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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nisar S, Yousuf Wani I, Altaf U, Muzaffer U, Kareem O, Tanvir M, Ganie MA. Thiamine deficiency-related neuropathy: A reversible entity from an endemic area. Eur J Neurol 2024; 31:e16155. [PMID: 38018774 DOI: 10.1111/ene.16155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/09/2023] [Accepted: 10/31/2023] [Indexed: 11/30/2023]
Abstract
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.
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Affiliation(s)
- Sobia Nisar
- Department of Medicine, Government Medical College and Associated SMHS Hospital Srinagar, Srinagar, India
| | | | - Umair Altaf
- Department of Medicine, Government Medical College and Associated SMHS Hospital Srinagar, Srinagar, India
| | - Umar Muzaffer
- Department of Medicine, Government Medical College and Associated SMHS Hospital Srinagar, Srinagar, India
| | - Ozaifa Kareem
- Department of Pharmaceutical Sciences, University of Kashmir, Srinagar, India
| | - Masood Tanvir
- Department of Medicine, Government Medical College, Srinagar, India
| | - Mohd Ashraf Ganie
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
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Ibrahim T, El Ansari W, Abusabeib A, Yousaf Z, Elhag W. Infrequent but serious? Beriberi And Thiamine deficiency among adolescents and young adults after bariatric surgery. Surg Obes Relat Dis 2024; 20:115-126. [PMID: 37620168 DOI: 10.1016/j.soard.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 08/26/2023]
Abstract
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.
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Affiliation(s)
- Tawheeda Ibrahim
- Department of Bariatric Surgery/Bariatric Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; Weill Cornell Medicine - Qatar, Doha, Qatar.
| | - Alyaa Abusabeib
- Department of Bariatric Surgery/Bariatric Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Zohaib Yousaf
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Wahiba Elhag
- Department of Bariatric Surgery/Bariatric Medicine, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine - Qatar, Doha, Qatar
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Nisar S, Kareem O, Muzaffer U, Tanvir M, Ganaie MA, Ahmed RN. Descriptive spectrum of thiamine deficiency in pregnancy: A potentially preventable condition. Int J Gynaecol Obstet 2024; 164:157-165. [PMID: 37458305 DOI: 10.1002/ijgo.14989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 12/18/2023]
Abstract
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.
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Affiliation(s)
- Sobia Nisar
- Department of Medicine, Government Medical College, Srinagar, India
| | - Ozaifa Kareem
- Department of Pharmaceutical Sciences, University of Kashmir, Srinagar, India
| | - Umar Muzaffer
- Department of Medicine, Government Medical College, Srinagar, India
| | - Masood Tanvir
- Department of Medicine, Government Medical College, Srinagar, India
| | - Mohd Ashraf Ganaie
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
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Kshirsagar SJ, Kute S, Bhalerao PM. Anaesthesia and intensive care management of shoshin beriberi in perioperative period in young adult. Ann Card Anaesth 2023; 26:318-320. [PMID: 37470531 PMCID: PMC10451140 DOI: 10.4103/aca.aca_133_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/26/2022] [Accepted: 10/18/2022] [Indexed: 07/21/2023] Open
Abstract
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.
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Affiliation(s)
- Sujit J. Kshirsagar
- Department of Anaesthesiology, B. J. Government Medical College, Pune, Maharashtra, India
| | - Shivaji Kute
- Department of Anaesthesiology, B. J. Government Medical College, Pune, Maharashtra, India
| | - Pradnya M. Bhalerao
- Department of Anaesthesiology, B. J. Government Medical College, Pune, Maharashtra, India
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Nisar S, Mohi-U-Din K, Tak SI, Andrabi SMA, Tanvir M, Muzaffer U, Kareem O, Ganie MA. Thiamine responsive high output heart failure of adults: an under-recognized entity. Eur J Clin Nutr 2023; 77:757-760. [PMID: 36859659 DOI: 10.1038/s41430-023-01279-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/24/2023] [Accepted: 02/09/2023] [Indexed: 03/03/2023]
Abstract
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.
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Affiliation(s)
- Sobia Nisar
- Department of Medicine, GMC and Associated SMHS Hospital Srinagar, Srinagar, Jammu and Kashmir, India.
| | - Khalid Mohi-U-Din
- Department of Cardiology, GMC and Associated SMHS Hospital Srinagar, Srinagar, Jammu and Kashmir, India
| | - Shahid Iqbal Tak
- Department of Cardiology, GMC and Associated SMHS Hospital Srinagar, Srinagar, Jammu and Kashmir, India
| | - Syed Manzoor Ali Andrabi
- Department of Cardiology, GMC and Associated SMHS Hospital Srinagar, Srinagar, Jammu and Kashmir, India
| | - Masood Tanvir
- Department of Medicine, GMC and Associated SMHS Hospital Srinagar, Srinagar, Jammu and Kashmir, India
| | - Umar Muzaffer
- Department of Medicine, GMC and Associated SMHS Hospital Srinagar, Srinagar, Jammu and Kashmir, India
| | - Ozaifa Kareem
- Department of Pharmaceutical Sciences, University of Kashmir, Srinagar, Jammu and Kashmir, India
| | - Mohd Ashraf Ganie
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
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7
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Ma T, Xu J, Xing W. Raise vigilance against refractory distributive shock due to severe wet beriberi. Am J Med Sci 2023; 365:396-400. [PMID: 36535540 DOI: 10.1016/j.amjms.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/05/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- Tianliang Ma
- Department of Intensive Care Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China; Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China; Hunan Engineering Research Center of Biomedical Metal and Ceramic Impants, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Jiaqi Xu
- Department of Intensive Care Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China; Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China; Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, China
| | - Wei Xing
- Department of Intensive Care Medicine, Third Xiangya Hospital, Central South University, Changsha 410013, China; Sepsis Translational Medicine Key Laboratory of Hunan Province, Central South University, Changsha, Hunan 410078, China.
