RESUMEN
Shoshin beriberi is a fulminant form of wet beriberi, but there are no large-scale studies detailing the clinical features of this disease. We investigated the clinical features and outcomes of Shoshin beriberi using data from a nationwide database in Japan.Using the Diagnosis Procedure Combination database, we identified patients with Shoshin beriberi between July 2010 and March 2021. We retrospectively investigated the characteristics, comorbidities, treatment, and in-hospital mortality of patients with Shoshin beriberi. The chi-square test or Fisher's exact test was used for categorical variables, and the Mann-Whitney U-test was used for continuous variables.We identified 62 patients with Shoshin beriberi. The median (interquartile range) age was 63 (48-69) years. Furthermore, 54 patients were male (87%). The most common comorbidity was alcohol-related disorder (34%). The median (interquartile range) length of hospital and intensive care unit stays were 17 (range, 10-35) and 5 (range, 1-9) days, respectively. The proportion of patients who received venoarterial extracorporeal membrane oxygenation, intra-aortic balloon pump, continuous renal replacement therapy, and mechanical ventilation was 11, 5, 29, and 63%, respectively. Among the patients with Shoshin beriberi, 53% received 2 or more catecholamines or inotropes. The in-hospital mortality was 23%. Impaired consciousness at admission was significantly related to in-hospital death (P < 0.001).The present study is the first and largest to describe the clinical features of patients with Shoshin beriberi using a nationwide database. Impaired consciousness at admission was significantly associated with in-hospital death.
Asunto(s)
Beriberi , Insuficiencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Anciano , Femenino , Beriberi/complicaciones , Beriberi/diagnóstico , Beriberi/tratamiento farmacológico , Mortalidad Hospitalaria , Estudios Retrospectivos , Insuficiencia Cardíaca/tratamiento farmacológico , Japón/epidemiología , Tiamina/uso terapéuticoRESUMEN
Thiamine deficiency is commonly associated with malnutrition, alcoholism and bariatric surgery. Thiamine deficiency can manifest in different ways, especially in developing countries: as peripheric neuropathy, as Wernicke encephalopathy or as beriberi disease. The authors present the case of a 72-year-old male, with a hiatal hernia that led to thiamine deficiency due to malnutrition. The initial clinical manifestation was an ST-elevation myocardial infarct equivalent, an ECG with a shark-fin pattern that evolved to a Wellens type B pattern. The patient evolved with severe altered mental status. A Wernicke encephalopathy diagnosis was confirmed by MRI; the patient was medicated with high-dose thiamine, with quick recovery, both neurologic and cardiac. The clinical history and response to treatment confirm the diagnosis of Wernicke encephalopathy and beriberi disease.
Asunto(s)
Beriberi , Síndrome de Korsakoff , Infarto del Miocardio con Elevación del ST , Deficiencia de Tiamina , Encefalopatía de Wernicke , Anciano , Humanos , Masculino , Beriberi/diagnóstico , Beriberi/tratamiento farmacológico , Beriberi/etiología , Síndrome de Korsakoff/complicaciones , Síndrome de Korsakoff/tratamiento farmacológico , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/etiología , Deficiencia de Tiamina/diagnóstico , Deficiencia de Tiamina/tratamiento farmacológico , Deficiencia de Tiamina/etiología , Encefalopatía de Wernicke/diagnóstico , Encefalopatía de Wernicke/tratamiento farmacológico , Encefalopatía de Wernicke/etiologíaRESUMEN
Background: Thiamin is an essential vitamin that is involved in every organ system in the body. Thiamin deficiency can present as beriberi or Wernicke's encephalopathy. We seek to educate practitioners in developed countries to include beriberi on the differential diagnosis when a patient with alcohol use disorder, poor diet and/or disordered eating presents with ascending paralysis without albuminocytologic dissociation. Case: In this case report, a 20-year-old female with no past medical history presented with three weeks of ascending paralysis. At presentation, she could not grasp objects, walk, or rise from a seated position. She reported consuming excessive alcohol and an otherwise limited diet due to picky eating. The patient was ultimately diagnosed with acute inflammatory demyelinating polyneuropathy secondary to dry beriberi from severe protein-calorie malnutrition and alcohol use disorder. She received an aggressive thiamin replacement regimen as well as physical and occupational therapy. She was discharged to home 24 days after her initial presentation. Discussion: This patient case offers a unique presentation of ascending paralysis without albuminocytologic dissociation due to severe dry beriberi from a diet of unenriched carbohydrates and excessive alcohol in an otherwise young, healthy adult in the United States. Our goal is that in reviewing the unusual details of this case, providers will be better equipped for the timely diagnosis and treatment of similar cases in the future.
