Clinical Features and Outcomes of Shoshin Beriberi.

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.

Thiamine deficiency-related neuropathy: A reversible entity from an endemic area.

BACKGROUND AND PURPOSE: Despite thiamine deficiency being a lesser-known entity in modern times, beriberi in various forms, including thiamine deficiency-related neuropathy, remains endemic in Kashmir due to the consumption of polished rice as a staple food. This observational study investigates cases of peripheral neuropathy of unknown etiology and their potential responsiveness to thiamine administration. METHODS: This prospective study enrolled adult patients presenting to the emergency department with weakness consistent with thiamine deficiency-related neuropathy and conducted a therapeutic challenge with thiamine on 41 patients. Response to thiamine therapy was monitored based on subjective and objective improvements in weakness and power. Patients were divided into thiamine responders (n = 25) and nonresponders (n = 16) based on their response to thiamine therapy and nerve conduction studies. RESULTS: Most of the baseline characteristics were similar between responders and nonresponders, except the responders exhibited lower thiamine levels and higher partial pressure of oxygen and lactate levels compared to nonresponders. All patients had a history of consuming polished rice and traditional salt tea. Although weakness in the lower limbs was present in both groups, nonresponders were more likely to exhibit weakness in all four limbs. Clinical improvement was observed within 24 h, but proximal muscle weakness persisted for an extended period of time. CONCLUSIONS: Thiamine deficiency-related neuropathy presents with predominant lower limb weakness, exacerbated by vomiting, poor food intake, psychiatric illness, and pregnancy. Thiamine challenge should be followed by observation of clinical and biochemical response.

Infrequent but serious? Beriberi And Thiamine deficiency among adolescents and young adults after bariatric surgery.

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.

Descriptive spectrum of thiamine deficiency in pregnancy: A potentially preventable condition.

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.

Anaesthesia and intensive care management of shoshin beriberi in perioperative period in young adult.

Thiamine deficiency presents as dry and wet beriberi. Wet beriberi is a complication of the cardiovascular system. Acute form of wet beriberi known as Shoshin beriberi is an acute presentation of cardiogenic shock which is rapidly reversed with thiamine administration. Here we present successful management of intraoperative acute decompensated heart failure, probably due to thiamine deficiency.

Pulmonary artery catheter usage in diagnosis of Shoshin beriberi presented with unexplained lactic acidosis.

Wet beriberi is a rare but fatal disease in modern society. The nonspecific clinical manifestations, including symptoms of heart failure and recalcitrant lactic acidosis, can prevent timely diagnosis. The use of a pulmonary artery catheter can promptly confirm a high cardiac output state and plays a crucial role in rapidly deteriorating cases. Appropriate treatment with intravenous administration of thiamine leads to dramatic recovery within hours. We present two cases of Shoshin beriberi, a fulminant variant of wet beriberi, diagnosed in 2016 and 2022 at our institute. The patients experienced haemodynamic collapse and refractory lactic acidosis, which were successfully diagnosed with the use of a pulmonary artery catheter and reversed by thiamine supplementation. We also reviewed 19 cases of wet beriberi reported between 2010 and 2022.

Thiamine responsive high output heart failure of adults: an under-recognized entity.

Thiamine deficiency, commonly presenting as dry and wet beriberi, a lesser-known entity in the present era, is increasingly being reported from Kashmir, a north Indian state. The present study aims to present the clinical profile of patients presenting with high-output heart failure (HOHF). Subjects with a primary diagnosis of denovo heart failure and features suggestive of HOHF were recruited; those who responded to intravenous administration of thiamine alone (responders) were adults with no co-morbidities and those who required other medications particularly diuretics (non-responders) were elderly with co-morbidities and underlying heart disease. Responders showed considerably lower mean thiamine pyrophosphate (TPP) levels and higher mean lactate and venous oxygen saturation than non-responders. More importantly, the mean drop in lactate and SVO2 following thiamine therapy was more in responders. In a setting of high risk for thiamine deficiency, features suggestive of HOHF along with elevated lactate and higher venous oxygen saturation, a response to thiamine challenge may serve as surrogate marker of thiamine deficiency.

Wernicke encephalopathy and beriberi disease presenting as STEMI-equivalent.

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.

Resurgence of Shoshin beriberi during the COVID-19 pandemic.

