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1.
BMJ Case Rep ; 14(7)2021 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-34301700

RESUMO

A 74-year-old man with a history of chronic alcohol use presented with progressive exertional dyspnoea and weight gain. On physical examination, he was noted to have wide pulse pressure, elevated jugular venous pressure, and alternating flushing and blanching of the nail beds in concert with the cardiac cycle, known as Quincke's pulse. Transthoracic echocardiography demonstrated normal biventricular systolic function and valvular function, but noted a dilated inferior vena cava. Right heart catheterisation revealed elevated filling pressures, high cardiac output and low systemic vascular resistance, consistent with high-output heart failure. Whole blood concentration of thiamine was low, confirming the diagnosis of wet beriberi. The patient abstained from alcohol use and was started on thiamine replacement therapy, resulting in narrowing of the pulse pressure over time and complete resolution of symptoms without the need for diuretic therapy.


Assuntos
Beriberi , Insuficiência Cardíaca , Idoso , Pressão Sanguínea , Ecocardiografia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Tiamina
3.
J Emerg Med ; 61(3): 314-319, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33836911

RESUMO

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.


Assuntos
Beriberi , Encefalopatias , Desnutrição , Deficiência de Tiamina , Encefalopatia de Wernicke , Adulto , Beriberi/complicações , Beriberi/diagnóstico , Feminino , Humanos , Desnutrição/complicações , Pessoa de Meia-Idade , Tiamina/uso terapêutico , Deficiência de Tiamina/complicações
4.
BMJ Case Rep ; 14(3)2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33731408

RESUMO

Thiamine is an essential cofactor in the process of nucleic acid synthesis. Neuronal tissues are especially sensitive to thiamine deficiency, manifesting as Wernicke's encephalopathy (WE). The typical triad of WE, encephalopathy, oculomotor dysfunction and gait ataxia, is only present in less than one-third of the cases. We present the case of a middle-aged man with hypoactive delirium due to presumed thiamine deficiency, who had a prolonged hospital course and a delayed diagnosis of the cause of altered mental status. The presentation of this disorder solely as a decreased level of consciousness is uncommon but has been reported in the literature. It is essential to recognise WE as a treatable condition that may manifest only as a hypoactive delirium. The delay in the diagnosis and treatment may lead to coma and death.


Assuntos
Beriberi , Delírio , Deficiência de Tiamina , Encefalopatia de Wernicke , Delírio/diagnóstico , Delírio/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tiamina/uso terapêutico , Deficiência de Tiamina/complicações , Deficiência de Tiamina/diagnóstico , Deficiência de Tiamina/tratamento farmacológico , Encefalopatia de Wernicke/diagnóstico , Encefalopatia de Wernicke/tratamento farmacológico , Encefalopatia de Wernicke/etiologia
5.
Nutrition ; 84: 111097, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33461052

RESUMO

OBJECTIVES: Thiamine deficiency (TD) is frequently suspected and treated at our hospital. In our retrospective study, we aimed at finding the clinical and laboratory spectrum of infantile TD presenting to a single center over a period of time. METHODS: The diagnosis was made on criterion standard of response to thiamine challenge. RESULTS: TD was suspected in 189 infants at admission; 43 infants were diagnosed as having TD in three distinct forms and a fourth group with mixed presentation. The first group (n = 30), which was the youngest (mean age = 67 d), was always associated with lactic acidosis. They had history of reflux and suddenly became irritable and developed acidotic breathing. This further worsened into shock (46%) and acute respiratory failure (50%). The second group (n = 5) presented with pulmonary arterial hypertension. They had hoarseness of voice and irritability. Chest radiograph showed prominent pulmonary conus. Their clinical course was complicated by congestive heart failure in three. Echocardiographic response to thiamine was uniformly seen within 3 d in this group. The clinical presentation of infants with Wernicke's encephalopathy (n = 5) who were the oldest of all (mean age = 190 d) was constantly marked by presence of bilateral ptosis and encephalopathy preceded by occurrence of vomiting. Their head ultrasonography showed presence of hyperechoic basal ganglia. CONCLUSIONS: Three clinically distinct forms of TD were recognized. Lactic acidosis was a universal finding in acidotic form. Infants with pulmonary hypertension as primary presentation are typically associated with aphonia. Infants with Wernicke's encephalopathy can be clinically diagnosed by presence of encephalopathy and ophthalmic signs (ptosis).


