How a well-intended advice can sometimes lead to disaster, due to ignorance and illiteracy of mother is described here. An 8-month-old female baby from poor socio-economic background was taken to a pediatrician for an episode of diarrhea. Probably some element of lactose intolerance was suspected and therefore the pediatrician advised the mother to stop feeding milk and give rice water instead. Mother followed the advice and diarrhea was promptly controlled. Quick control of diarrhea impressed the mother and she took the advice to her heart. Thinking that rice water is superior to milk she continued to feed the baby with rice water only instead of milk.

After one month the baby was brought in emergency in a poor general condition with severe dyspnea and aphonia. On examination there were signs of congestive heart failure such as tachycardia, pedal edema, hepatomegaly, and cardiomegaly, in addition the baby was not able to cry.

Combination of congestive heart failure and aphonia lead us to suspect the possibility of infantile beriberi(1) and then corroborative feeding history was also forthcoming. Therefore, in addition to other measures, 0.25 mL of injection Beplex forte containing 22 mg thiamine (vitamin B1) was administered intramuscularly. Within 12 hr, the signs of congestive heart failure started receding and the cry also improved. In next 48 hr the baby recovered completely, thereafter with proper feeding advice and vitamin supplements the baby was discharged.

Polished rice is known to be deficient in thiamine, prolonged deficiency of which leads to beriberi. It is one of the life-threatening vitamin deficiency state, which promptly responds to the thiamine administration(2). Dramatic response to the thiamine administration is considered therapeutic as well as diagnostic(2).

Infantile beriberi appears to be a rare disease. There are no published case reports on infantile beriberi in Indian medical literature. In year 2004, 15 cases of infantile beriberi were reported from Israel, which were subsequently traced to a defective infant formula(3). In 2003 a very high infant mortality was recorded in Karen refugees at the border of Thailand attributable mainly to infantile beriberi(4).

This case report emphasizes the need to keep a provision of follow up for child patients who have illiterate primary caretakers.

Ghanshyam Rathi,
Consultant Pediatrician,
Sanjivani Hospital,
25,Vigyan Nagar Special,
Kota 324 005, Rajasthan, India.
E-mail: [email protected]  

1. Vani SN. Water Soluble Vitamins: B Complex Vitamins. In: Parthasarthy A, Nair MKC, Menon PSN, editors. IAP Textbook of Pediatrics. 3rd ed. New Delhi: Jaypee; 2006 p. 181-182.

2. William CH. Vitamin Deficiencies and Excesses. In: Behrman RE, Kliegman RM, Jenson MD, eds. Nelsons Textbook of Pediatrics. 17th edn. New Delhi: Saunders; 2004, P. 139-140.

3. Vikhanski L. Fatal flaw in baby formula sparks reform in Israeli ministry. Nature Medicine 2004; 10: 7.

4. Luxemburger C, White NJ, ter Kuile F, Singh HM, Allier-Frachon I, Ohn M, et al. Beri-beri: The major cause of infant mortality in Karen refugees. Trans R Soc Trop Med Hyg 2003; 97: 251-255.