Wet beriberi (high-output cardiac failure), dry beriberi (peripheral neuropathy), Wernicke-Korsakoff syndrome (eye movement disorders, ataxia and impaired memory)



Nutrient Therapy
Vitamin B12 1000 μg IM x 6 doses to replenish stores, then 1000 μg IM monthly
Vitamin Ea 800–1200 mg PO qd
Vitamin Ka 10 mg IV × 1
1–2 mg PO qd or 1–2 mg IV weekly in chronic malabsorption
Thiamineb 300 mg IV qd × 3 days, followed by 10 mg PO qd until recovery
Niacin 100–200 mg PO tid for 5 days
Pyridoxine 50 mg PO qd, 100–200 mg PO qd if deficiency related to medications
Zincb,c 60 mg PO bid



Thiamine dietary deficiency from excess of polished rice can cause beriberi. 



Riboflavin deficiency leads to mouth ulcers (stomatitis), cheilosis (dry, scaly lips), scaly skin (seborrhea), and photophobia.


Riboflavin deficiency leads to mouth ulcers (stomatitis), cheilosis (dry, scaly lips), scaly skin (seborrhea), and photophobia.



Content 9


Complications of Injecting Drug Use

  • Local problems—Abscess (Figures 240-2 
    Image not available.

    A 32-year-old woman with type 1 diabetes developed large abscesses all over her body secondary to injection of cocaine and heroin. Her back shows the large scars remaining after the healing of these abscesses. (Courtesy of ­Richard P. Usatine, MD.)

    and 240-3; Abscess), cellulitis, septic thrombophlebitis, local induration, necrotizing fasciitis, gas gangrene, pyomyositis, mycotic aneurysm, compartmental syndromes, and foreign bodies (e.g., broken needle parts) in local areas.2
    • IDUs are at higher risk of getting methicillin-resistant Staphylococcus aureus(MRSA) skin infections that the patient may think are spider bites (Figure 240-4).
    • Some IDUs give up trying to inject into their veins and put the cocaine directly into the skin. This causes local skin necrosis that produces round atrophic scars (Figure 240-5).
  • IDUs are at risk for contracting systemic infections, including HIV and hepatitis B or hepatitis C.
    • Injecting drug users are at risk of endocarditis, osteomyelitis (Figures 240-6and 240-7), and an abscess of the epidural region. These infections can lead to long hospitalizations for intravenous antibiotics. The endocarditis that occurs in IDUs involves the right-sided heart valves (see Chapter 50, Bacterial Endocarditis).2 They are also at risk of septic emboli to the lungs, group A β-hemolytic streptococcal septicemia, septic arthritis, and candidal and other fungal infections.


Content 3

Content 11


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