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Mizuguchi Y, Mouri H, Jo T, Hashimoto Y, Matsui H, Fushimi K, Yasunaga H, Taniguchi T. Clinical Features and Outcomes of Shoshin Beriberi. Int Heart J 2024; 65:271-278. [PMID: 38479848 DOI: 10.1536/ihj.23-459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
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.
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Affiliation(s)
- Yoshiki Mizuguchi
- Department of Anesthesiology and Intensive Care Medicine, Kanazawa University
| | - Hideyuki Mouri
- Department of Anesthesiology and Intensive Care Medicine, Kanazawa University
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo
- Department of Respiratory Medicine, The University of Tokyo Hospital
| | - Yohei Hashimoto
- Save Sight Institute, The University of Sydney, South Block, Sydney Eye Hospital
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine and Dental Science
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Takumi Taniguchi
- Department of Anesthesiology and Intensive Care Medicine, Kanazawa University
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Agedal KJ, Steidl KE, Burgess JL. An Overview of Type B Lactic Acidosis Due to Thiamine (B1) Deficiency. J Pediatr Pharmacol Ther 2023; 28:397-408. [PMID: 38130495 PMCID: PMC10731935 DOI: 10.5863/1551-6776-28.5.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/08/2022] [Indexed: 12/23/2023]
Abstract
Type B lactic acidosis can occur secondary to several factors, including thiamine deficiency, and is not as common as type A. Recognizing thiamine deficiency-associated lactic acidosis is challenging because serum thiamine concentrations are not routinely obtained, and a thorough and specific history is necessary for clinicians to suspect thiamine deficiency as a root cause. Furthermore, the appropriate dose and duration of thiamine treatment are not well defined. Untreated thiamine deficiency-associated lactic acidosis can lead to critical illness requiring lifesaving extracorporeal therapies. Additionally, if thiamine and glucose are not administered in an appropriate sequence, Wernicke encephalopathy or Korsakoff syndrome may occur. This review aims to summarize therapeutic treatment for thiamine deficiency-associated lactic acidosis, based on case reports/series and nutritional guidance. After a literature search of the PubMed database, 63 citations met inclusion criteria, of which 21 involved pediatric patients and are the focus of this review. -Citations describe dosing regimens ranging from 25 to 1000 mg of intravenous (IV) thiamine as a single dose, or multiple daily doses for several days. Specific guidance for critically ill adults recommends a thiamine range of 100 mg IV once daily to 400 mg IV twice daily. Although there are no specific recommendations for the pediatric population, given the relative safety of thiamine administration, its low cost, and our review of the literature, treatment with thiamine 100 to 200 mg IV at least once is supported, with ongoing daily doses based on clinical response of the patient, regardless of age.
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Affiliation(s)
- Kaitlyn J. Agedal
- Department of Pharmacy (KJA, KES, JLB), SUNY Upstate University Hospital, Syracuse, NY
| | - Kelly E. Steidl
- Department of Pharmacy (KJA, KES, JLB), SUNY Upstate University Hospital, Syracuse, NY
- Department of Pediatrics (KES), SUNY Upstate Medical University, Syracuse, NY
| | - Jeni L. Burgess
- Department of Pharmacy (KJA, KES, JLB), SUNY Upstate University Hospital, Syracuse, NY
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Vitamin B1 Deficiency and Perimyocarditis Fulminans: A Case Study of Shoshin Syndrome in a Woman Following an Unbalanced Dietary Pattern Followed by a Literature Review. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010205. [PMID: 36676154 PMCID: PMC9864204 DOI: 10.3390/life13010205] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/07/2023] [Accepted: 01/08/2023] [Indexed: 01/12/2023]
Abstract
(1) Background: vitamin B1 level depletion, known as a beriberi syndrome, can lead to severe cardiovascular complications, from which perimyocarditis fulminans is one of the most severe. (2) Methods: this is a retrospective case study that includes an adult patient with clinical presentations of acute heart failure (HF) symptoms following perimyocarditis on the grounds of thiamine deficiency. (3) Results: A 49-year-old woman presented with acute HF symptoms due to perimyocarditis. The patient suddenly developed refractory cardiogenic shock with metabolic acidosis requiring maximal medical management, including an intra-aortic balloon pump and extracorporeal membrane oxygenation. Due to additional peripheral polyneuropathy, beriberi disease was suspected after excluding other possible causes of the patient's condition. After administration of vitamin B1, clinical improvement in the patient's condition and the resolution of metabolic abnormalities were observed, which ultimately confirmed the diagnosis of Shoshin syndrome caused by the implementation of a gluten-free diet without indications for its adherence. (4) Conclusions: Fulminant beriberi disease, although considered rare, is a life-threatening condition and should always be included in the differential diagnosis of critically ill patients, notably those with malnutrition. An unbalanced diet can be detrimental and have severe consequences, i.e., perimyocarditis fulminans. However, treatment with thiamine can significantly improve the patient's cardiac function and restore hemodynamic and metabolic parameters.
