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Morimoto J, Satogami K, Naraoka T, Taruya A, Tanaka A. Long-Term Maintenance of Normal Serum Vitamin B 1 Levels Is Associated with Better Outcomes in Patients with Heart Failure. Int Heart J 2024; 65:458-465. [PMID: 38749749 DOI: 10.1536/ihj.23-550] [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: 06/04/2024]
Abstract
Deficiency of vitamin B1 (VB1), an essential micronutrient, causes heart failure (HF). A recent randomized controlled trial failed to show any improvement in HF prognosis after short-term VB1 supplementation. In the current study, we investigated the efficacy of long-term maintenance of normal blood VB1 levels in preventing adverse outcomes in patients with HF.This study included 88 consecutive patients with HF who received guideline-directed medical therapy at Arida Municipal Hospital. The patients were divided into 3 groups: a control group with normal VB1 levels and no VB1 supplementation (normal group, n = 25), and those presenting with VB1 deficiency, who either required short-term VB1 supplementation (short-term supplementation group, n = 25), or long-term maintenance of normal blood VB1 levels (long-term maintenance group, n = 38). The time to the first appearance of composite outcomes, including cardiovascular death and hospitalization for HF, was compared between the 3 groups.VB1 deficiency was observed in 63 (72%) patients. The Kaplan-Meier curve showed that the long-term maintenance group had better outcomes than the other 2 groups. In the multivariate analysis, long-term maintenance of normal blood VB1 levels and age were independent predictors of composite outcomes.VB1 deficiency is frequently observed, and the long-term maintenance of normal blood VB1 levels may result in better outcomes in patients with HF. Our results suggest that the detection of VB1 deficiency and long-term restoration of VB1 levels may be part of the overall therapeutic strategy for HF.
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Affiliation(s)
| | - Keisuke Satogami
- Department of Cardiology, Arida Municipal Hospital
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Akira Taruya
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University
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2
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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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3
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Schostak T, Millan IS, Jani A, Johnson RJ. Thiamine deficiency: a commonly unrecognised but easily treatable condition. Postgrad Med J 2023; 99:844-848. [PMID: 37125640 PMCID: PMC10398819 DOI: 10.1136/pmj-2022-141972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/20/2022] [Indexed: 11/04/2022]
Abstract
Thiamine is present in many foods and is well recognised as an essential nutrient critical for energy metabolism. While thiamine deficiency is commonly recognised in alcoholism, it can present in many other settings where it is often not considered and goes unrecognised. One challenging aspect to diagnosis is that it may have varied metabolic, neurological and cardiac presentations. Here we present an overview of the disorder, focusing on the multiple causes and clinical presentations. Interestingly, thiamine deficiency is likely increasing in frequency, especially among wildlife, where it is linked with changing environments and climate change. Thiamine deficiency should be considered whenever neurological or cardiological disease of unknown aetiology presents, especially in any patient presenting with lactic acidosis.
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Affiliation(s)
- Tritia Schostak
- Division of Nephrology, Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Iňigo San Millan
- Division of Endocrinology, Department of Medicine, University of Colorado—Anschutz Medical Campus, Aurora, Colorado, USA
| | - Alkesh Jani
- Division of Nephrology, Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Richard Joseph Johnson
- Division of Nephrology, Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
- Division of Endocrinology, Department of Medicine, University of Colorado—Anschutz Medical Campus, Aurora, Colorado, USA
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4
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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] [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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5
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Hung YH, Yu AL, Chen CK, Liao MT, Hsieh MY, Chen WJ. Pulmonary artery catheter usage in diagnosis of Shoshin beriberi presented with unexplained lactic acidosis. ESC Heart Fail 2023. [PMID: 37051632 PMCID: PMC10375197 DOI: 10.1002/ehf2.14374] [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: 12/21/2022] [Revised: 03/08/2023] [Accepted: 03/23/2023] [Indexed: 04/14/2023] Open
Abstract
Wet beriberi is a rare but fatal disease in modern society. The nonspecific clinical manifestations, including symptoms of heart failure and recalcitrant lactic acidosis, can prevent timely diagnosis. The use of a pulmonary artery catheter can promptly confirm a high cardiac output state and plays a crucial role in rapidly deteriorating cases. Appropriate treatment with intravenous administration of thiamine leads to dramatic recovery within hours. We present two cases of Shoshin beriberi, a fulminant variant of wet beriberi, diagnosed in 2016 and 2022 at our institute. The patients experienced haemodynamic collapse and refractory lactic acidosis, which were successfully diagnosed with the use of a pulmonary artery catheter and reversed by thiamine supplementation. We also reviewed 19 cases of wet beriberi reported between 2010 and 2022.