Assuntos
Beriberi , Deficiência de Tiamina , Encefalopatia de Wernicke , Idoso , Beriberi/complicações , Beriberi/diagnóstico , Humanos , Lactente , Estudos Retrospectivos , Tiamina , Deficiência de Tiamina/complicações , Deficiência de Tiamina/diagnóstico
6.
Eat Weight Disord ; 26(2): 729-732, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32130681

RESUMO

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.


Assuntos
Beriberi , Transtornos da Alimentação e da Ingestão de Alimentos , Deficiência de Tiamina , Encefalopatia de Wernicke , Beriberi/complicações , Beriberi/diagnóstico , Beriberi/tratamento farmacológico , Feminino , Humanos , Tiamina/uso terapêutico , Deficiência de Tiamina/complicações , Deficiência de Tiamina/tratamento farmacológico , Encefalopatia de Wernicke/diagnóstico , Encefalopatia de Wernicke/tratamento farmacológico , Encefalopatia de Wernicke/etiologia
7.
Eur J Clin Nutr ; 75(3): 564-566, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32895510

RESUMO

Despite the fact that both thiamine deficiency (TD) and Wernicke encephalopathy (WE) have been observed to some degree in cancer patients, such cases of TD and/or WE reported to date have all been diagnosed after the initiation of treatment. We here report a case of TD that presented without the commonly accepted triad of WE symptoms based on a total nutritional evaluation prior to the onset of treatment for cancer. The patient was a 71-year-old man with esophageal cancer who was referred to the oncology outpatient clinic for evaluation to determine the treatment plan. Although he did not present with delirium, cerebellar signs, or ocular symptoms, TD was suspected based on a reduction in appetite lasting 2 months as thiamine stores in the body are depleted in as few as 18 days. Blood findings showed a marked decline in serum thiamine level supported, which the diagnosis of TD. This case revealed the existence of a cancer patient with subclinical TD prior to the onset of treatment for cancer. Due to the fact that TD can occur without the characteristic symptoms as in this case, we believe it is important that total nutritional evaluation of cancer patients always be considered.


Assuntos
Beriberi , Neoplasias Esofágicas , Deficiência de Tiamina , Encefalopatia de Wernicke , Idoso , Neoplasias Esofágicas/complicações , Humanos , Masculino , Tiamina , Deficiência de Tiamina/complicações , Deficiência de Tiamina/diagnóstico , Deficiência de Tiamina/tratamento farmacológico , Encefalopatia de Wernicke/diagnóstico , Encefalopatia de Wernicke/tratamento farmacológico , Encefalopatia de Wernicke/etiologia
8.
Indian Pediatr ; 57(9): 859-860, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32999118

RESUMO

Twenty eight exclusively breastfed infants presented between 1 July, 2017 and 30 June, 2018 with acute heart failure syndrome, with 23 (92%) showing dramatic clinical resolution of shock within 24 hours of receiving intravenous thiamine (100 mg) bolus. Our findings raise awareness for addressing this neglected nutritional disease in North East India.