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Kirty K, Sarda Y, Jacob A, Venugopala D. Wernicke's encephalopathy post hyperemesis gravidarum misdiagnosed as Guillain-Barre syndrome: lessons for the frontline. BMJ Case Rep 2021; 14:14/3/e239977. [PMID: 33727293 PMCID: PMC7970206 DOI: 10.1136/bcr-2020-239977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of a 26-year-old pregnant woman, who presented with subacute limb weakness. This was initially suspected to be Guillain-Barre syndrome but subsequently found to be the motor neuropathy of dry beriberi (vitamin B1, thiamine deficiency) along with associated Wernicke's encephalopathy (WE). The underlying cause was revealed as hyperemesis gravidarum (HG). HG complicates up to 3% of pregnancies and if severe, without nutritional supplements, may lead to electrolyte disturbances, calorie loss and vitamin deficiency. Although the association of HG and WE was first reported in 1939, it remains an under diagnosed condition with potential for serious and permanent neurological deficits, and some mortality, in both mother and baby. Early recognition of the problem, with timely and careful fluid, electrolyte, glucose and vitamin replacement is needed to avoid complications. We highlight current best practice in the treatment of WE. An open mind to the possibility of HG complications in any pregnant woman presenting with neurological symptoms is probably the most important lesson to learn from the front line.
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Affiliation(s)
- Kaushiki Kirty
- Internal Medicine, Kasturba Medical College Mangalore, Mangalore, India
| | - Yashendu Sarda
- Internal Medicine, Kasturba Medical College Mangalore, Mangalore, India
| | - Annu Jacob
- Medicine, Kasturba Medical College Mangalore, Mangalore, India
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Imamura T, Kinugawa K. Shoshin Beriberi With Low Cardiac Output and Hemodynamic Deterioration Treated Dramatically by Thiamine Administration. Int Heart J 2015; 56:568-70. [PMID: 26346515 DOI: 10.1536/ihj.15-033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
"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.