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8
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Martins Carvalho M, Proença T, Alves Pinto R, Pinto R, Macedo F. Wernicke encephalopathy and beriberi disease presenting as STEMI-equivalent. Monaldi Arch Chest Dis 2023; 93. [PMID: 36806824 DOI: 10.4081/monaldi.2023.2513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/02/2023] [Indexed: 02/23/2023] Open
Abstract
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.
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Affiliation(s)
- Miguel Martins Carvalho
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto; Cardiovascular R&D Center, Faculty of Medicine, University of Porto.
| | - Tânia Proença
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto.
| | - Ricardo Alves Pinto
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto.
| | - Roberto Pinto
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto.
| | - Filipe Macedo
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto; Cardiovascular R&D Center, Faculty of Medicine, University of Porto.
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Govind K, Gaskin GL, Naidoo DP. Resurgence of Shoshin beriberi during the COVID-19 pandemic. Cardiovasc J Afr 2023; 34:40-43. [PMID: 36472624 PMCID: PMC10392798 DOI: 10.5830/cvja-2021-051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/09/2021] [Indexed: 06/07/2023] Open
Abstract
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.
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Affiliation(s)
- K Govind
- Department of Internal Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - G L Gaskin
- Department of Internal Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - D P Naidoo
- Department of Cardiology, University of KwaZulu-Natal, Durban, South Africa.
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Abstract
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.
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Affiliation(s)
- Sabrina Silhadi
- Service de médecine interne générale, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Simon Édouard Pinaud
- Service de médecine interne générale, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Mathieu Nendaz
- Service de médecine interne générale, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Jérôme Stirnemann
- Service de médecine interne générale, Hôpitaux universitaires de Genève, 1211 Genève 14
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Abstract
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.
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Affiliation(s)
| | - Hideo Tsushima
- Department of Nephrology, Saiseikai Suita Hospital, Japan
| | - Naoki Kachi
- Department of Nephrology, Saiseikai Suita Hospital, Japan
| | - Fumie Jimura
- Department of Nephrology, Saiseikai Suita Hospital, Japan
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Tallaksen C, Narverud SF. Shoshin beriberi. Tidsskr Nor Laegeforen 2021; 141:21-0215. [PMID: 33876616 DOI: 10.4045/tidsskr.21.0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Samprathi M, Mohammad F, M S, Ramachandra P, Vemgal P. Case Report: Fulminant Infantile Beriberi: A Report of Six Cases. Am J Trop Med Hyg 2021; 104:2238-2240. [PMID: 33872213 DOI: 10.4269/ajtmh.20-0881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 03/03/2021] [Indexed: 11/07/2022] Open
Abstract
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.
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Abstract
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.
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Affiliation(s)
| | | | - Yuriko Ishida
- Department of Internal Medicine, Tomakomai City Hospital, Japan
| | - Tetsuya Horita
- Department of Internal Medicine, Tomakomai City Hospital, Japan
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15
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Abstract
RATIONALE Circulatory failure, especially with low systemic vascular resistance (SVR), as observed in septic shock, thyrotoxicosis, and anemia, is a particular pattern that should suggest thiamine (vitamin B1) deficiency. The clinical picture of wet beriberi secondary to thiamine deficiency only demonstrates non-specific clinical manifestations. For a diagnosis of wet beriberi, medical history is very important. Interestingly, imprisonment was also found to be related to thiamine deficiency. This article presents a rare case of wet beriberi associated with multiple organ failure (MOF) in a prison patient with years of heavy alcohol consumption. PATIENT CONCERNS The patient reported repetitive symptoms of nausea, vomiting, respiratory distress, and palpitations for a period of 1 month; dyspnea and edema for 5 days; and decreased blood pressure and urine volume for 2 days. DIAGNOSES The heart failure patient had a history of dietary deficiency. Right heart catheterization showed high cardiac output (CO) and low SVR. Measurement of serum thiamine concentration was low. The most important factor was that the hemodynamic indices were remarkably reversed by thiamine administration. INTERVENTIONS The patient started treatment with thiamine (100 mg) by intramuscular injection, together with basic supportive care. OUTCOMES The hemodynamic indices improved within 12 hours after thiamine administration. Echocardiographic examinations revealed right ventricular function improvement within a few days, which were normal within a month. LESSONS A diagnosis of wet beriberi should be considered for a prison patient who has unexplained heart failure, lactic acidosis, and/or MOF. Moreover, the patient should be empirically given thiamine administration without delay.