This report describes two patients who presented with severe type B lactic acidosis and shock, initially thought to be due to bowel ischaemia/myocardial infarction and pulmonary sepsis, respectively. This led to a delay in the diagnosis of thiamine deficiency. In both cases there was a dramatic response to intravenous thiamine, confirming the diagnosis of Shoshin beriberi. Both patients admitted to drinking home-brewed alcohol during the time of COVID-19 restrictions on alcohol consumption. These cases highlight the need for early diagnosis and immediate empirical treatment with intravenous thiamine in patients presenting with unexplained severe metabolic acidosis and circulatory shock.

Raise vigilance against refractory distributive shock due to severe wet beriberi.

Differentiating the type and cause of shock is crucial for intensive care. The rapid aggravation of lactic acidosis in patients often indicates a severe impairment of oxygen uptake in tissues. Herein, we presented a rare case of refractory distributive shock with severe wet beriberi. A 40-year-old male was admitted to the emergency department (ED) with recurrent chest tightness and lower extremity edema. The condition of the patient continued to deteriorate after symptomatic treatments. After several turnovers, the medical history of the patient was requested again and finally obtained. Our emergency management team hypothesized that the thiamine-deficient diet caused an aerobic metabolism disorder in the patient. Overall, we aimed to alert clinicians to unusual causes of distributive shock and further discussed the application of thiamine supplementary therapy in critical care.

Shoshin beriberi and thiamine-responsive right heart failure: A case report in Mayotte Recognition and management of infant Shoshin beriberi.

Infant Shoshin beriberi is an acute life-threatening condition for which the diagnosis is frequently delayed. Therefore, rapid recognition of right heart failure with lactic acidemia is a crucial element in the diagnosis and therapeutic management. We present the case of a 2-month-old girl with bronchiolitis, right heart failure, and lactic acidosis, who quickly and favorably responded to thiamine supplementation. Thiamine deficiency was established through laboratory tests. We present a brief review of the literature with the different thiamine dosages proposed in emergencies and provide an emergency protocol in cases of clinical suspicion, since thiamine supplementation could help to speed up recovery in infants with Shoshin beriberi.

[Thiamin: Simply a vitamin?] / Thiamine : une simple vitamine ?

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.

Clinical profile of patients presenting with thiamine-responsive upper-gastrointestinal upset: A pointer toward gastric beriberi.

OBJECTIVES: Although beriberi is considered a forgotten disease in the West, Kashmir has a rice-eating population that has beriberi in endemic proportions. Patients with a thiamine deficiency (TD) occasionally present with gastrointestinal (GI) symptoms, including nausea, recurrent vomiting, loss of appetite, and abdominal discomfort. Together these often respond to thiamine, which points to gastric beriberi. METHODS: Patients with GI symptoms suggestive of TD were recruited from the Department of Medicine at the Government Medical College and its associated hospital, SMHS, in Srinagar, India. Patients were evaluated for serum thiamine levels, serum lactate, biochemical parameters, and transabdominal ultrasonography after ruling out the usual causes of acute abdominal pain and vomiting. RESULTS: A total of 27 patients were recruited with a mean age of 47.28 ± 20.84 y. The mean lactate of patients at the time of admission was 6.43 ± 5.22 mmol/L, and the mean lactate at the time of discharge was 1.23 ± 0.50 mmol/L. All patients had a history of consuming polished rice, washed two to three times before cooking, as the staple diet. The most common GI symptoms were recurrent vomiting, nausea, and loss of appetite. All of the patients responded to the thiamine treatment, and showed improvement in their GI symptoms and decreased serum lactate levels within 2 to 6 h of their hospital stay. CONCLUSIONS: Gastric beriberi is a rare presentation of TD that can lead to severe GI symptoms and lactic acidosis. Given the rapid response to thiamine, it is the standard-of-care treatment in such cases. Thus, clinicians should suspect TD when patients present with either mild or moderate-to-severe GI symptoms and raised blood lactate.

Cardiac Dysfunction Due to Thiamine Deficiency after Hemodialysis for Biguanide-related Lactic Acidosis.

Biguanide is an ideal drug for the treatment of type 2 diabetes mellitus. When used appropriately, the incidence of lactic acidosis is reported to be very low. Risk factors associated with biguanide-related lactic acidosis include chronic kidney disease, congestive heart failure, alcohol use, severe dehydration, shock, hypoxic states, sepsis, and advanced age. We herein report a case of cardiac dysfunction due to thiamine deficiency after hemodialysis in a patient with suspected biguanide-related lactic acidosis. Patients who develop severe lactic acidosis while taking biguanides should be given a large dose of thiamine without delay, given the possibility of thiamine deficiency as a complication.