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Affiliation(s)
- Teruhiko Imamura
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
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6
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Basiri B, Sutton JM, Hanberry BS, Zastre JA, Bartlett MG. Ion pair liquid chromatography method for the determination of thiamine (vitamin B1) homeostasis. Biomed Chromatogr 2015; 30:35-41. [DOI: 10.1002/bmc.3544] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 06/11/2015] [Accepted: 06/19/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Babak Basiri
- Department of Pharmaceutical and Biomedical Sciences; The University of Georgia College of Pharmacy; 250 W. Green Street Athens GA 30602-2352 USA
| | - James Michael Sutton
- Department of Pharmaceutical and Biomedical Sciences; The University of Georgia College of Pharmacy; 250 W. Green Street Athens GA 30602-2352 USA
| | - Bradley S. Hanberry
- Department of Pharmaceutical and Biomedical Sciences; The University of Georgia College of Pharmacy; 250 W. Green Street Athens GA 30602-2352 USA
| | - Jason A. Zastre
- Department of Pharmaceutical and Biomedical Sciences; The University of Georgia College of Pharmacy; 250 W. Green Street Athens GA 30602-2352 USA
| | - Michael G. Bartlett
- Department of Pharmaceutical and Biomedical Sciences; The University of Georgia College of Pharmacy; 250 W. Green Street Athens GA 30602-2352 USA
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Abstract
One of the earliest vitamins to be discovered and synthesized, thiamin was originally spelled with an "e". The terminal "e" was dropped when it was found that it was not an amine. It is still spelled with and without the "e" depending on the text. This chapter provides a brief historical review of the association of thiamin with the ancient scourge of beriberi. It emphasizes that beriberi is the model for high calorie malnutrition because of its occurrence in predominantly white rice consuming cultures. Some of the symptomatology of this ancient scourge is described, emphasizing the difference from that seen in starvation. High calorie malnutrition, due to excessive ingestion of simple carbohydrates, is widely encountered in the U.S.A. today. Thiamin deficiency is commonly associated with this, largely because of its cofactor status in the metabolism of glucose. The biochemistry of the three phosphorylated esters of thiamin and the transporters are discussed and the pathophysiology of thiamin deficiency reviewed. The role of thiamin, and particularly its synthetic derivatives as therapeutic agents, is not fully appreciated in Western civilization and a clinical section describes some of the unusual cases described in the scientific literature and some experienced by the author. The possible role of high calorie malnutrition and related thiamin deficiency in juvenile crime is hypothesized.
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Loma-Osorio P, Peñafiel P, Doltra A, Sionis A, Bosch X. Shoshin Beriberi Mimicking a High-risk Non-ST-Segment Elevation Acute Coronary Syndrome with Cardiogenic Shock: When the Arteries are Not Guilty. J Emerg Med 2011; 41:e73-7. [DOI: 10.1016/j.jemermed.2008.03.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Revised: 01/18/2008] [Accepted: 03/17/2008] [Indexed: 11/30/2022]
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Essa E, Velez MR, Smith S, Giri S, Raman SV, Gumina RJ. Cardiovascular magnetic resonance in wet beriberi. J Cardiovasc Magn Reson 2011; 13:41. [PMID: 21838901 PMCID: PMC3175447 DOI: 10.1186/1532-429x-13-41] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 08/12/2011] [Indexed: 11/23/2022] Open
Abstract
The clinical presentation of beriberi can be quite varied. In the extreme form, profound cardiovascular involvement leads to circulatory collapse and death. This case report is of a 72 year-old male who was admitted to the Neurology inpatient ward with progressive bilateral lower extremity weakness and parasthesia. He subsequently developed pulmonary edema and high output cardiac failure requiring intubation and blood pressure support. With the constellation of peripheral neuropathy, encephalopathy, ophthalmoplegia, unexplained heart failure, and lactic acidosis, thiamine deficiency was suspected. He was empirically initiated on thiamine replacement therapy and his thiamine level pre-therapy was found to be 23 nmol/L (Normal: 80-150 nmol/L), consistent with the diagnosis of beriberi. Cardiovascular magnetic resonance (CMR) showed severe left ventricular systolic dysfunction, markedly increased myocardial T2, and minimal late gadolinium enhancement (LGE). After 5 days of daily 100 mg IV thiamine and supportive care, the hypotension resolved and the patient was extubated and was released from the hospital 3 weeks later. Our case shows via CMR profound myocardial edema associated with wet beriberi.
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Affiliation(s)
- Essa Essa
- Division of Cardiovascular Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
- Department of Internal Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
| | - Michael R Velez
- Department of Internal Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
| | - Sakima Smith
- Division of Cardiovascular Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
- Department of Internal Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
| | - Shivraman Giri
- Division of Cardiovascular Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
- Department of Internal Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
| | - Subha V Raman
- Division of Cardiovascular Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
- Department of Internal Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
| | - Richard J Gumina
- Division of Cardiovascular Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
- Department of Internal Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
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10
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Abstract
We report a case of a 58-year-old man with Shoshin beriberi who demonstrated ST-segment elevation and myocardial damage without coronary artery stenosis. The patient subsequently recovered with thiamine treatment. We conclude that it is important to consider Shoshin beriberi as part of the differential diagnosis in patients with shock and ST-segment elevation.