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Affiliation(s)
- Yi-Hsin Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - An-Li Yu
- Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Kai Chen
- Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Min-Tsun Liao
- Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Mu-Yang Hsieh
- Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Wen-Jone Chen
- Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
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6
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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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7
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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] [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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8
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Pawar RD, Balaji L, Grossestreuer AV, Thompson G, Holmberg MJ, Issa MS, Patel PV, Kronen R, Berg KM, Moskowitz A, Donnino MW. Thiamine Supplementation in Patients With Alcohol Use Disorder Presenting With Acute Critical Illness : A Nationwide Retrospective Observational Study. Ann Intern Med 2022; 175:191-197. [PMID: 34871057 PMCID: PMC9169677 DOI: 10.7326/m21-2103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Thiamine supplementation is recommended for patients with alcohol use disorder (AUD). The authors hypothesize that critically ill patients with AUD are commonly not given thiamine supplementation. OBJECTIVE To describe thiamine supplementation incidence in patients with AUD and various critical illnesses (alcohol withdrawal, septic shock, traumatic brain injury [TBI], and diabetic ketoacidosis [DKA]) in the United States. DESIGN Retrospective observational study. SETTING Cerner Health Facts database. PATIENTS Adult patients with a diagnosis of AUD who were admitted to the intensive care unit with alcohol withdrawal, septic shock, TBI, or DKA between 2010 and 2017. MEASUREMENTS Incidence and predicted probability of thiamine supplementation in alcohol withdrawal and other critical illnesses. RESULTS The study included 14 998 patients with AUD. Mean age was 52.2 years, 77% of participants were male, and in-hospital mortality was 9%. Overall, 7689 patients (51%) received thiamine supplementation. The incidence of thiamine supplementation was 59% for alcohol withdrawal, 26% for septic shock, 41% for TBI, and 24% for DKA. Most of those receiving thiamine (n = 3957 [52%]) received it within 12 hours of presentation in the emergency department. The predominant route of thiamine administration was enteral (n = 3119 [41%]). LIMITATION Specific dosing and duration were not completely captured. CONCLUSION Thiamine supplementation was not provided to almost half of all patients with AUD, raising a quality-of-care issue for this cohort. Supplementation was numerically less frequent in patients with septic shock, DKA, or TBI than in those with alcohol withdrawal. These data will be important for the design of quality improvement studies in critically ill patients with AUD. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Rahul D Pawar
- Division of Hospital Medicine, Department of Medicine, and Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts (R.D.P.)
| | - Lakshman Balaji
- Center for Resuscitation Science and Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (L.B., A.V.G., G.T., P.V.P.)
| | - Anne V Grossestreuer
- Center for Resuscitation Science and Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (L.B., A.V.G., G.T., P.V.P.)
| | - Garrett Thompson
- Center for Resuscitation Science and Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (L.B., A.V.G., G.T., P.V.P.)
| | - Mathias J Holmberg
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, and Department of Anesthesiology and Intensive Care, Randers Regional Hospital, Randers, Denmark (M.J.H.)
| | - Mahmoud S Issa
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts (M.S.I.)
| | - Parth V Patel
- Center for Resuscitation Science and Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (L.B., A.V.G., G.T., P.V.P.)
| | - Ryan Kronen
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (R.K.)
| | - Katherine M Berg
- Center for Resuscitation Science and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (K.M.B.)
| | - Ari Moskowitz
- Center for Resuscitation Science and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and Division of Critical Care Medicine, Montefiore Medical Center, Bronx, New York (A.M.)
| | - Michael W Donnino
- Center for Resuscitation Science, Department of Emergency Medicine, and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (M.W.D.)
