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1.
Infection ; 48(1): 137-140, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31606875

RESUMO

CASE DESCRIPTION: A 73-year-old male presented with new onset dizziness and a 22-kg weight loss due to antibiotic-induced nausea/vomiting. Due to gaze-evoked nystagmus (GEN), thiamine deficiency was suspected. Within 12 h after replacement, his GEN decreased. CONCLUSION: In patients with nutritional deprivation, new onset GEN should prompt further diagnostics and immediate thiamine supplementation to avoid disease progression.


Assuntos
Antibacterianos/efeitos adversos , Desnutrição/etiologia , Náusea/complicações , Deficiência de Tiamina/diagnóstico , Idoso , Humanos , Masculino , Náusea/induzido quimicamente , Nistagmo Patológico/induzido quimicamente , Deficiência de Tiamina/induzido quimicamente , Deficiência de Tiamina/terapia , Resultado do Tratamento
2.
Indian Pediatr ; 56(8): 673-681, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31477649

RESUMO

CONTEXT: The wide spectrum of clinical presentation in infantile thiamine deficiency is difficult to recognize, and the diagnosis is frequently missed due to the lack of widespread awareness, and non-availability of costly and technically demanding investigations. EVIDENCE ACQUISITION: The topic was searched by two independent researchers using online databases of Google scholar and PubMed. We considered the related studies published in the last 20 years. The terms used for the search were 'thiamine', 'thiamine deficiency', 'beri-beri', 'B-vitamins','micronutrients', 'malnutrition', 'infant mortality'. 'Wernicke's syndrome','Wernicke's encephalopathy', and 'lactic acidosis'. RESULTS: In the absence of specific diagnostic tests, a low threshold for a therapeutic thiamine challenge is currently the best approach to diagnose infantile thiamine deficiency in severe acute conditions. The practical approach is to consider thiamine injection as a complementary resuscitation tool in infants with severe acute conditions; more so in presence of underlying risk factors, clinically evident malnutrition or where a dextrose-based fluid is used for resuscitation. Further, as persistent subclinical thiamine deficiency during infancy can have long-term neuro-developmental effects, reasonable strategy is to treat pregnant women suspected of having the deficiency, and to supplement thiamine in both mother and the baby during breastfeeding. CONCLUSIONS: Health care professionals in the country need to be sensitized to adopt a high level of clinical suspicion for thiamine deficiency and a low threshold for the administration of thiamine, particularly when infantile thiamine deficiency is suspected.


Assuntos
Deficiência de Tiamina , Humanos , Lactente , Fatores de Risco , Deficiência de Tiamina/diagnóstico , Deficiência de Tiamina/etiologia , Deficiência de Tiamina/terapia
3.
BMJ Case Rep ; 12(2)2019 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-30737323

RESUMO

Wernicke's encephalopathy (WE) is an uncommon neurological complication in pregnancies complicated with hyperemesis due to thiamine deficiency. In women with hyperemesis, inadvertent glucose administration prior to thiamine supplementation triggers the development of neurological manifestations. Delay in the diagnosis can lead to maternal morbidity, and in one-third of cases may lead to persistence of some neurological deficit. With early recognition and thiamine supplementation, complete recovery is reported. We report a case of WE complicating a case of triplet pregnancy with hyperemesis gravidarum, which highlights the importance of early recognition and treatment, resulting in complete recovery as in the index case.


Assuntos
Infecções por Escherichia coli/diagnóstico , Hiperêmese Gravídica/complicações , Lactente Extremamente Prematuro , Doenças do Prematuro/mortalidade , Tiamina/uso terapêutico , Encefalopatia de Wernicke/diagnóstico , Amicacina/uso terapêutico , Antibacterianos/uso terapêutico , Infecções por Escherichia coli/fisiopatologia , Infecções por Escherichia coli/terapia , Feminino , Hidratação , Humanos , Hiperêmese Gravídica/fisiopatologia , Hiperêmese Gravídica/terapia , Gravidez , Gravidez de Trigêmeos , Deficiência de Tiamina/fisiopatologia , Deficiência de Tiamina/terapia , Resultado do Tratamento , Encefalopatia de Wernicke/tratamento farmacológico , Encefalopatia de Wernicke/etiologia , Adulto Jovem
4.
Rev Med Interne ; 40(1): 20-27, 2019 Jan.
Artigo em Francês | MEDLINE | ID: mdl-30031565

