Acute pernicious (sho-shin) beri-beri: a report of three cases.

Acute pernicious or sho-shin beri-beri is characterised by haemodynamic and biochemical features which include hypotension, high cardiac output, low peripheral vascular resistance, lactic acidosis and high mixed venous content. The disorder is a metabolic emergency and requires immediate treatment with intravenous thiamine. Three cases are described which were successfully treated with intravenous thiamine (500 mg intravenously, followed by 100 mg 8-hourly for 24 hours then 100 mg daily) without using catecholamines or sodium bicarbonate. Digoxin was used in two cases to manage cardiac dysfunction which was poorly responsive to thiamine.