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9
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Biological Properties of Vitamins of the B-Complex, Part 1: Vitamins B1, B2, B3, and B5. Nutrients 2022; 14:nu14030484. [PMID: 35276844 PMCID: PMC8839250 DOI: 10.3390/nu14030484] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
This review summarizes the current knowledge on essential vitamins B1, B2, B3, and B5. These B-complex vitamins must be taken from diet, with the exception of vitamin B3, that can also be synthetized from amino acid tryptophan. All of these vitamins are water soluble, which determines their main properties, namely: they are partly lost when food is washed or boiled since they migrate to the water; the requirement of membrane transporters for their permeation into the cells; and their safety since any excess is rapidly eliminated via the kidney. The therapeutic use of B-complex vitamins is mostly limited to hypovitaminoses or similar conditions, but, as they are generally very safe, they have also been examined in other pathological conditions. Nicotinic acid, a form of vitamin B3, is the only exception because it is a known hypolipidemic agent in gram doses. The article also sums up: (i) the current methods for detection of the vitamins of the B-complex in biological fluids; (ii) the food and other sources of these vitamins including the effect of common processing and storage methods on their content; and (iii) their physiological function.
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10
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Lim MS, Win W, Von Essen A, Gannon D, Ramali M. Lessons of the month 1: Shoshin beriberi: A case report of fulminant cardiovascular collapse, intractable hyperlactatemia and deteriorating consciousness. Clin Med (Lond) 2021; 21:e670-e672. [PMID: 34862232 DOI: 10.7861/clinmed.2021-0550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Shoshin beriberi is a fulminant variant of thiamine deficiency, often presenting with severe lactic acidosis and cardiogenic shock. Due to the sparsity of this condition, delays in diagnosis can lead to fatality. However, rapid reversal of symptoms can be easily achieved through intravenous thiamine replacement.In this case report, we discuss a 57-year-old woman, who was previously fit and well, who presented to the emergency department with a 3-day history of extreme malaise, breathlessness and abdominal pain, with marked hypotension and tachycardia requiring vasopressor support and a severe rising lactic acidosis. Upon further questioning, a history of alcohol excess was noted. Rapid reversal of the marked haemodynamic instability was achieved upon administration of intravenous thiamine and the patient was discharged within 48 hours.
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Affiliation(s)
| | - Wutyee Win
- Colchester General Hospital, Colchester, UK
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11
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Ahmad S, Ikram S, Dunn BK. Fatal Wernicke's Encephalopathy with Cardiovascular Involvement in a Young Psychiatric Patient. Am J Med Sci 2021; 363:273-278. [PMID: 34861213 DOI: 10.1016/j.amjms.2021.10.015] [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] [Received: 01/28/2021] [Revised: 06/26/2021] [Accepted: 10/21/2021] [Indexed: 11/01/2022]
Abstract
Wernicke's encephalopathy (WE) is an acute neurological disorder caused by thiamine deficiency that is frequently missed in non-alcoholic patients. Coma and cardiomyopathy are uncommon presentations of WE that have been rarely reported in the literature. We report the case of a 36-year-old male with a known history of schizophrenia who presented with coma and vasopressor refractory hypotension. Initial computed tomography (CT) of the head at admission was unremarkable. Transthoracic echocardiogram showed diffuse myocardial hypokinesia with a left ventricular ejection fraction of 40%-45%. Due to persistent encephalopathy, a repeat non-enhanced CT head was obtained on the second day of hospital admission followed by magnetic resonance imaging (MRI) of brain that showed findings suggestive of WE. The patient was immediately started on high-dose intravenous (IV) thiamine therapy. Although his hemodynamic parameters significantly improved following thiamine replacement, he did not show signs of neurological recovery and resulted in a dismal outcome. This case illustrates the importance of early recognition of thiamine deficiency in critically ill patients to prevent fatal outcomes. Immediate parenteral thiamine administration should be considered in all patients presenting with coma, cardiomyopathy, and refractory hypotension regardless of their body mass index, and alcohol use status.