RESUMO

Thiamine-responsive megaloblastic anemia (TRMA), also known as Rogers syndrome, is a rare autosomal recessive disease characterized by three main components: megaloblastic anemia, diabetes mellitus and sensorineural deafness. Those features occur in infancy but may arise during adolescence. Diagnosis relies on uncovering genetic variations (alleles) in the SLC19A2 gene, encoding for a high affinity thiamine transporter. This transporter is essentially present in hematopoietic stem cells, pancreatic beta cells and inner ear cells, explaining the clinical manifestations of the disease. Based on a multidisciplinary approach, treatment resides on lifelong thiamine oral supplementation at pharmacological doses, which reverses anemia and may delay development of diabetes. However, thiamine supplementation does not alleviate already existing hearing defects.


Assuntos
Anemia Megaloblástica/diagnóstico , Diabetes Mellitus/diagnóstico , Perda Auditiva Neurossensorial/diagnóstico , Proteínas de Membrana Transportadoras/genética , Deficiência de Tiamina/congênito , Tiamina/uso terapêutico , Anemia Megaloblástica/fisiopatologia , Anemia Megaloblástica/terapia , Diabetes Mellitus/fisiopatologia , Diabetes Mellitus/terapia , Diagnóstico Diferencial , Suplementos Nutricionais , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Neurossensorial/terapia , Humanos , Mutação , Deficiência de Tiamina/diagnóstico , Deficiência de Tiamina/fisiopatologia , Deficiência de Tiamina/terapia
5.
Ann N Y Acad Sci ; 1430(1): 3-43, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30151974

RESUMO

Thiamine is an essential micronutrient that plays a key role in energy metabolism. Many populations worldwide may be at risk of clinical or subclinical thiamine deficiencies, due to famine, reliance on staple crops with low thiamine content, or food preparation practices, such as milling grains and washing milled rice. Clinical manifestations of thiamine deficiency are variable; this, along with the lack of a readily accessible and widely agreed upon biomarker of thiamine status, complicates efforts to diagnose thiamine deficiency and assess its global prevalence. Strategies to identify regions at risk of thiamine deficiency through proxy measures, such as analysis of food balance sheet data and month-specific infant mortality rates, may be valuable for understanding the scope of thiamine deficiency. Urgent public health responses are warranted in high-risk regions, considering the contribution of thiamine deficiency to infant mortality and research suggesting that even subclinical thiamine deficiency in childhood may have lifelong neurodevelopmental consequences. Food fortification and maternal and/or infant thiamine supplementation have proven effective in raising thiamine status and reducing the incidence of infantile beriberi in regions where thiamine deficiency is prevalent, but trial data are limited. Efforts to determine culturally and environmentally appropriate food vehicles for thiamine fortification are ongoing.


Assuntos
Suplementos Nutricionais , Alimentos Fortificados , Saúde Pública , Deficiência de Tiamina/epidemiologia , Saúde Global , Humanos , Prevalência , Fatores de Risco , Deficiência de Tiamina/diagnóstico , Deficiência de Tiamina/terapia
6.
Br J Nutr ; 120(5): 491-499, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29986774

RESUMO

As the co-enzyme of pyruvate dehydrogenase and α-ketoglutarate dehydrogenase, thiamine plays a critical role in carbohydrate metabolism in dairy cows. Apart from feedstuff, microbial thiamine synthesis in the rumen is the main source for dairy cows. However, the amount of ruminal thiamine synthesis, which is influenced by dietary N levels and forage to concentrate ratio, varies greatly. Notably, when dairy cows are overfed high-grain diets, subacute ruminal acidosis (SARA) occurs and results in thiamine deficiency. Thiamine deficiency is characterised by decreased ruminal and blood thiamine concentrations and an increased blood thiamine pyrophosphate effect to >45 %. Thiamine deficiency caused by SARA is mainly related to the increased thiamine requirement during high grain feeding, decreased bacterial thiamine synthesis in the rumen, increased thiamine degradation by thiaminase, and decreased thiamine absorption by transporters. Interestingly, thiamine deficiency can be reversed by exogenous thiamine supplementation in the diet. Besides, thiamine supplementation has beneficial effects in dairy cows, such as increased milk and component production and attenuated SARA by improving rumen fermentation, balancing bacterial community and alleviating inflammatory response in the ruminal epithelium. However, there is no conclusive dietary thiamine recommendation for dairy cows, and the impacts of thiamine supplementation on protozoa, solid-attached bacteria, rumen wall-adherent bacteria and nutrient metabolism in dairy cows are still unclear. This knowledge is critical to understand thiamine status and function in dairy cows. Overall, the present review described the current state of knowledge on thiamine nutrition in dairy cows and the major problems that must be addressed in future research.