Asunto(s)
Alcoholismo , Beriberi , Trastornos de Alimentación y de la Ingestión de Alimentos , Adulto , Alcoholismo/complicaciones , Beriberi/complicaciones , Beriberi/diagnóstico , Etanol , Trastornos de Alimentación y de la Ingestión de Alimentos/complicaciones , Femenino , Humanos , Parálisis/complicaciones , Tiamina/uso terapéutico , Adulto JovenRESUMEN
Vitamin B1 also known as thiamin is an essential vitamin assuring body functioning and comes exclusively from food. Vitamin B1 deficiency is an under-diagnosed disease because it is less frequently suspected in high income countries. However, its risk factors, like alcohol and malnutrition, are common in the general population. Thiamin deficiency can lead to three clinical entities, Gayet-Wernicke encephalopathy, which can progress to Korsakoff encephalopathy, wet Beriberi and its dry form. These diseases are associated with high mortality and heavy long-term sequelae. Rapid diagnosis enables timely treatment.
La vitamine B1 ou thiamine est une vitamine essentielle au bon fonctionnement de l'organisme et provient exclusivement de l'alimentation. La carence en vitamine B1 est une maladie sous-diagnostiquée car sous-évoquée dans les pays à haut revenu. Pourtant, les facteurs de risque, tels que l'alcool et la malnutrition, sont répandus dans la population. Les conséquences d'une carence en thiamine se manifestent sous trois formes, l'encéphalopathie de Gayet-Wernicke, pouvant progresser en encéphalopathie de Korsakoff, le béribéri humide ou sa forme sèche. Ces maladies sont grevées d'une haute mortalité et peuvent entraîner à long terme de lourdes séquelles. Un diagnostic rapide permet d'instaurer un traitement substitutif simple et efficace.
Asunto(s)
Beriberi , Deficiencia de Tiamina , Encefalopatía de Wernicke , Humanos , Tiamina/uso terapéutico , Vitaminas/uso terapéutico , Deficiencia de Tiamina/diagnóstico , Deficiencia de Tiamina/tratamiento farmacológico , Deficiencia de Tiamina/complicaciones , Beriberi/complicaciones , Beriberi/diagnóstico , Beriberi/tratamiento farmacológico , Encefalopatía de Wernicke/diagnósticoRESUMEN
BACKGROUND: Thiamine deficiency is an uncommon cause of severe illness in the United States that can lead to significant morbidity because of high-output cardiac failure, peripheral neuropathy, and permanent neurologic impairment. We report the case of a middle-aged woman with extreme malnutrition caused by complications of Roux-en-Y gastric bypass (RYGB) surgery who presented with signs and symptoms of severe thiamine deficiency and septic shock. CASE REPORT: A 43-year-old woman who had undergone RYGB surgery and who had multiple complications presented to the emergency department with agitation, confusion, and lethargy. The physical examination revealed an obtunded woman appearing much older than her reported age with significant peripheral edema. She was hypoxemic, hypotensive, and febrile. The initial laboratory analysis revealed a serum lactate level above the measurable limit, a normal thyroid-stimulating hormone, and elevated levels of troponin and brain natriuretic peptide. A transthoracic echocardiogram showed high-output heart failure. The patient's family later revealed that for the past year her diet had consisted almost exclusively of frozen blended lattes. High doses of thiamine and folate were started. Her shock, hyperlactatemia, and respiratory failure resolved by hospital day 3 and her encephalopathy resolved soon thereafter. Why Should an Emergency Physician be Aware of This?: Thiamine deficiency is a rare but reversible cause of shock, heart failure, and encephalopathy. Identifying patients who are at risk for severe nutritional deficiencies may aid in more rapid treatment with relatively benign medications with little downside, in this case high-dose vitamin B1, and ultimately improve patient-oriented outcomes such as mortality, morbidity, and hospital length of stay.