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Affiliation(s)
- Soban Ahmad
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina, USA.
| | - Sundus Ikram
- Department of Internal Medicine, SEGi University, Kota Damansara, Malaysia
| | - Bryan K Dunn
- Division of Pulmonary, Critical Care, and Sleep Medicine, East Carolina University, Greenville, North Carolina, USA
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12
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Abstract
Beriberi is a nutritional complication of gastric surgery, caused by deficiency of vitamin B1, or thiamine. Thiamine deficiency leads to impaired glucose metabolism, decreased delivery of oxygen by red blood cells, cardiac dysfunction, failure of neurotransmission, and neuronal death. This review describes the history and pathophysiology of beriberi as well as the relationship between beriberi and nutritional deficiencies after gastric surgery. A literature review of the history and pathophysiology of beriberi and the risk factors for thiamine deficiency, particularly after gastric resection or bariatric surgery, was performed. Recommendations for nutritional follow-up post gastric surgery are based on current national guidelines. Patients may have subclinical thiamine deficiency after upper gastrointestinal surgery, and thus beriberi may be precipitated by acute illness such as sepsis or poor dietary intake. This may occur very soon or many years after gastrectomy or bariatric surgery, even in apparently well-nourished patients. Prompt recognition and administration of supplemental thiamine can decrease morbidity and mortality in patients with beriberi. Dietary education post surgery and long-term follow-up to determine nutritional status, including vitamin and mineral assessment, is recommended for patients who undergo gastric surgery.
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Affiliation(s)
- Robert Beaumont Wilson
- Upper Gastrointestinal Surgery Department, University of New South Wales, Liverpool Public Hospital, Liverpool, Sydney, New South Wales, Australia, and the Sydney Institute for Obesity Surgery, Ashfield, Sydney, New South Wales, Australia
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13
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Khan F, Sharma N, Ud Din M, Bansal V. Isolated Pulvinar/Hockey Stick Sign in Nonalcoholic Wernicke's Encephalopathy. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e928272. [PMID: 33380716 PMCID: PMC7784713 DOI: 10.12659/ajcr.928272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Wernicke's encephalopathy (WE), a commonly misdiagnosed and underdiagnosed pathology, presents with altered mental status, ataxia, and ophthalmoplegia. WE is most commonly caused by excessive alcohol use, but also has diverse nonalcoholic etiologies. Here we describe 2 cases of nonalcoholic WE with different etiologies that were initially misdiagnosed due to lack of correlation of magnetic resonance imaging (MRI) findings with clinical information. CASE REPORT Patient A, a 50-year-old woman with recent gastric sleeve surgery, presented with horizontal gaze-evoked nystagmus, ataxia, and altered mental status. MRI fluid-attenuated inversion recovery (FLAIR) revealed isolated bilateral, symmetrical, thalamic hyperintensities, initially diagnosed as variant Creutzfeldt-Jakob disease. A review of imaging and clinical presentation provided an alternate diagnosis of nonalcoholic WE secondary to nutritional deficiency. Intravenous (IV) thiamine improved symptoms with resolution of MRI findings 6 months later. Patient B, a 64-year-old woman, presented with nausea, vomiting, dizziness, altered mental status, and weight loss. MRI FLAIR revealed isolated bilateral, symmetrical, thalamic hyperintensities, initially determined to be ischemia, prompting stroke management. A diagnosis of nonalcoholic WE was suggested, given the patient's low thiamine levels and history of malnutrition, and was confirmed by her excellent therapeutic response to IV thiamine. CONCLUSIONS Nonalcoholic WE remains a challenging diagnosis because of the variable clinical presentation, myriad of underlying etiologies, and lack of standardized diagnostic laboratory tests. A multidisciplinary approach with close collaboration between the radiologist and clinical care team is critical to narrow down the differential and initiate correct management. WE is a reversible disease with catastrophic consequences if it is not recognized and treated promptly.
