Research Fellowship Award, Mayo Clinic’s Center for Translational Science Activities Medical Student Clinical/Translational Research Award, and departmental funds of the Departments of Pediatric and Adolescent Medicine and Gastroenterology at Mayo Clinic, Rochester, MN, USA.