Asunto(s)
Beriberi , Encefalopatías , Desnutrición , Deficiencia de Tiamina , Encefalopatía de Wernicke , Adulto , Beriberi/complicaciones , Beriberi/diagnóstico , Femenino , Humanos , Desnutrición/complicaciones , Persona de Mediana Edad , Tiamina/uso terapéutico , Deficiencia de Tiamina/complicacionesRESUMEN
INTRODUCTION: Nowadays, reports of beriberi are rare in developed countries. Wernicke encephalopathy may be present in about 25% of patients with beriberi. CASE REPORT: We report the case of a woman with history of depression and chronic eating disorder, who complained Wernicke encephalopathy and beriberi. Sural nerve and muscular biopsy were performed, showing severe axonal neuropathy. Thiamine supplementation was started with rapid improvement of the pulmonary and cardiac affections; improvement of peripheral neuropathy was incomplete. CONCLUSIONS: Thiamine deficiency can be misdiagnosed. Beriberi is an important cause of acute flaccid paralysis; hence, clinicians should consider this diagnosis and prompt start thiamine treatment to avoid permanent neurological sequelae.
Asunto(s)
Beriberi , Trastornos de Alimentación y de la Ingestión de Alimentos , Deficiencia de Tiamina , Encefalopatía de Wernicke , Beriberi/complicaciones , Beriberi/diagnóstico , Beriberi/tratamiento farmacológico , Femenino , Humanos , Tiamina/uso terapéutico , Deficiencia de Tiamina/complicaciones , Deficiencia de Tiamina/tratamiento farmacológico , Encefalopatía de Wernicke/diagnóstico , Encefalopatía de Wernicke/tratamiento farmacológico , Encefalopatía de Wernicke/etiologíaRESUMEN
We aimed to elucidate characteristics of beriberi neuropathy (BB) in a general hospital (GH) setting. Nerve conduction studies (NCS), cross-referenced with clinical records of patients admitted to a GH (May 2011-July 2017), were reviewed for diagnosis of BB. Thirteen patients (age range 23-64 years; five women) were diagnosed with BB. Eleven were incarcerated (2-24 months) at time of index event. Eleven reported prior, severe anorexia (2-6 months); five reported significant weight loss, three had recurrent vomiting, and three reported alcohol misuse. Commonest presentation was weakness (12/13); nine had symptom evolution over ≥3 weeks. At nadir, 11/13 could not walk independently. Other features included numbness/paraesthesiae (10/13), dysautonomia (6/13), vocal cord dysfunction/dysphagia (4/13), nystagmus (3/13). Pain was not prominent. Cerebrospinal fluid, tested in five patients, was acellular; one showed mildly increased protein. NCS showed predominantly sensorimotor, axonal polyneuropathy, rarely asymmetric. Only one patient had sural-sparing pattern. All received high dose thiamine. Two of the thirteen received intravenous immunoglobulin for suspicion of Guillain-Barré syndrome (GBS). Eleven improved to independent ambulation. One patient died from pulmonary embolism; one was lost to follow-up. Two of the thirteen had residual neurocognitive effects; both misused alcohol. Besides GBS, BB is an important cause of acute to subacute flaccid paralysis, especially in incarcerated patients and those with significant dietary deprivation. Features favoring BB over GBS are ≥3 weeks of symptoms, nystagmus, confusion, vocal cord dysfunction, volume overload, normal spinal fluid, elevated lactate, and absence of sural-sparing pattern in NCS.