Assuntos
Beriberi , Deficiência de Tiamina , Beriberi/tratamento farmacológico , Beriberi/epidemiologia , Aleitamento Materno , Feminino , Humanos , Índia/epidemiologia , Lactente , Tiamina
9.
Am J Trop Med Hyg ; 103(6): 2600-2604, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32996449

RESUMO

Thiamin deficiency, or beriberi, is an increasingly re-recognized cause of morbidity and mortality in the developing world. Thiamin status has traditionally been measured through the erythrocyte activation assay (ETKA) or basal transketolase activity (ETK), which indirectly measure thiamin diphosphate (TDP). Thiamin diphosphate can also be measured directly by high-performance liquid chromatography (HPLC), which may allow a more precise estimation of thiamin status. We compared the direct measurement of TDP by HPLC with basal ETK activity and ETKA in 230 patients with Plasmodium falciparum malaria in rural southern Laos without overt clinical beriberi, as part of a trial of thiamin supplementation. Admission thiamin status measured by basal ETK activity and ETKA (α) were compared with thiamin status assessed by the measurement of TDP by HPLC. 55% of 230 included patients were male, and the median age was 10 (range 0.5-73) years. Using α ≥ 25% as the gold standard of thiamin deficiency, the sensitivity of TDP < 275 ng/gHb as a measure of thiamin deficiency was 68.5% (95% CI: 54.4-80.5%), with specificity of 60.8 (95% CI: 53.2-68.1%). There was a significant inverse correlation between the results of the two tests (Kendall's tau = -0.212, P < 0.001). Basal ETK activity was also significantly positively correlated with TDP levels (Kendall's tau = 0.576, P < 0.001). Thiamin diphosphate measurement may have a role in measuring thiamin levels in clinical settings. Further studies evaluating TDP concentration in erythrocytes with basal ETK activity and ETKA (α) in beriberi patients would help establish comparative values of these assays.


Assuntos
Beriberi/complicações , Cromatografia Líquida de Alta Pressão/métodos , Eritrócitos/enzimologia , Malária Falciparum/complicações , Transcetolase/metabolismo , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Tiamina Pirofosfato/sangue , Adulto Jovem
10.
Nutr Rev ; 78(12): 1015-1029, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-32388553

RESUMO

Beriberi is a nutritional complication of gastric surgery, caused by deficiency of vitamin B1, or thiamine. Thiamine deficiency leads to impaired glucose metabolism, decreased delivery of oxygen by red blood cells, cardiac dysfunction, failure of neurotransmission, and neuronal death. This review describes the history and pathophysiology of beriberi as well as the relationship between beriberi and nutritional deficiencies after gastric surgery. A literature review of the history and pathophysiology of beriberi and the risk factors for thiamine deficiency, particularly after gastric resection or bariatric surgery, was performed. Recommendations for nutritional follow-up post gastric surgery are based on current national guidelines. Patients may have subclinical thiamine deficiency after upper gastrointestinal surgery, and thus beriberi may be precipitated by acute illness such as sepsis or poor dietary intake. This may occur very soon or many years after gastrectomy or bariatric surgery, even in apparently well-nourished patients. Prompt recognition and administration of supplemental thiamine can decrease morbidity and mortality in patients with beriberi. Dietary education post surgery and long-term follow-up to determine nutritional status, including vitamin and mineral assessment, is recommended for patients who undergo gastric surgery.


Assuntos
Beriberi/etiologia , Suplementos Nutricionais , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Estado Nutricional , Estômago/cirurgia , Tiamina/uso terapêutico , Complexo Vitamínico B/uso terapêutico , Cirurgia Bariátrica/efeitos adversos , Beriberi/sangue , Beriberi/fisiopatologia , Beriberi/terapia , Gastrectomia/efeitos adversos , Humanos , Desnutrição , Tiamina/sangue , Deficiência de Tiamina/sangue , Deficiência de Tiamina/etiologia , Deficiência de Tiamina/terapia , Complexo Vitamínico B/sangue
11.
Indian Pediatr ; 57(4): 376-377, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32284488

Assuntos
Beriberi , Humanos
12.
Eur J Clin Nutr ; 74(4): 659-662, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32047291

RESUMO

We described the case of a young man with morbid obesity who underwent bariatric surgery who experiences different complications. After the discharge the patient starts to complain about nausea, dizziness, and visual impairment. After a first access to an emergency department, with a diagnosis of labyrinthopathy, the patient gets worse. He then has been hospitalized and a wernicke's encephalopathy was diagnosed. During the hospitalization other comploication of low thiamine appeared such as wet beriberi. The clinical picture was also complicated with the refeeding syndrome. Wernicke's encephalopathy, wet beriberi, and refeeding syndrome are life-threatening conditions that can be prevented and treated. Both physicians and patients must be warned about these potential risks in order to put in act a prompt treatment.