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Affiliation(s)
| | | | | | | | - Yingru Lu
- Department of Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Tanabe N, Hiraoka E, Kataoka J, Naito T, Matsumoto K, Arai J, Norisue Y. Wet Beriberi Associated with Hikikomori Syndrome. J Gen Intern Med 2018; 33:384-387. [PMID: 29188542 PMCID: PMC5834955 DOI: 10.1007/s11606-017-4208-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 05/18/2017] [Accepted: 10/05/2017] [Indexed: 11/26/2022]
Abstract
Wet beriberi, characterized by high cardiac output with predominantly right-sided heart failure and lactic acidosis, is a disease caused by thiamine deficiency, and is rarely seen in modern society. However, patients with social withdrawal syndrome, also known as hikikomori syndrome, may be a new population at risk of thiamine deficiency. Hikikomori syndrome, first recognized in Japan, is becoming a worldwide issue. A 39-year-old Japanese patient was brought to our hospital, with a 3-week history of progressive shortness of breath and generalized edema. The patient had right-sided high-output heart failure, lactic acidosis, and Wernicke-Korsakoff syndrome. Because of his history of social isolation, we diagnosed hikikomori syndrome according to the Japanese government's definition, which is as follows: lifestyle centered at home; no interest or willingness to attend school or work; persistence of symptoms beyond 6 months; and exclusion of other psychiatric and developmental disorders. Considering his diagnosis of hikikomori syndrome and social isolation, we suspected malnutrition, particularly thiamine deficiency, and successfully treated him. Clinicians should be aware of the potential risk of thiamine deficiency associated with hikikomori syndrome and initiate thiamine replacement in cases of high-output heart failure associated with lactic acidosis.
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Affiliation(s)
- Natsumi Tanabe
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu-city, Chiba, 279-0001, Japan
| | - Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu-city, Chiba, 279-0001, Japan.
| | - Jun Kataoka
- Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu-city, Japan
| | - Takaki Naito
- Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu-city, Japan
| | - Ko Matsumoto
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu-city, Chiba, 279-0001, Japan
| | - Junya Arai
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu-city, Chiba, 279-0001, Japan
| | - Yasuhiro Norisue
- Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu-city, Japan
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Comelli I, Lippi G, Merli MF, Cervellin G. [Sometimes they come back! A case of Shoshin Beriberi in Northern Italy (2012)]. Recenti Prog Med 2014; 105:303-306. [PMID: 25072547 DOI: 10.1701/1574.17120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 78-year-old man presented to the emergency department with symptoms and signs suggestive of heart failure. Only after a long interview we discovered that the patient has been eating, for over 20 years, only chestnut honey and chestnut jam produced by himself. He refused any other foods, because of the fear of being poisoned; he did not drink alcohol at all. The clinical picture was attributable to Beriberi, and the patient recovered promptly after treatment with thiamine. A high clinical suspicion and an early thiamine supplementation might shorten the duration of work-up and hospital length of stay, as well as prevent extensive and expensive diagnostic work-up, thus simplifying the clinical management.
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Tejedor A, Solé M, Prieto-González S, Alba MA, Grau JM, Cid MC, Hernández-Rodríguez J. Acute dilated cardiomyopathy in a patient with beriberi and cryoglobulinaemic vasculitis: an unusual potential complication of two rare disorders. Clin Exp Rheumatol 2014; 32:S66-S69. [PMID: 24429381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 11/12/2013] [Indexed: 06/03/2023]
Abstract
We report the case of a 45-year-old patient who presented with acute dilated cardiomyopathy. During admission the patient was consecutively diagnosed with cryoglobulinaemic vasculitis and beriberi. In both diseases, cardiac involvement may occur as dilated cardiomyopathy. Thiamin deficiency was the final cause for the severe cardiac manifestations (cardiac acute beriberi or Shoshin syndrome), which returned to normal after thiamin supplementation.
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Affiliation(s)
- Ana Tejedor
- Vasculitis Research Unit, Department of Autoimmune Diseases. Hospital Clínic of Barcelona. IDIBAPS. University of Barcelona. Barcelona, Spain.
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Abstract
BACKGROUND The epidemic growth of morbid obesity has led to an increase in the number of bariatric interventions. During the distribution process of bariatric surgical interventions, the risk for severe nutritious complications such as bariatric beriberi can rise. METHODS By means of systematic literature review, epidemiological data, clinical characteristics and diagnostic as well as therapeutic recommendations for bariatric beriberi were elicited. Databases and registries such as PubMed, Cochrane and Ovid were searched for a defined time period with the key words 'lack of thiamine' / 'Wernicke-Korsakoff syndrome' / 'encephalopathy' after bariatric surgical interventions. RESULTS Up to December 2013, overall 255 patients had been found as published cases, indicating that the risk for the postoperative occurrence of thiamine deficiency and Wernicke-Korsakoff syndrome is increased in women. In addition, the risk correlates with patient's age. The majority of patients developed symptoms of a dry beriberi with peripheral neuritis, ataxia and paraplegia, indicating an advanced stage of disease approximately 4-12 weeks postoperatively. Laboratory analysis in case of a suspicious clinical finding is the appropriate diagnostics. As treatment, prompt initiation of parenteral thiamine substitution under clinical monitoring is required. CONCLUSION Bariatric beriberi can occur within the first 1-3 postoperative months. To minimize the risk of severe consequences, immediate substitution of thiamine in clinical suspicion or prolonged parenteral nutrition is necessary. A delayed diagnosis or missing the correct diagnosis can lead to irreversible damages of the CNS with coma and fatal outcome. Knowledge on the subject, including development of thiamine deficiency, symptomatology and emergency treatment, are considered essential for bariatric surgeons but also for further medical disciplines involved in treatment.