Asunto(s)
Beriberi/diagnóstico , Beriberi/fisiopatología , Hipotonía Muscular/diagnóstico , Parálisis/diagnóstico , Enfermedad Aguda , Adulto , Beriberi/complicaciones , Beriberi/tratamiento farmacológico , Femenino , Síndrome de Guillain-Barré/complicaciones , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Hipotonía Muscular/etiología , Hipotonía Muscular/fisiopatología , Parálisis/etiología , Parálisis/fisiopatología , Prisioneros , Estudios Retrospectivos , Tiamina/administración & dosificación , Complejo Vitamínico B/administración & dosificación , Adulto JovenAsunto(s)
Acidosis Láctica , Beriberi , Deficiencia de Tiamina , Encefalopatía de Wernicke , Humanos , Deficiencia de Tiamina/complicaciones , Deficiencia de Tiamina/diagnóstico , Encefalopatía de Wernicke/diagnóstico , Encefalopatía de Wernicke/etiología , Encefalopatía de Wernicke/tratamiento farmacológico , Acidosis Láctica/etiología , Acidosis Láctica/diagnóstico , Beriberi/diagnóstico , Beriberi/complicaciones , Beriberi/tratamiento farmacológico , Beriberi/etiología , Masculino , Tiamina/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Niño , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , FemeninoRESUMEN
A 38-year-old woman was admitted in a psychiatric hospital because of memory disorders. Dry beriberi and Korsakoff's syndrome, as a late neuropsychiatric manifestation of Wernicke's encephalopathy, were established. The beriberi symptoms decreased slowly, but the patient's memory impairments persisted. These clinical features were caused by a thiamine deficiency. Gastric bypass surgery is associated with an increased risk of thiamine deficiency. Excessive alcohol consumption and poor compliance with vitamin deficiency treatment both contributed to the rapid onset of these disorders. The case we describe demonstrates how important it is that patients who have undergone bariatric surgery are prescribed the correct vitamin supplements and that the treatment is continued for an appropriate period of time; this treatment is particularly important in the case of patients who are also suffering from an comorbid alcohol-related disorder.
Asunto(s)
Beriberi/etiología , Deficiencia de Tiamina/complicaciones , Complejo Vitamínico B/uso terapéutico , Encefalopatía de Wernicke/etiología , Adulto , Cirugía Bariátrica/efectos adversos , Beriberi/diagnóstico , Femenino , Humanos , Trastornos de la Memoria/etiología , Deficiencia de Tiamina/tratamiento farmacológico , Encefalopatía de Wernicke/diagnósticoAsunto(s)
Beriberi/diagnóstico , Enfermedad de Crohn/complicaciones , Insuficiencia Multiorgánica/inmunología , Tiamina/sangre , Pérdida de Peso , Lesión Renal Aguda/sangre , Lesión Renal Aguda/inmunología , Lesión Renal Aguda/terapia , Antibacterianos/uso terapéutico , Beriberi/sangre , Beriberi/inmunología , Biopsia , Cardiotónicos/uso terapéutico , Niño , Colon Transverso/diagnóstico por imagen , Colon Transverso/patología , Colonoscopía , Enfermedad de Crohn/sangre , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/inmunología , Glucocorticoides/uso terapéutico , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/inmunología , Insuficiencia Cardíaca/terapia , Humanos , Íleon/diagnóstico por imagen , Íleon/patología , Mucosa Intestinal/diagnóstico por imagen , Mucosa Intestinal/patología , Masculino , Insuficiencia Multiorgánica/sangre , Insuficiencia Multiorgánica/terapia , Respiración con Presión Positiva , Insuficiencia Respiratoria/sangre , Insuficiencia Respiratoria/inmunología , Insuficiencia Respiratoria/terapiaRESUMEN
Wet beriberi-induced pericardial effusion has rarely been previously described. Little is known about the effect of beriberi-induced pericardial effusion on hemodynamics. Here we present a case of wet beriberi with pericardial effusion that exhibited constrictive physiology, which was dramatically improved after treatment. A 61-year-old male patient was admitted to our hospital for progressive leg edema, dyspnea on exertion, and lower-extremity muscle weakness. Echocardiography showed a hyperkinetic left ventricle and a moderate amount of pericardial effusion. Hemodynamic measurements, including simultaneous measurement of left and right ventricular pressures, revealed high output heart failure and constrictive physiology. Blood test showed lactic acidosis, and low level of serum thiamine levels; consistent with a diagnosis of wet beriberi. After thiamine replacement therapy, the patient's hemodynamic state rapidly improved. Additionally, pericardial effusion decreased and constrictive physiology was successfully resolved. No other possible causes of pericardial effusion could be identified, with the exception of thiamine deficiency. This case illustrates the importance of considering wet beriberi as a possible cause of pericardial effusion with constrictive physiology.
