A 3-month-old exclusively breastfed infant presents with sudden tachypnoea, tachycardia, peripheral cyanosis, and hepatomegaly. Chest radiograph shows cardiomegaly. The mother reports a diet consisting almost entirely of polished rice with negligible pulses or meat. Immediate treatment should be:

• A Intravenous calcium gluconate
• B High-dose injectable vitamin K
• C Oral pyridoxine
• D Parenteral thiamine ✓

Explanation

This is acute infantile (cardiac or wet) beriberi occurring in a breastfed infant whose thiamine-deficient mother consumes polished rice, which loses its thiamine-rich germ and bran during milling. The infant presents with high-output cardiac failure. Parenteral thiamine produces dramatic improvement within hours and must not be delayed for confirmatory testing. Vitamin K addresses haemorrhagic disease of the newborn, and calcium addresses tetany, neither of which explains this cardiomyopathic picture.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.