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Affiliation(s)
- Hiroaki Kawano
- Department of Cardiovascular Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto
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11
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Aguiar AC, Costa VM, Ragazzo PC, Caiado RR, Gusmão CA, Melo-Souza SED. Mielinólise pontina e extra-pontina associada a Shoshin beribéri em paciente etilista. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:733-6. [PMID: 15334241 DOI: 10.1590/s0004-282x2004000400032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A mielinólise pontina está classicamente associada à rápida correção de hiponatremia crônica. Recentemente, fatores importantes adicionais tem sido descritos na patogênese dessa condição. Relatamos o caso de um paciente de 43 anos, etilista, desnutrido, que apresentou quadro agudo de insuficiência cardíaca por "Shoshin beribéri", insuficiência renal com tratamento por diálise. Evoluiu com tetraparesia e coma. Apresentou mielinólise pontina central e extra-pontina à ressonância magnética de crânio e anormalidades no potencial evocado auditivo.
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12
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Betrosian AP, Thireos E, Toutouzas K, Zabaras P, Papadimitriou K, Sevastos N. Occidental beriberi and sudden death. Am J Med Sci 2004; 327:250-2. [PMID: 15166742 DOI: 10.1097/00000441-200405000-00020] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Beriberi, thiamine deficiency, is classified as "dry" (neurologic) or "wet" (cardiovascular) and may be mixed. Deficiency of this vitamin may be nutritional or secondary to alcohol intoxication. In Western societies (occidental beriberi), the disorder is more commonly observed in long-term alcohol abusers. However, it may go undiagnosed because it is relatively uncommon. In some cases (acute cardiovascular beriberi), early treatment with parenteral vitamin B1 is required to prevent the development of low-output state and sudden death. We report a case of occidental beriberi with fatal outcome despite therapy.
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Affiliation(s)
- Alex P Betrosian
- Intensive Care Unit, Hippokration General Hospital, Athens University, Athens, Greece.
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13
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Chen KT, Twu SJ, Chiou ST, Pan WH, Chang HJ, Serdula MK. Outbreak of beriberi among illegal mainland Chinese immigrants at a detention center in Taiwan. Public Health Rep 2003. [PMID: 12604765 DOI: 10.1016/s0033-3549(04)50217-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The authors describe an outbreak of beriberi in a detention center in Taiwan and examine risk factors for illness. METHODS A survey was conducted among a sample of 176 randomly selected detainees. A menu-assisted dietary recall method was used to obtain diet information from nine hospitalized detainees. A probable case patient was defined as an individual who had at least two of the following characteristics: leg edema, weakness of the extremities, poor appetite, and dyspnea. Possible case patients were those who had only one of these characteristics. RESULTS Of the 176 survey respondents, 19% were classified as probable case patients and 40% as possible case patients. The mortality rate based on probable cases was 1.1%. Body Mass Index (BMI) was negatively associated with illness (p < 0.0001), and length of stay in the detention center was independently positively associated with illness (p < 0.05). The average intake of dietary thiamine among the nine hospitalized case patients who completed three-day dietary recall surveys was 0.49 +/- 0.1 mg/day. After thiamine administration, all symptoms and signs of beriberi resolved. CONCLUSION This outbreak is a reminder of the importance of ensuring adequate diets for poor, institutionalized, or refugee populations who are unable to supplement their diets.