Asunto(s)
Beriberi/sangre , Derrame Pericárdico/sangre , Beriberi/complicaciones , Beriberi/diagnóstico , Beriberi/tratamiento farmacológico , Disnea/sangre , Disnea/complicaciones , Ecocardiografía , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/tratamiento farmacológico , Derrame Pericárdico/etiología , Tiamina/administración & dosificación , Tiamina/sangre , Resultado del TratamientoAsunto(s)
Beriberi , Insuficiencia Cardíaca , Beriberi/diagnóstico , Beriberi/tratamiento farmacológico , Humanos , TiaminaRESUMEN
"Shoshin beriberi", which is a fulminant form of cardiovascular beriberi accompanied by hemodynamic deterioration with high cardiac output and decreased systemic blood pressure, caused by thiamine deficiency due to alcoholic abuse or malnutrition, is often difficult to address because of its rarity and non-specific symptoms. We here present a patient with a history of alcoholic abuse who had suffered hemodynamic deterioration with extremely low cardiac output refractory to extracorporeal membrane oxygenation and intravenous catecholamine support, which was improved dramatically by bolus intravenous thiamine administration. Such a type with low cardiac output would be the most severe form of Shoshin beriberi, and cannot be rescued without diagnostic administration of thiamine.
Asunto(s)
Alcoholismo/complicaciones , Beriberi , Gasto Cardíaco Bajo , Tiamina/administración & dosificación , Adulto , Beriberi/complicaciones , Beriberi/diagnóstico , Beriberi/tratamiento farmacológico , Beriberi/etiología , Beriberi/fisiopatología , Gasto Cardíaco Bajo/diagnóstico , Gasto Cardíaco Bajo/etiología , Gasto Cardíaco Bajo/fisiopatología , Gasto Cardíaco Bajo/terapia , Diagnóstico Diferencial , Manejo de la Enfermedad , Oxigenación por Membrana Extracorpórea/métodos , Hemodinámica , Humanos , Hipotensión/tratamiento farmacológico , Hipotensión/etiología , Hipotensión/fisiopatología , Inyecciones Intravenosas , Masculino , Resultado del Tratamiento , Complejo Vitamínico B/administración & dosificaciónRESUMEN
We report the case of a 45-year-old patient who presented with acute dilated cardiomyopathy. During admission the patient was consecutively diagnosed with cryoglobulinaemic vasculitis and beriberi. In both diseases, cardiac involvement may occur as dilated cardiomyopathy. Thiamin deficiency was the final cause for the severe cardiac manifestations (cardiac acute beriberi or Shoshin syndrome), which returned to normal after thiamin supplementation.
Asunto(s)
Beriberi , Cardiomiopatía Dilatada , Crioglobulinemia , Herpes Zóster/complicaciones , Infecciones Oportunistas/complicaciones , Vasculitis Sistémica , Tiamina/administración & dosificación , Enfermedad Aguda , Beriberi/complicaciones , Beriberi/diagnóstico , Beriberi/tratamiento farmacológico , Beriberi/fisiopatología , Cardiomiopatía Dilatada/diagnóstico , Cardiomiopatía Dilatada/etiología , Cardiomiopatía Dilatada/fisiopatología , Cardiomiopatía Dilatada/terapia , Crioglobulinemia/complicaciones , Crioglobulinemia/diagnóstico , Resultado Fatal , Glucocorticoides/administración & dosificación , Glucocorticoides/efectos adversos , Herpesvirus Humano 3/patogenicidad , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/etiología , Vasculitis Sistémica/sangre , Vasculitis Sistémica/complicaciones , Vasculitis Sistémica/diagnóstico , Vasculitis Sistémica/tratamiento farmacológico , Vasculitis Sistémica/fisiopatología , Vitaminas/administración & dosificaciónRESUMEN
A 78-year-old man presented to the emergency department with symptoms and signs suggestive of heart failure. Only after a long interview we discovered that the patient has been eating, for over 20 years, only chestnut honey and chestnut jam produced by himself. He refused any other foods, because of the fear of being poisoned; he did not drink alcohol at all. The clinical picture was attributable to Beriberi, and the patient recovered promptly after treatment with thiamine. A high clinical suspicion and an early thiamine supplementation might shorten the duration of work-up and hospital length of stay, as well as prevent extensive and expensive diagnostic work-up, thus simplifying the clinical management.