Assuntos
Doenças dos Bovinos/terapia , Indústria de Laticínios/métodos , Deficiência de Tiamina/veterinária , Tiamina/metabolismo , Acidose/etiologia , Acidose/veterinária , Animais , Bactérias/metabolismo , Bovinos , Dieta/veterinária , Suplementos Nutricionais , Grão Comestível/efeitos adversos , Feminino , Fermentação , Estado Nutricional , Rúmen/metabolismo , Rúmen/microbiologia , Gastropatias/etiologia , Gastropatias/veterinária , Tiamina/biossíntese , Tiamina/fisiologia , Deficiência de Tiamina/etiologia , Deficiência de Tiamina/terapia
7.
Ann N Y Acad Sci ; 1408(1): 15-19, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-29064578

RESUMO

Staple diets that are deficient in thiamine can result in low body thiamine levels, which may be subclinical or may manifest as a thiamine-deficiency syndrome. In many communities in the developing countries of Africa, the staple diets of polished rice or processed cassava are deficient in thiamine, and thus the communities are at high risk for marginal or frank thiamine deficiency unless their diets are supplemented by other sources of thiamine, such as protein meals and vegetables. African communities with large numbers of individuals in low socioeconomic strata are more likely to subsist on a monotonous diet of rice or cassava with minimal or no protein supplementation and are therefore particularly at risk of thiamine-deficiency disorders. Indeed, there is evidence of widespread biochemical thiamine deficiency from community-based studies in Africa. The protean manifestations of thiamine deficiency disorders in the developing countries of Africa are presented in this paper. We present evidence supporting the contention that there is a diagnosis and treatment gap for thiamine-deficiency disorders in Africa. We discuss research and clinical options for bridging the putative diagnosis and treatment gap for thiamine-deficiency disorders in the developing countries of Africa.


Assuntos
Deficiência de Tiamina/diagnóstico , Deficiência de Tiamina/terapia , África ao Sul do Saara/epidemiologia , Dieta , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Fatores de Risco , Síndrome , Deficiência de Tiamina/epidemiologia
8.
Metab Brain Dis ; 32(2): 377-384, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27734188

RESUMO

Wernicke's encephalopathy (WE) is a thiamine deficiency-related condition, in which lesions are usually present in the periventricular and subcortical areas of the brain. However, lesions have also been found in atypical areas, such as the cerebral cortex. The present study summarizes the clinical outcomes and radiological features of WE with cortical impairment. We report two cases of cortical involvement in patients with WE, and review 22 similar cases from other reports. Among all 24 cases, 4 patients had a confirmed history of chronic daily alcohol abuse, and 19 of them had an identified causes of thiamine deficiency. 17 cases reported specific clinical information, among which 11 patients had symptoms of cortical impairment. 23 cases reported prognostic information at the end of treatment or at follow-up. The mortality rate was 26.1 % in our review. All patients had abnormal magnetic resonance imaging (MRI) signals or pathological findings in the bilateral cortex. Among patients with available MRI, 89.0 % had banding-like signs along the para-central sulcus. 13 cases underwent follow-up MRI examinations and 76.9 % displayed normal images. We suggest that WE with bilateral cortical involvement may have an acceptable prognosis, but that the mortality rate is higher than that among typical cases, especially if patients are not treated promptly and correctly. We identified the frontal and parietal lobes, especially around the central sulcus, to be the most susceptible areas, and suggest that the banding signs may be characteristic of WE. Persistent hyper-intensity on T2-weighted-fluid-attenuated inversion recovery, or gadolinium enhancement, may predict poor outcome.