Assuntos
Beriberi , Laparoscopia , Síndrome da Realimentação , Deficiência de Tiamina , Encefalopatia de Wernicke , Beriberi/diagnóstico , Beriberi/tratamento farmacológico , Beriberi/etiologia , Gastrectomia/efeitos adversos , Humanos , Masculino , Tiamina , Deficiência de Tiamina/diagnóstico , Deficiência de Tiamina/tratamento farmacológico , Deficiência de Tiamina/etiologia , Encefalopatia de Wernicke/diagnóstico , Encefalopatia de Wernicke/tratamento farmacológico , Encefalopatia de Wernicke/etiologia
14.
Intern Med ; 59(3): 373-376, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31534090

RESUMO

A 48-year-old man was brought to our emergency room with acute abdominal pain and systemic edema, indicating acute circulatory failure with lactic acidosis. Furosemide treatment paradoxically worsened the systemic edema and induced confusion. He had no drinking history but hardly ate legumes or meats containing thiamine. Administration of fursultiamine dramatically improved the symptoms and subsequently caused pulmonary edema. Thiamine deficiency may occur in nondrinkers with an unbalanced diet. In this condition, diuretic therapy can worsen the symptoms before thiamine supplementation by promoting the flushing of water-soluble vitamins but is needed for the management of secondary pulmonary edema after thiamine replenishment.


Assuntos
Beriberi/tratamento farmacológico , Fursultiamina/efeitos adversos , Fursultiamina/uso terapêutico , Edema Pulmonar/induzido quimicamente , Edema Pulmonar/tratamento farmacológico , Deficiência de Tiamina/complicações , Deficiência de Tiamina/tratamento farmacológico , Complexo Vitamínico B/uso terapêutico , Beriberi/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Tiamina/uso terapêutico , Resultado do Tratamento
15.
Toxins (Basel) ; 11(11)2019 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-31671523

RESUMO

Citreoviridin (CTV) in an inhibitor of mitochondrial ATPase that has been isolated from molded yellow rice and linked to the human disease Shoshin-kakke (acute cardiac beriberi). The disease results from a deficiency of thiamine, however, purified CTV can reproduce the symptoms in experimental animals. The link between CTV and Shoshin-kakke has been difficult to resolve, in part because cases of the disease are rare. In addition to rice, CTV has been found in maize, pecan nuts, and wheat products. A method to screen for CTV and its geometric isomer, iso-CTV, in commodities was developed, based upon the isolation of two novel monoclonal antibodies (mAb). In an antigen-immobilized competitive enzyme-linked immunosorbent assay format (CI-ELISA), the observed IC50s for CTV were 11 ng/mL and 18 ng/mL (mAbs 2-2 and 2-4, respectively). The assays were relatively tolerant to methanol and acetonitrile, which allowed their application to the detection of CTV in spiked polished white rice. For quantification, a standard mixture of CTV and iso-CTV was used, along with matrix matched calibration. The dynamic range of the ELISA using mAb 2-4 was equivalent to 0.23 to 2.22 mg/kg in rice. Recoveries over the range of 0.36 to 7.23 mg/kg averaged 97 ± 10%. The results suggest that the mAb 2-4-based immunoassay can be applied to the screening of white rice for CTV. Both mAbs were also observed to significantly enhance the fluorescence of the toxin.


