title: Shoshin beriberi-thiamine responsive pulmonary hypertension in exclusively breastfed infants: A study from northern India.
abstract: OBJECTIVE
  To study the effect of thiamine administration on the resolution of pulmonary hypertension in exclusively breastfed infants.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Hospital based study of a tertiary care hospital.
  
  
  METHODS
  A total of 29 infants with 17 males (58.6%) and 12 females (41.4%) were included in the study.
  
  
  METHODS
  In addition to the management of shock, right heart failure and renal failure, patients received intravenous thiamine 100mg/kg IV followed by 10mg/day till introduction of supplementary feeds.
  
  
  METHODS
  Resolution of shock, metabolic complications and pulmonary hypertension.
  
  
  RESULTS
  Mean age at presentation was 78.45±30.7 days. All infants were exclusively breastfed. 86.2% of mothers were on customary dietary restrictions. Biventricular failure and tachycardia was commonly present. There were four deaths in our series. Acute metabolic acidosis was a universal feature with a mean pH of 7.21±0.15. Pulmonary hypertension was present in all patients on admission. Intravenous thiamine 100mg/kg IV stat was given immediately after documenting pulmonary hypertension. Repeat echocardiography showed complete resolution of pulmonary hypertension.
  
  
  CONCLUSIONS
  Many infants present to us with Shoshin beriberi with unusually high pulmonary pressures. These patients respond to thiamine challenge with prompt resolution of metabolic complications and reversal of pulmonary hypertension. We believe this is first of its kind from the region, which is reported.
authors.affiliation: Department of Pediatrics, SKIMS Srinagar, J&K, India. Electronic address: drjaveediqbal@gmail.com.
authors.forename: Javeed Iqbal
authors.initials: JI
authors.lastname: Bhat
authors.affiliation: Department of Cardiology, SKIMS Srinagar, J&K, India. Electronic address: eemaan3@yahoo.co.in.
authors.forename: Hilal Ahmad
authors.initials: HA
authors.lastname: Rather
authors.affiliation: Department of Anesthesiology and Critical Care, GMC Srinagar, J&K, India. Electronic address: ambreenaa@rediffmail.com.
authors.forename: Ambreen Ali
authors.initials: AA
authors.lastname: Ahangar
authors.affiliation: GB Panth Hospital Srinagar, J&K, India. Electronic address: drumaramin@rediffmail.com.
authors.forename: Umar Amin
authors.initials: UA
authors.lastname: Qureshi
authors.affiliation: GB Panth Hospital Srinagar, J&K, India. Electronic address: parvezdar@gmail.com.
authors.forename: Parvez
authors.initials: P
authors.lastname: Dar
authors.affiliation: Department of Pediatrics, SKIMS Srinagar, J&K, India. Electronic address: drqaziiqbal@yahoo.co.in.
authors.forename: Qazi Iqbal
authors.initials: QI
authors.lastname: Ahmed
authors.affiliation: Department of Pediatrics, SKIMS Srinagar, J&K, India. Electronic address: charoobash@gmail.com.
authors.forename: Bashir Ahmed
authors.initials: BA
authors.lastname: Charoo
authors.affiliation: Department of Pediatrics, SKIMS Srinagar, J&K, India. Electronic address: syedwajidaliskims@rediffmail.com.
authors.forename: Syed Wajid
authors.initials: SW
authors.lastname: Ali
mesh_terms: D001602:Beriberi / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D001942:Breast Feeding; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D007275:Injections, Intravenous; D008297:Male; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D013831:Thiamine / Q000008:administration & dosage*; D016896:Treatment Outcome; D014803:Vitamin B Complex / Q000627:therapeutic use
chemical_list: D014803:Vitamin B Complex; D013831:Thiamine
keywords: Beriberi; Pulmonary hypertension; Thiamine