A 65-year-old recent alcoholic with dyspnea on exertion and orthopnea due to beriberi should be treated with which?

A 65-year-old recent alcoholic with dyspnea on exertion and orthopnea due to beriberi should be treated with which?

• A. IV dextrose
• B. IV enalapril
• C. IV thiamine
• D. IV dopamine

Answer: (C)

Thiamine deficiency from chronic alcohol use leads to beriberi, particularly the wet form that causes high-output heart failure with dyspnea and orthopnea. The essential treatment is repletion of thiamine to restore the heart’s energy metabolism. Thiamine is a cofactor for enzymes like pyruvate dehydrogenase; without it, the heart muscle cannot efficiently convert carbohydrates into usable energy, leading to edema and poor contractility. Providing thiamine intravenously offers rapid replenishment and can reverse the cardiac symptoms as metabolism normalizes. Giving sugar solutions first can worsen deficiency and precipitate further cardiac or neurologic complications, since the body would require thiamine to process the glucose. That’s why thiamine is given promptly in suspected beriberi, even before other supportive therapies. Other options would treat symptoms or blood pressure but do not address the underlying deficiency. Enalapril might help afterload in heart failure but won’t fix the thiamine shortage; dopamine could support hemodynamics without correcting the metabolic defect; and dextrose would not correct the root cause and could worsen the condition.

Thiamine deficiency from chronic alcohol use leads to beriberi, particularly the wet form that causes high-output heart failure with dyspnea and orthopnea. The essential treatment is repletion of thiamine to restore the heart’s energy metabolism. Thiamine is a cofactor for enzymes like pyruvate dehydrogenase; without it, the heart muscle cannot efficiently convert carbohydrates into usable energy, leading to edema and poor contractility. Providing thiamine intravenously offers rapid replenishment and can reverse the cardiac symptoms as metabolism normalizes.

Giving sugar solutions first can worsen deficiency and precipitate further cardiac or neurologic complications, since the body would require thiamine to process the glucose. That’s why thiamine is given promptly in suspected beriberi, even before other supportive therapies.

Other options would treat symptoms or blood pressure but do not address the underlying deficiency. Enalapril might help afterload in heart failure but won’t fix the thiamine shortage; dopamine could support hemodynamics without correcting the metabolic defect; and dextrose would not correct the root cause and could worsen the condition.