Assuntos
Anticorpos Monoclonais/análise , Aurovertinas/análise , Aurovertinas/toxicidade , Beriberi/imunologia , Micotoxinas/análise , Micotoxinas/imunologia , Oryza/microbiologia , Beriberi/fisiopatologia , Ensaio de Imunoadsorção Enzimática/métodos , Imunoensaio/métodos
16.
Eur J Clin Nutr ; 73(12): 1598-1600, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31285553

RESUMO

BACKGROUND/OBJECTIVES: Thiamine deficiency is a treatable disease with an excellent prognosis. However, it is often unrecognized because of the diversity of its clinical presentations. SUBJECTS/METHODS: Herein, we report two atypical cases of nonalcoholic thiamine deficiency that presented with refractory hypotension in the absence of lactic acidosis. RESULTS: Case 1 developed recurrent hypotension, right-sided heart failure, and a classic triad of Wernicke's encephalopathy (WE) after gastrointestinal surgery. Case 2 had decreased dietary intake and diuretic abuse, and had multiple episodes of syncope prior to present admission with refractory hypotension and mental status changes. The diagnosis of both cases was confirmed by undetectable pretreatment serum thiamine and dramatic improvement with thiamine replacement. CONCLUSIONS: In this report, we highlight refractory hypotension as a complication of, not only cardiovascular, but also neurologic beriberi. Moreover, thiamine replacement should be considered without delay in hypotensive patients with signs of WE and/or risk factors for beriberi.


Assuntos
Beriberi , Hipotensão/etiologia , Idoso , Beriberi/complicações , Beriberi/diagnóstico , Beriberi/patologia , Beriberi/fisiopatologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Encefalopatia de Wernicke/etiologia
17.
Int J Vitam Nutr Res ; 89(5-6): 225-226, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31066645

RESUMO

The history of the discovery of vitamins was the history of their deficiency disorders. Casimir Funk, the father of vitaminic therapy, studied the interrelationships in the human body of those elements that Christiaan Eijkman demonstrated in animals, particularly birds. In 1911, he designated these factors vitamins (vita = life and amine, a nitrogenous substance essential for life); this name was accepted by the scientific community in 1912. Here, we intend to give an illustrative view on the early days of vitamin research as carried out by Casimir Funk.


Assuntos
Beriberi , Escorbuto , Animais , Ácido Ascórbico , Humanos , Vitamina A , Vitaminas
18.
Pediatr Transplant ; 23(5): e13493, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31124207

RESUMO

Pediatric kidney transplant surgery is usually well tolerated, despite suboptimal physical conditioning that may result from uremia and nutritional deficiencies that accompany end-stage kidney failure. Nutritional supplementation is used to overcome such deficiencies, especially for children needing dialysis. Thiamine, a water-soluble vitamin also known as vitamin B1, is a critical cofactor in energy metabolism and may be competitively inhibited by the antimetabolite oxythiamine, a uremic toxin that accumulates in kidney failure. We report a case of a thiamine deficiency syndrome leading to overwhelming cardiac dysfunction, metabolic instability, and hemodynamic compromise, after otherwise uneventful kidney transplant surgery. Prior to transplant, this 14-year-old boy was treated with peritoneal dialysis and received thiamine supplementation. Post-transplant, the patient first developed hyperglycemia, then lactic acidosis, and subsequently hemodynamic instability despite escalating treatment with volume resuscitation and inotropic medication. He made a rapid and complete recovery after administration of IV thiamine. This is the first reported case of Shoshin beriberi syndrome in a pediatric kidney transplant recipient. Inadequate dialysis may have been a key factor, with toxin accumulation and thiamine transporter downregulation contributing to his status. Functional thiamine deficiency should be considered as a potential treatable cause of early post-transplant hemodynamic instability.


Assuntos
Beriberi/tratamento farmacológico , Beriberi/etiologia , Transplante de Rim , Deficiência de Tiamina/tratamento farmacológico , Adolescente , Hemodinâmica , Humanos , Masculino , Diálise Peritoneal , Deficiência de Tiamina/etiologia
19.
J Peripher Nerv Syst ; 24(1): 162-163, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30873682

Assuntos
Beriberi , Humanos
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