Asunto(s)
Beriberi/complicaciones , Beriberi/tratamiento farmacológico , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/etiología , Tiamina/uso terapéutico , Complejo Vitamínico B/uso terapéutico , Anciano , Beriberi/diagnóstico , Beriberi/etiología , Servicio de Urgencia en Hospital , Insuficiencia Cardíaca/diagnóstico , Humanos , Italia , Masculino , Resultado del TratamientoRESUMEN
BACKGROUND: Thiamine deficiency (TD) among adolescents following metabolic and bariatric surgery (MBS) has not been assessed. OBJECTIVE: We assessed TD among adolescents following MBS. SETTING: University Hospital. METHODS: A retrospective chart review was conducted for all adolescents and young adults (aged 10-25 years) who had MBS and subsequently presented with TD at our institution (n = 30). Diagnosis used clinical, laboratory, brain imaging, and neurophysiology criteria. Of 1575 patients, 7 subsequently had TD. Another 23 adolescents had MBS at private hospitals or overseas and presented at our institution with TD. RESULTS: Based on MBS undertaken at our institution, TD prevalence was .45 cases per 100 MBS. The mean age of patients was 19.5 ± 3.23 years, 53.3% were male, 96.7% had sleeve gastrectomy, and time from MBS to admission averaged 4.97 ± 11.94 months. Mean weight loss from surgery to admission was 33.68 ± 10.90 kg. Associated factors included poor oral intake (90%), nausea and vomiting (80%), and noncompliance with multivitamins (71%). Signs and symptoms included generalized weakness, nystagmus, numbness, and paraparesis (83.3%-80%). Seven patients had Wernicke encephalopathy full triad; 16 displayed a mixed picture of Wernicke encephalopathy and dry beriberi; and there were no cases of wet beriberi. Half the patients achieved complete resolution of symptoms, whereas 47% and 40% had residual weakness or persistent sensory symptoms, respectively. There was no mortality. Most common concurrent nutritional deficiencies were of vitamins K, D, and A. CONCLUSIONS: This is the first in-depth study of TD among adolescents after MBS. Although TD is uncommon among adolescents after MBS, it is serious, requiring diligent suspicion and prompt treatment. Bariatric teams should emphasize compliance with multivitamin regimens and follow it up.
Asunto(s)
Cirugía Bariátrica , Beriberi , Deficiencia de Tiamina , Encefalopatía de Wernicke , Humanos , Masculino , Adulto Joven , Adolescente , Adulto , Femenino , Beriberi/etiología , Beriberi/diagnóstico , Beriberi/tratamiento farmacológico , Encefalopatía de Wernicke/diagnóstico , Encefalopatía de Wernicke/epidemiología , Encefalopatía de Wernicke/etiología , Estudios Retrospectivos , Deficiencia de Tiamina/epidemiología , Deficiencia de Tiamina/etiología , Vitaminas/uso terapéutico , Cirugía Bariátrica/efectos adversos , Tiamina/uso terapéuticoRESUMEN
We describe an overweight but otherwise previously healthy 17-year-old female who presented with altered mental status and rapidly progressive weakness. She was ultimately diagnosed with Wernicke encephalopathy and wet beriberi resulting from severe thiamine deficiency. She required admission to the pediatric ICU because of hypoventilation with progressive weakness and worsening encephalopathy and was found to have impaired cardiac function as assessed by echocardiography. Her heart function and encephalopathy improved on initiation of thiamine repletion. She remained in inpatient rehabilitation for 10 months but still remained weak at discharge. Thiamine deficiency is not commonly considered in the United States as a diagnosis other than in patients with severe alcohol use disorder. However, thiamine may be depleted in as little as 2 weeks if nutrition is inadequate. In such a setting, thiamine deficiency is an important etiology to consider early in the pediatric patient with altered mentation especially because it can be readily and safely treated.