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Affiliation(s)
- Christine Stroh
- SRH Municipal Hospital, Department of General, Abdominal and Pediatric Surgery, Gera, Germany, Magdeburg, Germany
- *Christine Stroh MD, Department of General, Abdominal and Pediatric Surgery, Municipal Hospital Gera, Straße des Friedens 122, 07548 Gera (Germany),
| | - Frank Meyer
- University Hospital, Department of General, Abdominal and Vascular Surgery, Magdeburg, Germany
| | - Thomas Manger
- SRH Municipal Hospital, Department of General, Abdominal and Pediatric Surgery, Gera, Germany, Magdeburg, Germany
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20
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Guilland JC. [When should we prescribe a vitamin?]. Rev Prat 2013; 63:1057-1059. [PMID: 24298821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Jean-Claude Guilland
- Laboratoire de biochimie spécialisée, plateau technique de biologie, CHU de Dijon, 21070 Dijon Cedex, France.
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Takahashi T, Omi K, Togashi N, Saito H, Kiribayashi N, Niizeki T, Sasaki T, Kaneko K, Sugawara S, Kubota I. [Case report: a case in which vitamin B1 was effective for treatment of shoshin beriberi and Wernicke's encephalopathy]. Nihon Naika Gakkai Zasshi 2013; 102:1790-1793. [PMID: 23947241 DOI: 10.2169/naika.102.1790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Nakano S, Sujino Y, Tanno J, Ariyama M, Muramatsu T, Senbonmatsu T, Nishimura S, Tamura Y, Fukuda K. Inducible intrapulmonary arteriovenous shunt in a patient with beriberi heart. Am J Respir Crit Care Med 2013; 187:332-3. [PMID: 23378443 DOI: 10.1164/ajrccm.187.3.332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ishiko T, Taguchi T, Takeguchi M, Saito H, Nanri K. [Case of Wernicke's encephalopathy and subacute combined degeneration of the spinal cord due to vitamin deficiency showing changes in the bilateral corpus striatum and cardiac arrest due to beriberi heart disease]. Brain Nerve 2009; 61:1069-1073. [PMID: 19803406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 52-year-old woman was admitted to the hospital because of appetite loss, unsteadiness, psychogenic symptoms, ataxia, and consciousness disturbance as a result of the ingestion of a diet restricted to only carbohydrates for a long term. Laboratory examination indicated the presence of pancytopenia with macrocytic anemia; further, decreased vitamin B1 and B12 levels were detected in her serum. Magnetic resonance imaging fluid attenuated inversion recovery (FLAIR), revealed high-signal intensity in the bilateral corpus striatum, third ventricle circumference, and cerebellar cortex. Thereafter, she received drip infusion that did not include vitamin B1 or B12 and subsequently suffered a cardiac arrest due to the aggravation of cardiac insufficiency; consequently, she was transferred to our hospital. Upon admission the patient was diagnosed to have obvious cardiomegaly with pleural effusion; further, a negative T-wave was obtained on the electrocardiogram. A diagnosis of beriberi heart disease was made because of thiamine deficiency. She was treated by thiamine administration, following which the cardiac symptoms improved immediately. Various neurological symptoms caused by encephalopathy, peripheral neuropathy and subacute combined spinal cord degeneration improved by treatment with thiamine and cyanocobalamine administration; however, some of these symptoms still remained. General awareness of the fact that neurological symptoms can be caused by vitamin deficiency is essential.
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Affiliation(s)
- Tomoko Ishiko
- Department of Neurology, Tokyo Medical University Hachioji Medical Center, 1163 Tate-machi, Hachioji-shi, Tokyo 193-0998, Japan
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Ishikawa Y, Miyagi M, Matsumoto T, Watanabe N, Tojo Y, Hiroi N, Kuboki K, Yoshino G, Tsubota T, Yoshihara K. [Beriberi heart failure caused by a retort pouch diet menu]. Nihon Naika Gakkai Zasshi 2008; 97:2552-2554. [PMID: 19051749 DOI: 10.2169/naika.97.2552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Yuichi Ishikawa
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine(Omori), Toho University School of Medicine
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25
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Sangtawesin C, Leartveravat S. Pediatric cardiac beriberi: 3 different presentations. J Med Assoc Thai 2008; 91 Suppl 3:S165-S168. [PMID: 19253515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The authors report 3 cases of pediatric cardiac beriberi at Queen Sirikit National Institute of Child Health during the last 10-year-period. The first two cases presented classically while the third case came with an unusual presentation. Cardiac beriberi is an old disease in modern Bangkok which can present in as several different clinical patterns. The diagnosis needs a high index of suspicion. Echocardiographic findings of right heart dysfunction and dramatic response to intravenous thiamine are diagnostic.
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Affiliation(s)
- Chaisit Sangtawesin
- Queen Sirikit National Institute of Child Health, Department of Medical Services, Thailand.