Assuntos
Córtex Cerebral/diagnóstico por imagem , Encefalopatia de Wernicke/diagnóstico por imagem , Encefalopatia de Wernicke/terapia , Progressão da Doença , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Necrose , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Prognóstico , Deficiência de Tiamina/terapia , Resultado do Tratamento , Encefalopatia de Wernicke/etiologia
9.
Prog. obstet. ginecol. (Ed. impr.) ; 59(4): 223-225, jul.-ago. 2016.
Artigo em Espanhol | IBECS | ID: ibc-163905

RESUMO

Los hallazgos de la encefalopatía de Wernicke han sido descritos como una combinación de confusión, anomalías oculares y ataxia. La encefalopatía puede complicar la hiperémesis gravídica debido a que esta altera la absorción correcta de una cantidad adecuada de tiamina y puede causar alteraciones electrolíticas. Se presenta el caso de una primigesta de 22 años de edad que fue hospitalizada por presentar letargia, debilidad generalizada, oftalmoplejía, alteraciones del lenguaje y pérdida de peso a las 12 semanas de embarazo. Tenía antecedentes de hiperémesis gravídica tres semanas antes de la hospitalización. El examen físico reveló una paciente letárgica con nistagmos horizontales, ataxia e hiporeflexia simétrica. Se inició tratamiento con tiamina. La paciente se recuperó de las alteraciones neurológicas 6 semanas después del tratamiento (AU)


The features of Wernicke’s encephalopathy have been described as a combination of confusion, ocular abnormalities, and ataxia. Encephalopathy can complicate hyperemesis gravidarum because it impairs correct absorption of an adequate amount of thiamine and can cause electrolyte imbalance. We present the case of a 22-year-old primipara who was admitted to hospital due to lethargy, generalized weakness, ophthalmoplegia, language disturbance, and weight loss in her 12th week of pregnancy. The patient had a history of hyperemesis gravidarum three weeks before admission. Physical examination revealed a lethargic patient with horizontal nystagmus, ataxia, and symmetric hyporeflexia. Parenteral thiamine therapy was started. The patient recovered from the neurological deficits after 6 weeks of treatment (AU)


Assuntos
Humanos , Feminino , Gravidez , Adulto , Encefalopatia de Wernicke/complicações , Hiperêmese Gravídica/complicações , Hiperêmese Gravídica/tratamento farmacológico , Complicações na Gravidez/diagnóstico , Tiamina/uso terapêutico , Deficiência de Tiamina/terapia , Complicações na Gravidez/terapia , Nistagmo Patológico/complicações , Piridoxina/uso terapêutico , Metoclopramida/uso terapêutico , Omeprazol/uso terapêutico
10.
Semin Pediatr Neurol ; 23(4): 341-350, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-28284395

RESUMO

B vitamins act as cofactors for strategic metabolic processes. The SLC19 gene family of solute carriers has a significant structural similarity, transporting substrates with different structure and ionic charge. Three proteins of this family are expressed ubiquitously and mediate the transport of 2 important water-soluble vitamins, folate, and thiamine. SLC19A1 transports folate and SLC19A2 and SLC19A3 transport thiamine. PCFT and FOLR1 ensure intestinal absorption and transport of folate through the blood-brain barrier and SLC19A25 transports thiamine into the mitochondria. Several damaging genetic defects in vitamin B transport and metabolism have been reported. The most relevant feature of thiamine and folate transport defects is that both of them are treatable disorders. In this article, we discuss the biology and transport of thiamine and folate, as well as the clinical phenotype of the genetic defects.


Assuntos
Deficiência de Ácido Fólico/metabolismo , Ácido Fólico/metabolismo , Proteínas de Membrana Transportadoras/deficiência , Erros Inatos do Metabolismo/metabolismo , Deficiência de Tiamina/metabolismo , Tiamina/metabolismo , Pré-Escolar , Deficiência de Ácido Fólico/terapia , Humanos , Lactente , Recém-Nascido , Erros Inatos do Metabolismo/terapia , Deficiência de Tiamina/terapia
12.
Nutr Clin Pract ; 30(1): 92-9, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25524882