Síntese de evidências para políticas de saúde: enfrentando o beribéri em terras indígenas / Synthesis of evidence for health policies: tackling beriberi in indigenous lands

O beribéri é uma doença com diferentes subtipos, causada pela deficiência de tiamina (vitamina B1), que, apesar de fácil tratamento, pode levar ao óbito (WORLD HEALTH ORGANIZATION, 1999). No Brasil, os casos mais recentes ocorreram a partir de 2006, ano em que se somaram 40 óbitos notificados no estado do Maranhão (PADILHA et al., 2011). Nos anos subsequentes, novos casos foram notificados nos estados de Tocantins e Roraima (BRASIL, 2018; CERRONI et al., 2010). Tendo em vista que, historicamente, no Brasil, essa deficiência está relacionada a condições de miséria (FRUTUOSO, 2010), observa-se que grande parte dos surtos atuais se conecta a condições de pobreza e fome, além da relação com a alimentação monótona, baseada em arroz polido e no consumo elevado de carboidratos simples. Alguns grupos populacionais têm maior risco de serem acometidos pela deficiência, tais como: alcoolistas, gestantes, crianças e pessoas que exercem atividade física extenuante (BRASIL, 2012). O agravo entre os povos indígenas, representando 84,5% dos casos confirmados notificados, no Brasil, entre 2014 e 2016, é de importante preocupação devido tanto às vulnerabilidades específicas dessa população quanto aos desafios de identificação e tratamento oportunos da doença (ALVES, 2017). Opções para enfrentar o problema: Opção 1 ­ Suplementação de tiamina (vitamina B1): Esta opção envolve tanto a suplementação oral de tiamina e de outras vitaminas B (DAY et al., 2013; HUTCHEON, 2015; JAIN et al., 2015; JULIAN et al., 2019; KOH et al., 2015; STROH; MEYER; MANGER, 2014), incluindo tanto a administração parenteral, em casos mais graves de desnutrição (HUTCHEON, 2015), quanto a administração intramuscular ou intravenosa de tiamina pelas equipes de saúde, em casos de suspeita de sintomas de beribéri (HUTCHEON, 2015). Devido à dificuldade de confirmação do diagnóstico de beribéri, adotar suplementação oral de tiamina, de modo a garantir as doses necessárias da vitamina entre populações mais vulneráveis à insegurança alimentar, pode prevenir a doença, bem como diversas outras condições relacionadas à insuficiência de vitamina B1. Opção 2 ­ Intervenções junto a pessoas que fazem uso prejudicial de álcool: Esta opção descreve intervenções voltadas à melhoria das condições nutricionais e à prevenção de doenças como o beribéri e neuropatias junto a populações vulneráveis para o uso de álcool. Foram identificadas intervenções de educação e orientação, que englobaram desde entrevistas motivacionais pelo telefone até sessões educativas de um ou mais dias, intervenções multicomponentes (IJAZ et al., 2018) e intervenções de abstinência do álcool (JULIAN et al., 2018). As intervenções de abstinência foram efetivas para melhorar parcialmente os sintomas sensoriais, todavia não reverteram o quadro por completo (JULIAN et al., 2019). Considerações gerais acerca das opções propostas: As opções de intervenção sugeridas nesta síntese, apesar de estarem descritas de modo separado, podem ser complementares entre si e exigem uma ação intersetorial e integrada localmente. A implementação das opções deve considerar a participação de diferentes atores, como tomadores de decisão, profissionais da saúde pública e representantes dos povos indígenas. Além disso, devem ser avaliados os diferentes contextos, incluindo as diferentes responsabilidades entre as esferas de governo (federal, estadual e municipal), as áreas de conhecimento específicas e os limites técnicos dos diferentes profissionais envolvidos. Outro ponto importante a ser analisado é a disponibilidade de recursos humanos e financeiros, adaptando as intervenções às diferentes realidades, bem como verificando a possível provisão dos dispositivos necessários. Em determinadas situações, a ampliação e a capacitação da equipe serão imprescindíveis para o sucesso da adesão às opções propostas.