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26
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Moonen M, Lancellotti P, Betz R, Lambermont B, Piérard L. [Beriberi]. Rev Med Liege 2007; 62:523-30. [PMID: 17853677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
We discuss the case of a 49 year old man who was admitted to the emergency department with acute heart failure. He suffered from severe alcoholism and malnutrition. His heart failure was of the high output type and the diagnosis beriberi, a disease caused by thiamine (vitamin B1) deficiency. The treatment consisted of intravenous administration of thiamine. The clinical response was spectacular with normalization of cardiac function within a few hours.
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Goto Y, Awata M, Uematsu M, Yano M, Morozumi T, Kotani JI, Watanabe T, Onishi T, Iida O, Sera F, Nanto S, Nagata S. [Shoshin beriberi complicating severe pulmonary hypertension: a case report]. J Cardiol 2007; 49:361-5. [PMID: 17633575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
A 44-year-old male was admitted to our hospital for dyspnea, associated with severe pulmonary hypertension. The patient fell into a shock state on the next day. Hemodynamic measurements revealed high output heart failure with low peripheral vascular resistance. We suspected shoshin beriberi, a fulminant form of cardiac beriberi, by ruling out other common causes of pulmonary hypertension. The rapid recovery after intravenous thiamine administration and the patient's history of improper diet strongly supported the diagnosis. The present case of shoshin beriberi complicating severe pulmonary hypertension shows that history taking is important in elucidating the etiology and selecting the correct treatment.
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Affiliation(s)
- Yuko Goto
- Cardiovascular Division, Kansai Rosai Hospital, Inabaso 3-1-69, Amagasaki, Hyogo 660-8511.
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28
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Akahori H, Tsujino T, Masutani M, Akagami T, Tanabe K, Masai M, Fujioka Y, Ohyanagi M, Masuyama T. [Postgastrectomy beriberi exaggerated by diuretic use: a case report]. J Cardiol 2007; 49:49-53. [PMID: 17269213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
A 66-year-old male was referred to our hospital because of severe pitting edema in the lower extremities in April 2003. He had undergone a partial gastrectomy for gastric cancer 17 years before and radiotherapy for oropharyngeal cancer 1 year before. He had suffered from the edema for 4 years. Loop diuretics prescribed by his family doctor were effective for relieving the edema at first, but the edema was not resolved. He was hospitalized with evidence of hypothyroidism from blood analysis. Administration of levothyroxin partially relieved the edema, but loop diuretics were continued because the edema was not completely diminished. He was admitted to our hospital again in October 2003, because of unsteady gait and worsened edema. Neurological examination revealed the stocking-and-glove pattern of sensory disturbance and distal muscle weakness in the lower extremities. Plasma vitamin B1 (thiamine)concentration was low, and the diagnosis was beriberi. After vitamin B, supplementation was initiated, the patient's edema completely disappeared in a few days, and his gait disturbance gradually subsided. Diuretics lead to increased urinary vitamin B1 excretion, so we should be watchful for thiamine deficiency in patients treated with diuretics who underwent gastrectomy and potentially have latent vitamin B1 deficiency.
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Affiliation(s)
- Hirokuni Akahori
- Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine, Hyogo
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29
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Onoe T, Usui M, Yahata M, Yoshie T, Yamamoto Y, Ichikawa K, Noda M, Saito T, Isobe M. [Shoshin beriberi after 20-year use of an alternative medicine]. Nihon Naika Gakkai Zasshi 2006; 95:2547-9. [PMID: 17240886 DOI: 10.2169/naika.95.2547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Tsuyoshi Onoe
- Department of Internal Medicine, Social Insurance Central General Hospital, Tokyo
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31
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Cox FME, Cornel JH, Aramideh M. [A man with the combination of dry and wet beriberi]. Ned Tijdschr Geneeskd 2006; 150:1347-50. [PMID: 16808367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
A 34-year-old alcoholic man had neurological and cardiac symptoms. The patient was admitted to the hospital for acute painful sensory disturbances and severe weakness of the feet. Neurological and electrophysiological investigation revealed axonal sensorimotor polyneuropathy that was most prominent in the legs. Cardiac assessment showed signs and symptoms of heart failure due to a high-output state. Blood analysis showed a low thiamine concentration of 58 nmol/l (lower reference limit: 80). Therefore, a diagnosis of combined wet beriberi with cardiomyopathy and dry beriberi with axonal polyneuropathy was made. The treatment of beriberi is simple and effective and consists of thiamine supplementation in conjunction with diuretic treatment. With this approach, the patient recovered fully. Patients with beriberi have a good prognosis, particularly when the diagnosis is made at an early stage.
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32
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Alves LFA, Gonçalves RM, Cordeiro GV, Lauria MW, Ramos AV. Beribéri pós bypass gástrico: uma complicação não tão rara. Relato de dois casos e revisão da literatura. ACTA ACUST UNITED AC 2006; 50:564-8. [PMID: 16936999 DOI: 10.1590/s0004-27302006000300021] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Accepted: 02/12/2006] [Indexed: 11/22/2022]
Abstract
É crescente o número de pacientes submetidos à cirurgia bariátrica para tratamento da obesidade mórbida; devido a isso, estão reaparecendo deficiências nutricionais com as quais muitos médicos já não estão familiarizados. No pós-operatório, podem ocorrer vários distúrbios nutricionais, sendo um deles a deficiência de tiamina (beribéri). A deficiência de tiamina e/ou vitamina B12 pode corresponder a 40% dos casos de neuropatia após a cirurgia bariátrica. Serão descritos dois pacientes com a clínica de neuropatia periférica e síndrome de Wernicke-Korsakoff. Alguns meses após a cirurgia, eles apresentaram prostração, depressão, confusão mental e nistagmo, associados a dor e parestesia dos membros (principalmente inferiores). Com a hipótese diagnóstica de beribéri, foi iniciado o tratamento com tiamina. Um dos pacientes apresentou melhora completa do quadro neurológico, porém o outro permaneceu com déficit motor, sendo aquele em que decorreu o maior tempo entre o aparecimento dos sintomas e o início do tratamento. Estes casos servem para nos alertar sobre a importância da vigilância nutricional após a cirurgia bariátrica.