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Affiliation(s)
- Faisal Khan
- Department of Neurology, Sugar Land Neurology and Sleep, Sugar Land, TX, USA.,Department of Neurology, Sam Houston University College of Osteopathic Medicine, Hunstville, TX, USA
| | - Neha Sharma
- Research Fellow, Houston Medical Clerkship, Sugar Land, TX, USA
| | - Moin Ud Din
- Research Fellow, Houston Medical Clerkship, Sugar Land, TX, USA
| | - Vivek Bansal
- Department of Neuroradiology, Radiology Partners Gulf Coast, Houston, TX, USA
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14
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Smith TJ, Johnson CR, Koshy R, Hess SY, Qureshi UA, Mynak ML, Fischer PR. Thiamine deficiency disorders: a clinical perspective. Ann N Y Acad Sci 2020; 1498:9-28. [PMID: 33305487 PMCID: PMC8451766 DOI: 10.1111/nyas.14536] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022]
Abstract
Thiamine is an essential water‐soluble vitamin that plays an important role in energy metabolism. Thiamine deficiency presents many challenges to clinicians, in part due to the broad clinical spectrum, referred to as thiamine deficiency disorders (TDDs), affecting the metabolic, neurologic, cardiovascular, respiratory, gastrointestinal, and musculoskeletal systems. Concurrent illnesses and overlapping signs and symptoms with other disorders can further complicate this. As such, TDDs are frequently misdiagnosed and treatment opportunities missed, with fatal consequences or permanent neurologic sequelae. In the absence of specific diagnostic tests, a low threshold of clinical suspicion and early therapeutic thiamine is currently the best approach. Even in severe cases, rapid clinical improvement can occur within hours or days, with neurological involvement possibly requiring higher doses and a longer recovery time. Active research aims to help better identify patients with thiamine‐responsive disorders and future research is needed to determine effective dosing regimens for the various clinical presentations of TDDs. Understanding the clinical diagnosis and global burden of thiamine deficiency will help to implement national surveillance and population‐level prevention programs, with education to sensitize clinicians to TDDs. With concerted effort, the morbidity and mortality related to thiamine deficiency can be reduced.
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Affiliation(s)
- Taryn J Smith
- Institute for Global Nutrition, University of California Davis, Davis, California
| | - Casey R Johnson
- Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Roshine Koshy
- Makunda Christian Leprosy and General Hospital, Karimganj, Assam, India
| | - Sonja Y Hess
- Institute for Global Nutrition, University of California Davis, Davis, California
| | - Umar A Qureshi
- G.B. Pant Hospital, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Mimi Lhamu Mynak
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Philip R Fischer
- Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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15
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Didisheim C, Ballhausen D, Choucair ML, Longchamp D, Natterer J, Ferry T, Perez MH, Amiet V. Severe Lactic Acidosis in a Critically Ill Child: Think About Thiamine! A Case Report. J Pediatr Intensive Care 2020; 10:307-310. [PMID: 34745706 DOI: 10.1055/s-0040-1713382] [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: 02/17/2020] [Accepted: 05/14/2020] [Indexed: 10/23/2022] Open
Abstract
In this article, we presented a teenager, in maintenance chemotherapy for leukemia, who was admitted for digestive symptoms related to a parasitic infection and required nutritional support with parenteral nutrition. After 6 weeks, his condition worsened with refractory shock of presumed septic origin, necessitating extracorporeal membrane oxygenation. Despite hemodynamic stabilization, his lactic acidosis worsened until thiamine supplementation was started. Lactate normalized within 12 hours. Thiamine is an essential coenzyme in aerobic glycolysis, and deficiency leads to lactate accumulation through anaerobic glycolysis. Thiamine deficiency is uncommon in the pediatric population. However, it should be considered in patients at risk of nutritional deficiencies with lactic acidosis of unknown origin.