Beriberi is a disease with different subtypes, caused by thiamine (vitamin B1) deficiency, which, despite easy treatment, can lead to death (WORLD HEALTH ORGANIZATION, 1999). In Brazil, the most recent cases occurred from 2006, when 40 deaths were reported in the state of Maranhão (PADILHA et al., 2011). In subsequent years, new cases were reported in the states of Tocantins and Roraima (BRASIL, 2018; CERRONI et al., 2010). Given that, historically in Brazil, this deficiency is related to conditions of misery (FRUTUOSO, 2010), it is observed that much of the current outbreaks connect to conditions of poverty and hunger, in addition to the relationship with monotonous diet, based on polished rice and high consumption of simple carbohydrates. Some population groups have a higher risk of being affected by the deficiency, such as alcoholics, pregnant women, children and people who exercise strenuous physical activity (BRASIL, 2012). The aggravation among indigenous peoples, representing 84.5% of the confirmed cases notified, in Brazil, between 2014 and 2016, is of important concern due to both the specific vulnerabilities of this population and the challenges of timely identification and treatment of the disease (ALVES, 2017). Options to address the problem: Option 1 - Thiamine (vitamin B1) supplementation: This option involves both oral supplementation of thiamine and other B vitamins (DAY et al., 2013; HUTCHEON, 2015; JAIN et al., 2015; JULIAN et al., 2019; KOH et al, 2015; STROH; MEYER; MANGER, 2014), including both parenteral administration in more severe cases of malnutrition (HUTCHEON, 2015) and intramuscular or intravenous administration of thiamine by health care teams in cases of suspected beriberi symptoms (HUTCHEON, 2015). Due to the difficulty in confirming the diagnosis of beriberi, adopting oral thiamine supplementation to ensure the necessary doses of the vitamin among populations most vulnerable to food insecurity may prevent the disease as well as several other conditions related to vitamin B1 insufficiency. Option 2 - Interventions for people who are harmful users of alcohol: This option describes interventions aimed at improving nutritional status and preventing diseases such as beriberi and neuropathies among populations vulnerable to alcohol use. Education and guidance interventions were identified, ranging from motivational interviewing over the phone to one- or multi-day educational sessions, multicomponent interventions (IJAZ et al., 2018), and alcohol abstinence interventions (JULIAN et al., 2018). The abstinence interventions were effective in partially improving sensory symptoms, but did not completely reverse the condition (JULIAN et al., 2019). General considerations about the proposed options: The intervention options suggested in this synthesis, although described separately, may be complementary to each other and require intersectoral and locally integrated action. The implementation of the options should consider the participation of different stakeholders such as decision-makers, public health professionals and indigenous peoples' representatives. In addition, the different contexts must be evaluated, including the different responsibilities between the spheres of government (federal, state, and municipal), the specific areas of knowledge, and the technical limits of the different professionals involved. Another important point to be analyzed is the availability of human and financial resources, adapting the interventions to the different realities, as well as verifying the possible provision of the necessary devices. In certain situations, the expansion and training of the team will be essential for the successful adherence to the proposed options.