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Affiliation(s)
- Lilian F A Alves
- Serviço de Endocrinologia, Hospital Felício Rocho, Rua Monte Alegre 851, 30240-230 Belo Horizonte, MG.
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Abstract
Cardiovascular beriberi is caused by thiamine deficiency and usually arises for one of two reasons: alcoholism or diet. Shoshin beriberi is a fulminant form of cardiac beriberi. We investigated the histopathological features of biopsied myocardial tissue samples from two patients with Shoshin beriberi (one patient with nonalcoholic beriberi and another patient with alcoholic beriberi). Interstitial fibrosis and a variation in size of the myocardial fibers were the main findings in the sample from these patients after thiamine treatment. These findings are persistent histopathological features in the myocardium of patients with Shoshin beriberi after thiamine treatment.
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Affiliation(s)
- Hiroaki Kawano
- Department of Cardiovascular Medicine, Course of Medical and Dental Science, Graduate School of Biomedical Science, Nagasaki University, Nagasaki 852-8501, Japan
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Affiliation(s)
- Huy A Tran
- Hunter Area Pathology Services, Newcastle, New South Wales, Australia.
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35
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Indraccolo U, Gentile G, Pomili G, Luzi G, Villani C. Thiamine deficiency and beriberi features in a patient with hyperemesis gravidarum. Nutrition 2005; 21:967-8. [PMID: 15979284 DOI: 10.1016/j.nut.2005.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2005] [Accepted: 04/06/2005] [Indexed: 11/30/2022]
Abstract
Wernicke's encephalopathy has been sporadically reported in patients with severe hyperemesis gravidarum. We report a new case of Wernicke's encephalopathy in a patient who had hyperemesis gravidarum associated with signs and symptoms of dry and wet beriberi. The case was managed with very large doses of thiamine. The conclusion was that, in long-lasting hyperemesis gravidarum, recognizing signs of beriberi may help prevent the onset of Wernicke's encephalopathy, thanks to timely therapy with thiamine supplements. A thiamine therapy similar to the one reported in this article could prove useful in long-lasting hyperemesis gravidarum complicated by Wernicke's encephalopathy.
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Affiliation(s)
- Ugo Indraccolo
- Department of Obstetrics and Gynaecology, University of Perugia, Perugia, Italy.
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Kountchev J, Bijuklic K, Bellmann R, Joannidis M. A patient with severe lactic acidosis and rapidly evolving multiple organ failure: a case of shoshin beri-beri. Intensive Care Med 2005; 31:1004. [PMID: 15875157 DOI: 10.1007/s00134-005-2648-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2005] [Indexed: 12/01/2022]
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Minicucci MF, Zornoff LAM, Matsue M, Inoue RMT, Matsubara LS, Okoshi MP, Okoshi K, Campana AO, Paiva SAR. Generalized edema and hyperdynamic circulation. A possible case of beriberi. Arq Bras Cardiol 2004; 83:176-8; 173-5. [PMID: 15322660 DOI: 10.1590/s0066-782x2004001400009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Marcos F Minicucci
- Medical School de Botucatu, Universidade Estadual Paulista, UNESP, Botucatu, SP, Brazil.
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38
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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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Abstract
The metabolic effects of chronic alcohol abuse can induce a broad spectrum of disorders. We describe the case of an initially unidentified alcoholic, poorly nourished woman who presented with ketoacidosis. She developed severe cardiac failure, which did not respond to classical treatment. The administration of intravenous thiamine resulted in an impressive recovery of cardiac function. Laboratory examinations confirmed the diagnosis of alcoholic ketoacidosis and cardiac beriberi. The clinical entity and treatment of these two uncommon disorders are discussed. If recognized early both diseases (and their combination) are fully reversible.
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Affiliation(s)
- Marc W Diltoer
- Critical Care Department, Akademisch Ziekenhuis Vrije Universiteit Brussel, Brussels, Belgium.
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Affiliation(s)
- Karen Morin
- Western Michigan University, Bronson School of Nursing, USA.
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Groeneveld JH, Geelhoed-Duijvestijn PH, Veldkamp RF, Baur HJ. [Shoshin beriberi provoked by the inhalation of salbutamol]. Ned Tijdschr Geneeskd 2003; 147:1601-3. [PMID: 12951730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
A 45-year-old male alcoholic with a deficient diet was given salbutamol for exertion-related dyspnoea. After inhalation, he presented with a severe dyspnoea, acrocyanosis, anuria and low blood pressure as well as a respiratory compensated lactate acidosis. Shoshin beriberi was suspected on clinical grounds. The low level of thiamine and the prompt recovery after thiamine repletion confirmed this diagnosis. Shoshin beriberi is an acute, cardiac form of beriberi, which can rapidly result in death due to cardiogenic shock and lactate acidosis. Adrenergic agents can cause a hyperdynamic circulation and thus aggravate the effects of a thiamine deficiency.
