TPN-induced fulminant beriberi: a report on our experience and a review of the literature.

Fulminant beriberi, once considered a rare disease, is now being encountered more frequently, yet little is known about its clinical features. This study was undertaken to determine the clinical features of total parenteral nutrition (TPN)-induced fulminant beriberi by reviewing the clinical data on 10 of our own patients who developed this complication, and 33 cases documented in the literature. TPN-induced fulminant beriberi became evident 4-40 days after the initiation of TPN, and was more likely to develop in patients with malignancies, ulcerative colitis, and short bowel syndrome, as well as in those receiving chemotherapy. Although the patients manifested various symptoms, very few developed the classical signs of beriberi or the constant findings seen in alcoholic patients. The severity of metabolic acidosis was extremely high and refractory to bicarbonate administration, but it responded quickly to intravenous (i.v.) thiamine. Thus, rapid i.v. administration of at least 100 mg of thiamine is imperative, and the patient must be transferred to the intensive care unit when TPN-induced fulminant beriberi develops.