El beriberi es una enfermedad con diferentes subtipos, causada por la carencia de tiamina (vitamina B1), que, a pesar de su fácil tratamiento, puede conducir a la muerte (ORGANIZACIÓN MUNDIAL DE LA SALUD, 1999). En Brasil, los casos más recientes ocurrieron a partir de 2006, cuando se registraron 40 muertes en el estado de Maranhão (PADILHA et al., 2011). En años posteriores, se notificaron nuevos casos en los estados de Tocantins y Roraima (BRASIL, 2018; CERRONI et al., 2010). Dado que, históricamente en Brasil, esta deficiencia se relaciona con condiciones de miseria (FRUTUOSO, 2010), se observa que gran parte de los brotes actuales se conectan a condiciones de pobreza y hambre, además de la relación con dieta monótona, basada en arroz pulido y alto consumo de carbohidratos simples. Algunos grupos de la población tienen mayor riesgo de ser afectados por la deficiencia, como los alcohólicos, las embarazadas, los niños y las personas que realizan actividades físicas extenuantes (BRASIL, 2012). El agravio entre los pueblos indígenas, que representan el 84,5% de los casos confirmados notificados, en Brasil, entre 2014 y 2016, es de importante preocupación debido tanto a las vulnerabilidades específicas de esta población como a los desafíos de identificación y tratamiento oportunos de la enfermedad (ALVES, 2017). Opciones para abordar el problema: Opción 1 - Suplementos de tiamina (vitamina B1): Esta opción implica tanto la suplementación oral de tiamina como de otras vitaminas del grupo B (DAY et al., 2013; HUTCHEON, 2015; JAIN et al., 2015; JULIAN et al., 2019; KOH et al, 2015; STROH; MEYER; MANGER, 2014), incluyendo tanto la administración parenteral en casos más graves de malnutrición (HUTCHEON, 2015) como la administración intramuscular o intravenosa de tiamina por parte de los equipos sanitarios en casos de sospecha de síntomas de beriberi (HUTCHEON, 2015). Dada la dificultad de confirmar el diagnóstico de beriberi, la administración de suplementos orales de tiamina para garantizar las dosis necesarias de la vitamina entre las poblaciones más vulnerables a la inseguridad alimentaria puede prevenir la enfermedad, así como varias otras afecciones relacionadas con la insuficiencia de vitamina B1. Opción 2 - Intervenciones para las personas que consumen alcohol de forma nociva: Esta opción describe las intervenciones destinadas a mejorar el estado nutricional y prevenir enfermedades como el beriberi y las neuropatías entre las poblaciones vulnerables al consumo de alcohol. Se identificaron intervenciones de educación y orientación, desde entrevistas motivacionales por teléfono hasta sesiones educativas de uno o varios días, intervenciones multicomponente (IJAZ et al., 2018) e intervenciones de abstinencia de alcohol (JULIAN et al., 2018). Las intervenciones de abstinencia fueron eficaces para mejorar parcialmente los síntomas sensoriales, pero no revirtieron completamente la afección (JULIAN et al., 2019). Consideraciones generales sobre las opciones propuestas: Las opciones de intervención sugeridas en esta síntesis, aunque se describen por separado, pueden ser complementarias entre sí y requieren una actuación intersectorial y localmente integrada. La aplicación de las opciones debe tener en cuenta la participación de las distintas partes interesadas, como los responsables de la toma de decisiones, los profesionales de la salud pública y los representantes de los pueblos indígenas. Además, deben evaluarse los distintos contextos, incluidas las diferentes responsabilidades entre las esferas gubernamentales (federal, estatal y municipal), las áreas específicas de conocimiento y los límites técnicos de los distintos profesionales implicados. Otro punto importante a analizar es la disponibilidad de recursos humanos y financieros, adaptando las intervenciones a las diferentes realidades, así como verificando la posible dotación de los dispositivos necesarios. En determinadas situaciones, la ampliación y la formación del equipo serán esenciales para el éxito de las opciones propuestas.

Lessons of the month 1: Shoshin beriberi: A case report of fulminant cardiovascular collapse, intractable hyperlactatemia and deteriorating consciousness.

Shoshin beriberi is a fulminant variant of thiamine deficiency, often presenting with severe lactic acidosis and cardiogenic shock. Due to the sparsity of this condition, delays in diagnosis can lead to fatality. However, rapid reversal of symptoms can be easily achieved through intravenous thiamine replacement.In this case report, we discuss a 57-year-old woman, who was previously fit and well, who presented to the emergency department with a 3-day history of extreme malaise, breathlessness and abdominal pain, with marked hypotension and tachycardia requiring vasopressor support and a severe rising lactic acidosis. Upon further questioning, a history of alcohol excess was noted. Rapid reversal of the marked haemodynamic instability was achieved upon administration of intravenous thiamine and the patient was discharged within 48 hours.

Case Report: Fulminant Infantile Beriberi: A Report of Six Cases.

Thiamine deficiency disorders are an under-recognized public health problem in low- and middle-income countries. Infantile beriberi, the most important symptom for children, is suspected to significantly contribute to infant mortality and lifelong neurodevelopmental morbidity. Lack of awareness, varied clinical presentation, and lack of a readily available diagnostic marker lead to frequent misdiagnoses. We report six thriving infants who presented with an acute fulminant illness with varied clinical manifestations mimicking common childhood illnesses like pneumonia and sepsis. Four of them presented with the severe cardiovascular form, called Shoshin beriberi, and severe pulmonary arterial hypertension. Empirical intravenous thiamine administered to four of the six infants resulted in dramatic recovery. Awareness of the clinical definition of infantile beriberi and treatment with empirical thiamine can be lifesaving.

Non-alcoholic beriberi, Wernicke encephalopathy and long-term eating disorder: case report and a mini-review.

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.