RESUMO

BACKGROUND: Wernicke's encephalopathy is a critical condition of neurological dysfunction resulting from a deficiency in thiamine. Chronic alcoholism is recognized as the most common cause of Wernicke's encephalopathy, but other causes, including fasting/starvation and malnutrition, have been documented within the scientific literature. These causes may not be readily recognized by healthcare professionals and may lead to Wernicke's encephalopathy being overlooked as a diagnosis when a nonalcoholic patient presents with classic signs and symptoms of the disorder. MATERIALS AND METHODS: A narrative review of thiamine and its relationship to the development, diagnosis, and treatment of Wernicke's encephalopathy is presented based on a review of evidence-based guidelines and published research. To heighten awareness of the development of Wernicke's encephalopathy in fasted/starved and malnourished patients and to contribute to the scientific body of knowledge for the identification and management of Wernicke's encephalopathy in these patients, the clinical course and treatment of an adult woman who developed Wernicke's encephalopathy following a 40-day water-only fasting diet is outlined. RESULTS: Clinical suspicion was required to identify the patient's condition and initiate immediate intervention through parenteral thiamine administration. Oral thiamine supplementation of 100 to 800 mg per day for 6 months was required to aid recovery. OUTCOMES: The patient's clinical course and response to treatment illustrate the necessity for clinical awareness and suspicion of Wernicke's encephalopathy among healthcare professionals, timely and adequate parenteral thiamine administration, and oral thiamine supplementation at therapeutic doses to correct the nutrient deficiency, halt the progression of Wernicke's encephalopathy, and promote recovery.


Assuntos
Jejum/efeitos adversos , Desnutrição/complicações , Deficiência de Tiamina/complicações , Deficiência de Tiamina/etiologia , Tiamina/uso terapêutico , Encefalopatia de Wernicke/diagnóstico , Adulto , Jejum/sangue , Feminino , Humanos , Masculino , Desnutrição/sangue , Desnutrição/diagnóstico , Desnutrição/etiologia , Fatores de Risco , Inanição/sangue , Inanição/complicações , Tiamina/administração & dosagem , Tiamina/sangue , Deficiência de Tiamina/sangue , Deficiência de Tiamina/terapia , Resultado do Tratamento , Água/administração & dosagem , Encefalopatia de Wernicke/sangue , Encefalopatia de Wernicke/etiologia , Encefalopatia de Wernicke/terapia
13.
Neurochem Res ; 40(2): 353-61, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25297573

RESUMO

Thiamine is an essential vitamin that is necessary to maintain the functional integrity of cells in the brain. Its deficiency is the underlying cause of Wernicke's encephalopathy (WE), a disorder primarily associated with, but not limited to, chronic alcoholism. Thiamine deficiency leads to the development of impaired energy metabolism due to mitochondrial dysfunction in focal regions of the brain resulting in cerebral vulnerability. The consequences of this include oxidative stress, excitotoxicity, inflammatory responses, decreased neurogenesis, blood-brain barrier disruption, lactic acidosis and a reduction in astrocyte functional integrity involving a loss of glutamate transporters and other astrocyte-specific proteins which together contribute in a major way to the resulting neurodegeneration. Exactly how these factors acting in concert lead to the demise of neurons is unclear. In this review we reassess their relative importance in the light of more recent findings and discuss therapeutic possibilities that may provide hope for the future for individuals with WE.


Assuntos
Deficiência de Tiamina/fisiopatologia , Deficiência de Tiamina/terapia , Animais , Glutamatos/fisiologia , Humanos , Estresse Oxidativo
14.
Nutr Clin Pract ; 30(1): 100-3, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25112945

RESUMO

An 11-year-old male with autism became less responsive and was hospitalized with hepatomegaly and liver dysfunction, as well as severe lactic acidosis. His diet for several years was self-limited exclusively to a single "fast food"-a particular type of fried chicken-and was deficient in multiple micronutrients, including the B vitamins thiamine and pyridoxine. Lactic acidosis improved rapidly with thiamine; 2 weeks later, status epilepticus-with low serum pyridoxine-resolved rapidly with pyridoxine. Dietary B vitamin deficiencies complicated the care of this critically ill autistic child and should be considered in this setting.