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Affiliation(s)
- Clémence Didisheim
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Diana Ballhausen
- Department of Metabolic Disease, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Marie-Louise Choucair
- Department of Pediatrics, Pediatric Hematology Oncology Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - David Longchamp
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Julia Natterer
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Thomas Ferry
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Marie-Hélène Perez
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Vivianne Amiet
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
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16
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Affiliation(s)
- Ashwin Jiawan
- Department of Cardiology, Waterland Ziekenhuis, Purmerend, the Netherlands
| | - Kenneth Tandjung
- Department of Cardiology, Waterland Ziekenhuis, Purmerend, the Netherlands
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17
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Hodgkinson LM, Shah A, Bae GH, Novoa R, Kwong BY. Shoshin beriberi in a patient with oral and cutaneous graft-versus-host disease. JAAD Case Rep 2020; 6:420-421. [PMID: 32382634 PMCID: PMC7200185 DOI: 10.1016/j.jdcr.2020.02.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Aatman Shah
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Gordon H Bae
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Roberto Novoa
- Department of Dermatology, Stanford University School of Medicine, Stanford, California.,Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Bernice Y Kwong
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
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18
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Ehsanian R, Anderson S, Schneider B, Kennedy D, Mansourian V. Prevalence of Low Plasma Vitamin B1 in the Stroke Population Admitted to Acute Inpatient Rehabilitation. Nutrients 2020; 12:nu12041034. [PMID: 32290066 PMCID: PMC7230706 DOI: 10.3390/nu12041034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine the prevalence of vitamin B1 (VitB1) deficiency in the stroke population admitted to acute inpatient rehabilitation. DESIGN Retrospective cohort study. SETTING Acute inpatient rehabilitation facility at an academic medical center. PARTICIPANTS 119 consecutive stroke patients admitted to stroke service from 1 January 2018 to 31 December 2018. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Plasma VitB1 level. RESULTS There were 17 patients (14%; 95% CI 9-22%) with low VitB1 with a range of 2-3 nmol/L, an additional 58 (49%; CI 40-58%) patients had normal low VitB1 with a range of 4-9 nmol/L, twenty-five patients (21%; CI 15-29%) had normal high VitB1 with a range of 10-15 nmol/L, and nineteen patients (16%; CI 10-24%) had high VitB1 with a range of 16-43 nmol/L. CONCLUSIONS In this cohort of patients admitted to the stroke service at an acute rehabilitation facility, there is evidence of thiamine deficiency. Moreover, the data suggest that there is inadequate acute intake of VitB1. Given the role of thiamine deficiency in neurologic function, further study of the role of thiamine optimization in the acute stroke rehabilitation population is warranted.
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Affiliation(s)
- Reza Ehsanian
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
- Department of Neurosurgery, Stanford University, Palo Alto, CA 34304, USA
- Division of Physical Medicine and Rehabilitation, Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Sean Anderson
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
| | - Byron Schneider
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
| | - David Kennedy
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
| | - Vartgez Mansourian
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
- Correspondence: ; Tel.: +615-936-7708
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19
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Gwathmey KG, Grogan J. Nutritional neuropathies. Muscle Nerve 2019; 62:13-29. [PMID: 31837157 DOI: 10.1002/mus.26783] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 12/07/2019] [Accepted: 12/07/2019] [Indexed: 12/17/2022]
Abstract
Neuropathies associated with nutritional deficiencies are routinely encountered by the practicing neurologist. Although these neuropathies assume different patterns, most are length-dependent, sensory axonopathies. Cobalamin deficiency neuropathy is the exception, often presenting with a non-length-dependent sensory neuropathy. Patients with cobalamin and copper deficiency neuropathy characteristically have concomitant myelopathy, whereas vitamin E deficiency is uniquely associated with a spinocerebellar syndrome. In contrast to those nutrients for which deficiencies produce neuropathies, pyridoxine toxicity results in a non-length-dependent sensory neuronopathy. Deficiencies occur in the context of malnutrition, malabsorption, increased nutrient loss (such as with dialysis), autoimmune conditions such as pernicious anemia, and with certain drugs that inhibit nutrient absorption. When promptly identified, therapeutic nutrient supplementation may result in stabilization or improvement of these neuropathies.
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Affiliation(s)
| | - James Grogan
- University of Virginia, Charlottesville, Virginia
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20
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Elias IM, Sinclair G, Blydt-Hansen TD. Acute Shoshin beriberi syndrome immediately post-kidney transplant with rapid recovery after thiamine administration. Pediatr Transplant 2019; 23:e13493. [PMID: 31124207 DOI: 10.1111/petr.13493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/27/2022]
Abstract
Pediatric kidney transplant surgery is usually well tolerated, despite suboptimal physical conditioning that may result from uremia and nutritional deficiencies that accompany end-stage kidney failure. Nutritional supplementation is used to overcome such deficiencies, especially for children needing dialysis. Thiamine, a water-soluble vitamin also known as vitamin B1, is a critical cofactor in energy metabolism and may be competitively inhibited by the antimetabolite oxythiamine, a uremic toxin that accumulates in kidney failure. We report a case of a thiamine deficiency syndrome leading to overwhelming cardiac dysfunction, metabolic instability, and hemodynamic compromise, after otherwise uneventful kidney transplant surgery. Prior to transplant, this 14-year-old boy was treated with peritoneal dialysis and received thiamine supplementation. Post-transplant, the patient first developed hyperglycemia, then lactic acidosis, and subsequently hemodynamic instability despite escalating treatment with volume resuscitation and inotropic medication. He made a rapid and complete recovery after administration of IV thiamine. This is the first reported case of Shoshin beriberi syndrome in a pediatric kidney transplant recipient. Inadequate dialysis may have been a key factor, with toxin accumulation and thiamine transporter downregulation contributing to his status. Functional thiamine deficiency should be considered as a potential treatable cause of early post-transplant hemodynamic instability.