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Affiliation(s)
- Kow-Tong Chen
- Field Epidemiology Training Program, Center for Disease Control, Department of Health, Taiwan, Republic of China
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14
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Tallaksen CM, Taubøll E. Excitatory effect of thiamin on CA1 pyramidal neurones in rat hippocampal slices in vitro. Eur J Neurol 2000; 7:693-8. [PMID: 11136357 DOI: 10.1046/j.1468-1331.2000.00132.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinically, acute thiamin deficiency may lead to Wernicke encephalopathy and fulminant cardial beriberi. Both diseases respond to high parenteral doses of thiamin. The cofactor role of intracellular thiamin diphosphate has been thoroughly investigated, but an additional acute effect of unphosphorylated extracellular thiamin has been postulated but not elucidated. In order to investigate the role of thiamin at the membrane level in the central nervous system, a study using a well-established in vitro rat hippocampal slice model was designed. Hippocampal slices were perfused with 0.5, 0.75 and 1 mM thiamin solutions for 30 min and the pre-synaptic volley, field excitatory post-synaptic potential and population spike amplitudes were recorded continuously. The results showed an acute, excitatory effect of high-dose thiamin on hippocampal neurones by significantly increasing the number of repetitive afterdischarges. Additional experiments with low concentrations of the potassium channel blocker 4-aminopyridine showed similar findings. The results support previous evidence of thiamin affecting membrane ion channel activity, probably involving potassium channels, although the precise mechanisms of action are still unclear.
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Affiliation(s)
- C M Tallaksen
- Department of Neurology, Rikshospitalet, The National Hospital, 0027 Oslo, Norway
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Hurreesing C, Babuty D, Fauchier L, d'Alteroche L, Montout M, Poret P, Cosnay P. [Pericardial extravasation as an indicator of congestive heart failure due to thiamine deficiency in a young adult]. Rev Med Interne 2000; 21:993-7. [PMID: 11109597 DOI: 10.1016/s0248-8663(00)00256-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Thiamine (B1) deficiency is one of the classical causes of congestive heart failure. Although in the western world and in other developed regions this disorder is generally associated with chronic alcoholism, it may also only occur as a result of a deficient diet. EXEGESIS A young patient was admitted for electrocardiographic examination, and pericardial extravasation was recorded. The etiological assessment showed a case of congestive heart failure due to thiamine (B1) deficiency. A hemodynamic examination and investigation of thiamine blood levels confirmed this diagnosis. The patient's health status improved following thiamine administration, with complete and rapid regression of symptoms of congestive heart failure. CONCLUSION Although cardiomyopathic beriberi is infrequent, it should systematically be taken into account in the etiology of congestive heart failure. The present study also notes that a dietary thiamine deficiency is uncommon, but should nevertheless be considered when other symptoms of denutrition are present.
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Affiliation(s)
- C Hurreesing
- Service de cardiologie B, hôpital Trousseau, Tours, France
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16
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Abstract
Despite modern pharmacologic agents in the therapy of heart failure, the prevalence of heart failure is increasing worldwide. In the vitamin B1 deficiency disease beriberi, cardiac symptoms may represent the central feature. Two new studies confirmed that all diuretics lead to increased urinary thiamin excretion depending on the urinary flow rate. In a subject at risk, such as an elderly patient, chronic diuretic treatment may lead to a subclinical thiamin deficiency. Whether subclinical thiamin nutriture is a modulator of the prevalence and/or severity of heart failure is not known; however, it seems to be plausible from the metabolic point of view.
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Affiliation(s)
- P M Suter
- Medical Policlinic, University Hospital, Zürich, Switzerland
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17
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Abstract
High-performance liquid chromatographic methods for the determination of thiamine (vitamin B1) in foodstuffs or biological tissues and fluids are outlined and discussed. The methods are often similar and interchangeable, sample extraction and clean up procedures being the major difference. Most of the methods use either ultraviolet or fluorescence detection. Fluorescence detection requires either precolumn or postcolumn oxidation of thiamine to thiochrome. A number of methods are recommended and problems with standardization are emphasized.
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Affiliation(s)
- P L Lynch
- Department of Clinical Chemistry, Altnagelvin Area Hospital, Londonderry, Northern Ireland, UK
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18
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Abstract
A case of acute fulminant cardiovascular beriberi, or "shoshin beriberi," is presented. Beriberi is classified as "dry" (neurologic) or "wet" (cardiovascular) and may be mixed. "Wet" beriberi refers to a spectrum of clinical manifestations ranging from a hyperdynamic state with high output cardiac failure to fulminant failure with collapsed peripheral circulation, lactic acidosis, and shock. Beriberi is probably much more common than previously recognized. Beriberi is caused by thiamine deficiency and should be suspected in alcoholics who present with unexplained lactic acidosis, a hyperdynamic state, high output cardiac failure, or cardiogenic shock without electrocardiographic (EKG) evidence of myocardial necrosis. Shoshin beriberi is rapidly fatal without immediate treatment with thiamine.