Assuntos
Transtorno Autístico/psicologia , Estado Terminal/terapia , Piridoxina/uso terapêutico , Tiamina/uso terapêutico , Deficiência de Vitaminas do Complexo B/etiologia , Deficiência de Vitaminas do Complexo B/terapia , Acidose Láctica/sangue , Acidose Láctica/etiologia , Acidose Láctica/terapia , Criança , Dieta/efeitos adversos , Fast Foods/efeitos adversos , Comportamento Alimentar/psicologia , Hepatomegalia/sangue , Hepatomegalia/etiologia , Hepatomegalia/terapia , Humanos , Hepatopatias/sangue , Hepatopatias/etiologia , Hepatopatias/terapia , Masculino , Piridoxina/administração & dosagem , Piridoxina/sangue , Piridoxina/deficiência , Estado Epiléptico/sangue , Estado Epiléptico/etiologia , Estado Epiléptico/terapia , Tiamina/administração & dosagem , Tiamina/sangue , Deficiência de Tiamina/terapia , Deficiência de Vitaminas do Complexo B/sangue , Deficiência de Vitaminas do Complexo B/complicações
15.
Semin Pediatr Neurol ; 21(2): 139-43, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25149949

RESUMO

A 19-month-old, white, Pennsylvanian boy, with an unremarkable medical history, presented to our hospital with a 3-week history of nonbloody, nonbilious emesis up to 5 times a day and nonbloody diarrhea. Ten days before admission, his gait became progressively unsteady, until he finally refused to walk. A day before admission, he found it difficult to move his eyes. The patient was hypoactive. History, physical and neurologic examination, blood and cerebrospinal (CSF) fluid studies, and neuroimaging studies ruled out the most frequent causes of acute ataxia. The etiology of bilateral, complete ophthalmoplegia was also taken into consideration. Magnetic resonance imaging (MRI) findings of bilateral thalami and mammillary bodies provided diagnostic clues. Additional history and specific tests established the final diagnosis and treatment plan. The patient improved to a normal neurologic state. This case provides important practical information about an unusual malnutrition cause of acute ataxia, particularly in young children of developing countries.


Assuntos
Ataxia/fisiopatologia , Transtornos da Consciência/fisiopatologia , Oftalmoplegia/fisiopatologia , Deficiência de Tiamina/diagnóstico , Deficiência de Tiamina/fisiopatologia , Ataxia/diagnóstico , Ataxia/patologia , Transtornos da Consciência/diagnóstico , Transtornos da Consciência/patologia , Diagnóstico Diferencial , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Oftalmoplegia/diagnóstico , Oftalmoplegia/patologia , Tiamina/administração & dosagem , Deficiência de Tiamina/patologia , Deficiência de Tiamina/terapia , Estados Unidos
16.
BMJ Case Rep ; 20142014 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-24895398

RESUMO

A 16-year-old perioperative paediatric patient presented with refractory lactic acidosis and multiorgan failure due to thiamine-deficient total parenteral nutrition during a recent national multivitamin shortage. Urgent empiric administration of intravenous thiamine resulted in prompt recovery from this life-threatening condition. Despite readily available treatment, a high index of suspicion is required to prevent cardiovascular collapse and mortality.


Assuntos
Acidose Láctica/etiologia , Insuficiência de Múltiplos Órgãos/etiologia , Nutrição Parenteral Total , Deficiência de Tiamina/complicações , Acidose Láctica/sangue , Acidose Láctica/diagnóstico , Adolescente , Diagnóstico Diferencial , Humanos , Concentração de Íons de Hidrogênio , Ácido Láctico/sangue , Masculino , Insuficiência de Múltiplos Órgãos/diagnóstico , Deficiência de Tiamina/terapia
17.
Arch Pediatr ; 21(4): 392-5, 2014 Apr.
Artigo em Francês | MEDLINE | ID: mdl-24636593