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Affiliation(s)
- J H Groeneveld
- Afd. Interne Geneeskunde, Medisch Centrum Haaglanden, locatie Westeinde, Postbus 432, 2501 CK Den Haag
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Maekawa S, Aibiki M, Hinami J, Shirakawa Y. Non-specific hyperamylasemia in shosin beri-beri. Resuscitation 2003; 58:227-30. [PMID: 12909386 DOI: 10.1016/s0300-9572(03)00117-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Several reports demonstrate non-specific hyperamylasemia in cardiac surgery or diabetic ketoacidosis. We report here for the first time non-specific hyperamylasemia in a cardiovascular beri-beri case who showed shock with severe metabolic acidosis. Her echocardiography revealed hyperkinetic wall motion of the small left ventricle. Despite intravascular volume expansion in parallel with dopamine administration, her blood pressure did not recover. Abdominal computed tomography (CT) did not reveal pancreatic swelling or any other signs of acute pancreatitis. Her history suggested a possibility of cardiovascular beri-beri due to chronic alcoholism. Thiamine administration dramatically reversed her haemodynamic derangements, metabolic acidosis and even relieved her abdominal pain. Isozyme examinations for hyperamylasemia showed that most of the serum amylase consisted of salivary type. This case report expands our information on non-specific hyperamylasemia encountered in the emergency setting.
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Affiliation(s)
- Souichi Maekawa
- Department of Emergency Medicine, Ehime University, Shitsukawa 454, Shigenobu, Onsen, 791-0295 Ehime, Japan
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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; 118:59-64. [PMID: 12604765 PMCID: PMC1497506 DOI: 10.1093/phr/118.1.59] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] 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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López Gastón OD, Malvino ER, McLoughlin D, Osatnik J, Chávez Zambrano MA, Pino C. [Acute cardiovascular beriberi (shoshin-beriberi)]. Medicina (B Aires) 2002; 62:331-4. [PMID: 12325490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
Beriberi (BB), thiamine deficiency, has been described in the Asian literature in the 17th century and is characterized by peripheral neuropathy and muscle weakness, also called "dry" beriberi (BB) to differentiate it from "wet" BB, with essentially cardiovascular manifestations. Wet can be either "classic" wet BB in which signs and symptoms of right-sided heart failure with normal or high cardiac output are the presenting features or the "shoshin" BB variant with severe biventricular failure and metabolic acidosis, which must be treated early to prevent the rapid development of low cardiac output failure and sudden death. In this case, we report a 58 year old alcoholic woman who developed dyspnea, oliguria, edema, cardiac failure with high output, metabolic acidosis, renal tubular dysfunction and serum lactate level of 5.6 mEq/L. Neurological examination revealed peripheral neuropathy in the lower legs and cognitive alteration. She was treated with a loading dose of 100 mg of intravenous thyamine and responded with a marked increase in urine output, correction of acidosis, reduction in pulmonary-capillary wedge pressure and a change of the hemodynamic pattern. We conclude that shoshin-BB is uncommonly encountered but not widely recognized. In lactic acidosis and/or hyperdynamic circulation without any other apparent etiology in patients with possible vitamin B1 deficiency, the diagnosis of BB must be considered and thiamine should be administered.
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Ito M, Tanabe Y, Suzuki K, Kumakura M, Aizawa Y. Shoshin beriberi with vasospastic angina pectoris possible mechanism of mid-ventricular obstruction: possible mechanism of mid-ventricular obstruction. Circ J 2002; 66:1070-2. [PMID: 12419944 DOI: 10.1253/circj.66.1070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A 73-year-old heavy drinker was admitted to hospital in a state of shock. He had been suffering from frequent angina at rest, causing him to drink more heavily in an effort to overcome his anginal chest pain. He had been drinking hard each day and had not eaten for 4 weeks. His hemodynamic state on admission showed high-output heart failure. Echocardiography revealed hyperkinesis of the left ventricle and mid-ventricular obstruction with peak intraventricular gradients of 30 mmHg. Although no improvement was seen despite administering the maximal dose in catecholamine therapy, his condition improved rapidly after vitamin B(1) was administered. Cardiac catheterization revealed mid-ventricular obstruction with an apical aneurysm. Coronary artery spasm was induced by injecting acetylcholine in the distal site of the left anterior descending artery, which perfused the area of the apical aneurysm. In the present case, both left ventricular hyperkinesis caused by shoshin beriberi and apical myocardial infarction caused by frequent coronary spasms produced mid-ventricular obstruction with an apical aneurysm.
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Affiliation(s)
- Masahiro Ito
- First Department of Internal Medicine, Niigata University School of Medicine, Japan.
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Shivalkar B, Engelmann I, Carp L, De Raedt H, Daelemans R. Shoshin syndrome: two case reports representing opposite ends of the same disease spectrum. Acta Cardiol 1998; 53:195-9. [PMID: 9842404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Thiamine deficiency can have cardiovascular and neurological manifestations. Cardiac beriberi is classically thought to represent a high-output state with oliguria and lactic acidosis. The condition can, however, also present itself with a low cardiac output and fulminant vascular collapse, or as an acute fatal form, causing sudden death, without clear-cut signs of cardiomegaly. In the western society beriberi is mainly encountered in alcoholics. We report on two cases, one with high-output failure and the other with low-output failure and cardiovascular collapse. In both patients the diagnosis of shoshin syndrome was made, and and both showed a spectacular improvement of congestive heart failure symptoms after treatment with thiamine. A therapeutic trial with thiamine is the only way to rapid diagnosis.