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Affiliation(s)
- S W Smith
- Department of Emergency Medicine, University of Minnesota School of Medicine, Hennepin County Medical Center, Minneapolis 55415, USA
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19
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Madl C, Kranz A, Liebisch B, Traindl O, Lenz K, Druml W. Lactic acidosis in thiamine deficiency. Clin Nutr 1993; 12:108-11. [PMID: 16843296 DOI: 10.1016/0261-5614(93)90060-h] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/1992] [Accepted: 12/16/1992] [Indexed: 10/26/2022]
Abstract
Two chronically ill patients with limited nutritional intake during several weeks developed prolonged lactic acidosis. As no other causes of hyperlactaemia could be identified, thiamine deficiency was suspected. Supplementation of 600 mg thiamine resulted in a rapid normalisation of serum lactate levels (in patient 1 from 10.9-2.4 mmol/l; in patient 2 from 11.8-2.0 mmol/l) and acid base status (patient 1: pH from 7.11-7.30, bicarbonate from 8.6-21.2 mmol/l; patient 2: pH from 7.24-7.46, bicarbonate from 16-28 mmol/l; before and after treatment, respectively). Thiamine deficiency was confirmed by the degree of stimulation of erythrocyte transketolase activation by adding thiamine pyrophosphate, evaluated before and after thiamine replacement therapy. Stimulation decreased in patient 1 from 170% to 17% and in patient 2 from 20% to 0%, respectively. In addition to the metabolic derangement right ventricular heart failure was confirmed by echocardiography in both patients and again this was rapidly reversible by thiamine supplementation. We conclude that in malnourished patients unexplained prolonged lactic acidosis may result from thiamine deficiency, which is rapidly reversible by thiamine replacement therapy.
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Affiliation(s)
- C Madl
- Department of Medicine IV University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
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20
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Tallaksen CM, Sande A, Bøhmer T, Bell H, Karlsen J. Kinetics of thiamin and thiamin phosphate esters in human blood, plasma and urine after 50 mg intravenously or orally. Eur J Clin Pharmacol 1993; 44:73-8. [PMID: 8436160 DOI: 10.1007/bf00315284] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The concentrations of thiamin and thiamin monophosphate and diphosphate in plasma and whole blood samples were assessed in six healthy subjects for 12 h and in urine for 24 h following an IV and PO bolus dose of 50 mg thiamin HCl. Unphosphorylated thiamin increased rapidly in plasma after IV administration and then decreased to its initial value within 12 h in all but one subject; the half-life was 96 min. Thiamin mono and -diphosphate increased moderately (56%), and decreased slowly; the half-life of diphosphate was 664 min. Within 24 h, 53% of the administered dose was recovered in the urine, indicating a restricted distribution. After oral administration, the peak thiamin concentration in plasma was reached after 53 min and the concentration then had increased to 179% of its initial value. The elimination half-life was 154 min, and only 2.5% of the given dose was recovered in the urine. The relative bioavailability of thiamin was 5.3%. A moderate amount of the administered thiamin was stored in blood. Other body tissues must play an important part, therefore, in the distribution of thiamin.
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Affiliation(s)
- C M Tallaksen
- Medical Department, Aker University Hospital, Norway
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Abstract
The classical form of thiamine deficiency in children is comprised of peripheral neuropathy, encephalopathy and high-output cardiac failure, predominantly right-sided. "Shoshin beriberi" cardiac failure has a different presentation, with vasoconstriction, hypotension and severe metabolic acidosis. A three-month breast-fed infant developed these features (biochemical tests confirmed the diagnosis). His mother, although non-symptomatic, had biochemical evidence of thiamine deficiency.
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Affiliation(s)
- P J Debuse
- Paediatric Intensive Care Unit, Royal Children's Hospital, Brisbane, Australia
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