RESUMO

Thiamine deficiency is recognized in varied parts of the world. In Asia, it remains an important public health problem where highly polished rice is the major staple food and where other primary dietary sources of thiamine are in short supply. Beriberi, or clinically apparent thiamine deficiency, may present a variety of syndromes including myocardial dysfunction or wet beriberi, dry beriberi with neurological symptoms, and the more severe form Shoshin beriberi with cardiac failure and lactic acidosis. Infantile thiamine deficiency is a very rare condition in developed countries today. It occurs mainly in breastfed infants of mothers who have inadequate intake of thiamine. Clinical symptoms in such infants include gastrointestinal symptoms, cardiac failure, and lactic acidosis. We report the case of a 10-week-old girl, admitted with diarrhea, vomiting, acidosis, and cardiac failure. After excluding other etiologies of cardiomyopathy, biochemical thiamine deficiency confirmed the diagnosis of beriberi in an infant of a thiamine-deficient mother from Reunion Island, a French island where recently, with Mayotte Island, epidemic cases of beriberi have been described. This case is important to highlight the manifestations in young infants and to alert physicians to the possibility of thiamine deficiency in developed countries.


Assuntos
Aleitamento Materno , Complicações na Gravidez , Deficiência de Tiamina/complicações , Deficiência de Tiamina/diagnóstico , Acidose/etiologia , Adulto , Biomarcadores/sangue , Cardiomegalia/complicações , Comores , Diarreia/etiologia , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Lactente , Gravidez , Fatores de Risco , Tiamina/sangue , Tiamina/uso terapêutico , Deficiência de Tiamina/sangue , Deficiência de Tiamina/etiologia , Deficiência de Tiamina/terapia , Resultado do Tratamento , Complexo Vitamínico B/sangue , Complexo Vitamínico B/uso terapêutico , Vômito/etiologia
18.
Rev Prat ; 63(8): 1074-5, 1077-8, 2013 Oct.
Artigo em Francês | MEDLINE | ID: mdl-24298824

RESUMO

Vitamin B1 (or thiamine) plays a key role in energy production from glucose. Since the main fuel of the nervous system is glucose, thiamine deficiency causes severe neurological symptoms. The biological exploration of vitamin B1 status is based on the measurement of thiamine pyrophosphate concentration or of the activity of a thiamine-dependent enzyme, transketolase, in erythrocytes. Severe deficiency states can be observed in chronic alcoholics, after protracted vomiting during pregnancy and after bariatric surgery. Mild deficiencies are common in the general population, but their clinical consequences are still unclear.


Assuntos
Deficiência de Tiamina , Tiamina/fisiologia , Adulto , Criança , Feminino , Humanos , Gravidez , Deficiência de Tiamina/complicações , Deficiência de Tiamina/diagnóstico , Deficiência de Tiamina/etiologia , Deficiência de Tiamina/terapia
20.
J Assoc Physicians India ; 60: 53-6, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-23029727

RESUMO

OBJECTIVE: We describe a case of Wernicke's encephalopathy associated with visual loss that was caused by hyperemesis gravidarum. METHODS: A 25 year old lady in her 20th week of her pregnancy consulted us. She had history of nausea and vomiting for 3 months with resultant weight loss. She now presented with sub-acute onset of visual loss in both her eyes, and gait disturbance with unsteadiness. Upon ophthalmologic examination she was found to have a visual acuity of 6/60 in both eyes; abduction restriction, nystagmus and retinal hemorrhages and macular oedema in both eyes. She also had truncal, stance and gait ataxia. RESULTS: She was treated with parenteral thiamine and her visual loss reversed and her ataxia improved dramatically. Magnetic resonance imaging (MRI) brain with diffusion weighted imaging showed findings consistent with Wernicke's Encephalopathy. CONCLUSION: Wernicke's Encephalopathy can occur in many hitherto under-recognised clinical scenarios associated with inadequate oral intake like hyperemesis gravidarum, after gastric bypass surgeries and those on total parenteral nutrition. Visual loss is increasingly being recognized as the additional, reversible feature of Wernicke's Encephalopathy. The changes that occur on MRI brain, especially on the diffusion weighted images, are characteristic and considered diagnostic of Wernicke's Encephalopathy.


Assuntos
Hiperêmese Gravídica/complicações , Complicações na Gravidez/diagnóstico , Deficiência de Tiamina/complicações , Transtornos da Visão/complicações , Encefalopatia de Wernicke/complicações , Adulto , Feminino , Humanos , Gravidez , Complicações na Gravidez/terapia , Deficiência de Tiamina/terapia , Transtornos da Visão/diagnóstico , Encefalopatia de Wernicke/diagnóstico , Encefalopatia de Wernicke/terapia
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