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. (author abstract)