Sonography for Beriberi. #POCUS for severe vitamin deficiency coming soon.

Ramping up for our fall trip to southeast Asia.  This year we are excited to start work on a project in Laos where we will be evaluating pediatric patients with severe vitamin B1 deficiency.  Also, commonly called Beriberi.  Did you know you can diagnose and manage Beriberi with ultrasound?  It likely has not crossed your mind unless you have worked in regions with severe vitamin deficiencies, but the literature is out there.  Some anyway.  Surprisingly the spectrum of vitamin B1 deficiency is not well characterized.  We worked over the past year to develop an exam protocol looking at infant brains and hearts for signs of beriberi as part of a Gates Foundation Grant.  Our experience from Laos showed us that due to the mother’s restrictive diets post-partum and cultural food preparation practices (rice washing) infants can present in florid heart failure due to beriberi.  As part of their manage in these endemic regions Vitamin B1 is given intramuscularly and rapid clinical improvement typical ensues.

Echo demonstrates global reduced systolic function.  Cranial has symmetric hyperechoic changes near the putamen, caudate nucleus.

The current plan is to train local Lao sonography technicians to do these exams and patients will be identified and tracked over time.  There will be a two-week training, remote quality assurance, and local oversight by a Lao pediatric cardiologist.  Likely re-visit in 6 months.

After the Lao training, we plan to move onto Hanoi, Vietnam where we will be training the PICU and ED physicians at one of the country’s largest pediatric hospitals in POCUS.  Since we were told they have not had previous training, we will start with the basics and move on to cover resuscitation, echo, lung, FAST, and procedural guidance.  There is an annual EM and critical care conference in Vietnam (VSEM) that runs a POCUS workshop that I know many attend (since I helped teach the course in 2015).

It is looking like fall is all pediatrics all the time!  Pictures to come.

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