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Affiliation(s)
- Isaac M Elias
- Multi Organ Transplant Program, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Graham Sinclair
- Department of Pathology and Laboratory Medicine, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Tom D Blydt-Hansen
- Multi Organ Transplant Program, BC Children's Hospital, Vancouver, British Columbia, Canada
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21
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Shockingly Deficient: An Elderly Woman with Refractory Hypotension and Acidosis. Ann Am Thorac Soc 2019; 14:1021-1024. [PMID: 28570152 DOI: 10.1513/annalsats.201612-1020cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Micronutrient Deficiencies in Medical and Surgical Inpatients. J Clin Med 2019; 8:jcm8070931. [PMID: 31261695 PMCID: PMC6678268 DOI: 10.3390/jcm8070931] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/17/2019] [Accepted: 06/21/2019] [Indexed: 02/06/2023] Open
Abstract
Inpatients are threatened by global malnutrition, but also by specific micronutrient (i.e., trace element and vitamins) deficiencies that frequently are overseen in the differential diagnosis of major organ dysfunctions. Some of them are related to specific geographic risks (iodine, iron, selenium, zinc, vitamin A), while others are pathology related, and finally many are associated with specific feeding patterns, including low dose enteral feeding. Among the pathologies in which laboratory blood investigations should include a micronutrient outwork, anemia is in the front line, followed by obesity with bariatric surgery, chronic liver disease, kidney disease, inflammatory bowel disease, cardiomyopathies and heart failure. The micronutrients at the highest risk are iron, zinc, thiamine, vitamin B12 and vitamin C. Admission to hospital has been linked with an additional risk of malnutrition—feeding below 1500 kcal/day was frequent and has been associated with a structural additional risk of insufficient micronutrient intake to cover basal needs. Although not evidence based, systematic administration of liberal thiamine doses upon admission, and daily complementation of inpatients’ food and enteral feeding solutions with multi-micronutrient tablets might be considered.
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23
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Polegato BF, Pereira AG, Azevedo PS, Costa NA, Zornoff LAM, Paiva SAR, Minicucci MF. Role of Thiamin in Health and Disease. Nutr Clin Pract 2019; 34:558-564. [DOI: 10.1002/ncp.10234] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Bertha F. Polegato
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Amanda G. Pereira
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Paula S. Azevedo
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Nara A. Costa
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Leonardo A. M. Zornoff
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Sergio A. R. Paiva
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
| | - Marcos F. Minicucci
- Internal Medicine Department; Medical School; São Paulo State University (Unesp); Botucatu São Paulo Brazil
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25
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Attaluri P, Castillo A, Edriss H, Nugent K. Thiamine Deficiency: An Important Consideration in Critically Ill Patients. Am J Med Sci 2018; 356:382-390. [PMID: 30146080 DOI: 10.1016/j.amjms.2018.06.015] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
Thiamine is an essential cofactor for 4 enzymes involved in the production of energy (ATP) and the synthesis of essential cellular molecules. The total body stores of thiamine are relatively small, and thiamine deficiency can develop in patients secondary to inadequate nutrition, alcohol use disorders, increased urinary excretion and acute metabolic stress. Patients with sepsis are frequently thiamine deficient, and patients undergoing surgical procedures can develop thiamine deficiency. This deficiency can cause congestive heart failure, peripheral neuropathy, Wernicke's encephalopathy, Korsakoff's syndrome and gastrointestinal beriberi. In addition, thiamine deficiency can contribute to the development of intensive care unit complications, such as heart failure, delirium, critical care neuropathy, gastrointestinal dysfunction and unexplained lactic acidosis. Consequently, clinicians need to consider thiamine deficiency in patients admitted to intensive care units and the development of thiamine deficiency during the management of critically ill patients. Intravenous thiamine can correct lactic acidosis, improve cardiac function and treat delirium.
