Complications
In wet beriberi, there is peripheral and systemic vasodilation, as well as myocardial damage. Treatment with thiamine results in recovery of systemic vasoconstriction before the myocardium is fully recovered, leading to a low-output state. Cardiovascular support will be required until the myocardium also recovers, usually within 24 hours.
Anaphylaxis and anaphylactoid reactions can occur when thiamine is given parenterally.[7] However, one study of more than 300,000 cases found no incidence of significant allergic reactions.[57]
It is recommended that thiamine is only given parenterally when CPR facilities and adrenaline are available.[28]
The exact incidence of this complication is unknown, and studies range from 50% to 85% of those who are untreated for, but do not die from, Wernicke's encephalopathy will develop Korsakoff's psychosis.[54]
It is characterised by retrograde and antegrade amnesia, causing the inability to memorise new information, and confabulation (inventing events in order to compensate for lack of memory), but with general preservation of other intellectual functions.[2]
Of those who develop Korsakoff's psychosis, 25% will require long-term institutional care.[55]
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