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Affiliation(s)
- B Shivalkar
- Department of Cardiology K.U. Leuven, Belgium
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Tallaksen CM, Bovim G. [Thiamine treatment today]. Tidsskr Nor Laegeforen 1998; 118:3946-9. [PMID: 9830340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
This article reviews some of the established data on thiamin and the most common symptoms of deficiency. Guidelines for appropriate therapy are offered. Thiamin or vitamin B1 was among the first vitamins to be discovered. Beriberi was the first disease to be associated with thiamin deficiency, and Wernicke's encephalopathy was shown to respond to thiamin treatment a few years later. However, thiamin treatment remains inadequate or delayed. Treatment is efficient in the early stages, but delays often causes permanent damage. It is important that all physicians are aware of what patients are susceptible to develop thiamin deficiency and that they recognize the symptoms as early as possible.
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Abstract
Beriberi is an endemic disease among the Naporuna indigenous people of Ecuadorean Amazonia (annual morbidity rate of 1.5%). A total of 47 patients with dry beriberi were seen at the Franklin Tello Hospital, Napo, during 1995-1996; a similar incidence was observed in previous years. No wet beriberi was found. Although the diagnosis of the disease was made clinically, an effective and quick response to thiamine treatment excluded other differential diagnoses, such as tropical ataxic neuropathy. Although indigenous people have several possible dietetic risk factors, none of them adequately explain the disease's high incidence. Some suggestions are made for the high incidence of beriberi among this Amazonian people but its cause remains unknown.
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Hahn JS, Berquist W, Alcorn DM, Chamberlain L, Bass D. Wernicke encephalopathy and beriberi during total parenteral nutrition attributable to multivitamin infusion shortage. Pediatrics 1998; 101:E10. [PMID: 9417174 DOI: 10.1542/peds.101.1.e10] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Wernicke encephalopathy (WE) is an acute neurologic disorder characterized by a triad of ophthalmoplegia, ataxia, and mental confusion. WE is attributable to thiamine (vitamin B1) deficiency. Beriberi is the systemic counterpart of thiamine deficiency and often manifests in cardiovascular collapse. WE is usually associated with alcoholism and malnutrition. It has also been seen in people with gastrointestinal diseases with malabsorption. Patients who have received total parenteral nutrition (TPN) without proper replacement of thiamine have also developed WE. Since November 1996, there has been a shortage of multivitamin infusion (MVI). Many patients who were on chronic TPN with MVI ceased to receive the MVI and were converted to an oral form of the multivitamin. As a result, there have been several reports of children and adults on TPN who have developed WE as a result of thiamine deficiency. With this case report, we bring to attention the association of the MVI shortage and WE. Early diagnosis of WE is important, because if it is treated with thiamine in the acute stages, the neurologic and cardiovascular abnormalities can be reversed. CASE REPORT We report a 20-year-old female patient with Crohn's disease who developed WE as a result of thiamine deficiency. She had Crohn's disease since age 9 years and was on chronic TPN. Two months before admission, MVI was discontinued in the TPN because of the shortage of its supply. An oral multivitamin tablet was substituted instead. She was admitted to the hospital for persistent vomiting. In the hospital, she continued to receive TPN without MVI, but continued taking an oral multivitamin preparation. Two weeks after admission, she developed signs of WE including diplopia, ophthalmoplegia, nystagmus, and memory disturbance. She also developed hypotension that was thought to be caused by beriberi. She was treated with 50 mg of intravenous thiamine. Within hours of the intravenous thiamine, her hypotension resolved. The day after the infusion, she no longer complained of diplopia, and her ophthalmoplegia had improved dramatically. Magnetic resonance imaging showed several areas of abnormally high signal on T2-weighted images in the brainstem, thalamus, and mamillary bodies. The topographic distribution of these changes was typical of WE. After 2 months, her mental status and neurologic status had recovered completely. CONCLUSION WE and thiamine deficiency should be considered in all patients with malabsorption, malnutrition, and malignancies. WE from thiamine deficiency can occur as a result of cessation of MVI in the TPN infusion. Even if an oral multivitamin preparation is given instead of MVI, patients with malabsorption may not absorb thiamine adequately. Prompt diagnosis of WE is important because it is potentially fatal and readily treatable with thiamine supplementation. Early recognition of WE may be more difficult in children, because the classic triad of symptoms may not develop fully. Magnetic resonance imaging may be useful in these cases to confirm the diagnosis of WE. Because the shortage of MVI is expected to be a long-term, there are likely to be more cases of WE in the pediatric population of TPN-dependent children. Because there is no shortage of intravenous thiamine, it should be administered with TPN even if MVI is not available.
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Affiliation(s)
- J S Hahn
- Departments of Neurology and Neurological Sciences, Pediatrics, and Ophthalmology Stanford University School of Medicine Packard Children's Hospital at Stanford Stanford, CA 94305-5235, USA
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