Asunto(s)
Beriberi , Insuficiencia Cardíaca , Deficiencia de Tiamina , Encefalopatía de Wernicke , Adolescente , Femenino , Humanos , Beriberi/complicaciones , Beriberi/diagnóstico , Insuficiencia Cardíaca/etiología , Sobrepeso/complicaciones , Tiamina , Deficiencia de Tiamina/complicaciones , Deficiencia de Tiamina/diagnóstico , Encefalopatía de Wernicke/diagnóstico , Encefalopatía de Wernicke/etiologíaRESUMEN
OBJECTIVE: Pregnancy, a nutritionally demanding situation in terms of macro- and micronutrient supply owing to heightened maternal, placental, and fetal needs, significantly affects thiamine reserves. Thiamine deficiency during pregnancy and the postpartum period, presenting with varied manifestations and outcomes, is a relatively common condition in our population. The study aimed to understand the various manifestations and outcomes of acute thiamine deficiency in pregnant and postpartum women, emphasizing the significance of early recognition and thiamine therapy to prevent serious complications during pregnancy and after childbirth. METHODS: This prospective study conducted in a tertiary care center in North India enrolled consecutive pregnant and postpartum women presenting with clinical features consistent with thiamine deficiency disorders, such as thiamine deficiency-related neuropathy, high-output heart failure, heart failure with reduced ejection fraction, Wernicke's encephalopathy, gastric beriberi, and thiamine-responsive acute pulmonary hypertension. In addition to capturing medical history including drug intake, dietary consumption, and comorbidities, women underwent brief relevant clinical examinations and laboratory assessments, including whole-blood thiamine levels. Response to intravenous thiamine supplementation was also monitored. RESULTS: Data of 31 women (12 pregnant, 19 postpartum) with a diagnosis of acute thiamine deficiency and a mean age of 28.88 ± 2.69 years were analyzed. The mean thiamine level was 1.28 ± 0.44 µg/dL with mean blood lactate of 3.46 ± 3.33. The most common presentation was gastric beriberi (n = 10), followed by paraparesis (n = 6), high-output heart failure (n = 6), acute pulmonary hypertension, heart failure with reduced ejection fraction (n = 3 each), and an acute confusional state (n = 2). All patients responded to thiamine challenge. CONCLUSION: In the context of borderline thiamine status, particularly in our population with endemic thiamine deficiency and heightened demand for thiamine during pregnancy and the peripartum period, the deficiency can have varied and serious manifestations of dry and wet beriberi. Early recognition of the clinical features and thiamine therapy can be life-saving. There is a need for validated clinical criteria owing to the non-availability of thiamine testing in resource-limited settings.
Asunto(s)
Beriberi , Insuficiencia Cardíaca , Hipertensión Pulmonar , Deficiencia de Tiamina , Femenino , Humanos , Embarazo , Adulto , Beriberi/diagnóstico , Beriberi/tratamiento farmacológico , Beriberi/etiología , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/tratamiento farmacológico , Estudios Prospectivos , Placenta , Deficiencia de Tiamina/complicaciones , Deficiencia de Tiamina/tratamiento farmacológico , Deficiencia de Tiamina/diagnóstico , Tiamina/uso terapéutico , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/tratamiento farmacológico , PartoRESUMEN
BACKGROUND: Undifferentiated altered mental status and hemodynamic instability are common presenting complaints in the Emergency Department (ED). Emergency practitioners do not have the luxury of time to perform sequential examination, history, testing, diagnosis, and treatment. Rather, we do all of these things at once to save lives and decrease morbidity. An important diagnosis to consider and upon which we can easily intervene is that of thiamine deficiency. OBJECTIVES: We present a case of an altered and unstable woman who presented to our busy ED and had rapid improvement after the administration of vitamin B1. We discuss the presentation, pathophysiology, consequences of missed diagnosis, and management of this disease process. CASE REPORT: A middle-aged woman presented to our ED with unstable vital signs and an alteration in her mental status. She was unable to provide a history. Empiric treatment with thiamine resulted in the resolution of her hemodynamic instability and improvement in her mental status. CONCLUSION: Our patient benefited from the swift administration of thiamine and illustrates the importance of thiamine administration in the altered or hemodynamically unstable emergency patient with an elevated lactate.