A 2-month-old exclusively breastfed infant presents with tachypnea, tachycardia, cardiomegaly, and hepatomegaly. The cry is weak and hoarse and the mother reports her own diet consists mainly of polished rice. Which of the following should be given IMMEDIATELY?

• A Intravenous 10% dextrose
• B Oral furosemide
• C Intramuscular thiamine ✓
• D Fresh frozen plasma

Explanation

This is infantile beriberi, acute cardiac thiamine deficiency, occurring in breastfed infants whose mothers eat a polished rice diet. Thiamine must be given before any dextrose infusion, because carbohydrate loading accelerates pyruvate entry into impaired aerobic pathways and can precipitate cardiovascular collapse. The hoarse or aphonic cry reflects recurrent laryngeal nerve palsy and strongly supports thiamine deficiency over primary cardiac disease.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.