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Affiliation(s)
- Pradeep Attaluri
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Austin Castillo
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Hawa Edriss
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
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26
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Lei Y, Zheng MH, Huang W, Zhang J, Lu Y. Wet beriberi with multiple organ failure remarkably reversed by thiamine administration: A case report and literature review. Medicine (Baltimore) 2018; 97:e0010. [PMID: 29489643 PMCID: PMC5851725 DOI: 10.1097/md.0000000000010010] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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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28
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Beriberi Induced Cardiomyopathy Requiring Salvage Venoarterial Extracorporeal Membrane Oxygenation. Case Rep Crit Care 2016; 2016:5043818. [PMID: 28050289 PMCID: PMC5165147 DOI: 10.1155/2016/5043818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/13/2016] [Accepted: 11/20/2016] [Indexed: 11/23/2022] Open
Abstract
Beriberi refers to a constellation of symptoms caused primarily by thiamine (vitamin B1) deficiency. An acute and fulminant presentation of this rare condition has been described in the literature as “Shoshin” beriberi which is characterized by catastrophic cardiovascular collapse. Early recognition and treatment lead to dramatic improvements of symptoms. We present a case of thiamine deficiency-induced acute heart failure in a malnourished patient leading to cardiac arrest necessitating VA-ECMO (venoarterial extracorporeal membrane oxygenation) with improvement in heart function secondary to thiamine administration.
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29
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van Snippenburg W, Reijnders MGJ, Hofhuis JGM, de Vos R, Kamphuis S, Spronk PE. Thiamine Levels During Intensive Insulin Therapy in Critically Ill Patients. J Intensive Care Med 2016; 32:559-564. [DOI: 10.1177/0885066616659429] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: Thiamine is an essential cofactor in carbohydrate metabolism, and deficiency can therefore cause various organ dysfunctions. Little is known about the prevalence and possible worsening of thiamine deficiency in critically ill patients. In this study, we investigated the prevalence of thiamine deficiency at admission to the intensive care unit (ICU) and hypothesized that intensive insulin therapy, aimed at regulating glucose levels, increases thiamine utilization and therefore might cause or worsen deficiency in patients with limited thiamine stores. Materials and Methods: An observational prospective cohort study was carried out in a medical–surgical ICU in a general teaching hospital in Apeldoorn, the Netherlands. All adults who were treated during that time with intensive insulin therapy were included. Deficiency was defined as a thiamine level <100 nmol/L. No thiamine supplementation was administered except for normal amounts present in standard enteral feeding. Results: A total of 58 patients were available for analysis. Median thiamine level at admission was 111 nmol/L. Deficiency was present in 39.7% of patients and was significantly associated with the presence of gastrointestinal pathology and with recent surgery. Thiamine levels increased a median of 14 nmol/L in 48 hours. Only 3.4% of patients showed a predefined relevant decline in thiamine levels. Conclusion: Intensive insulin therapy does not appear to cause or worsen thiamine deficiency. However, based on the high prevalence of deficiency at admission, it might be warranted to supplement thiamine in all patients admitted to the ICU, especially when there is an underlying gastrointestinal disease or recent surgery.
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Affiliation(s)
| | | | - Jose G. M. Hofhuis
- Department of Intensive Care, Gelre Hospitals, Apeldoorn, the Netherlands
| | - Rien de Vos
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Stephan Kamphuis
- Department of Clinical Chemistry and Hematology, Gelre Hospitals, Apeldoorn, the Netherlands
| | - Peter E. Spronk
- Department of Intensive Care, Gelre Hospitals, Apeldoorn, the Netherlands
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30
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Mallat J, Lemyze M, Thevenin D. Do not forget to give thiamine to your septic shock patient! J Thorac Dis 2016; 8:1062-6. [PMID: 27293820 DOI: 10.21037/jtd.2016.04.32] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jihad Mallat
- 1 Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier du Dr. Schaffner de Lens, Lens Cedex, France ; 2 Intensive Care Unit, Centre Hospitalier d'Arras, Arras, France
| | - Malcolm Lemyze
- 1 Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier du Dr. Schaffner de Lens, Lens Cedex, France ; 2 Intensive Care Unit, Centre Hospitalier d'Arras, Arras, France
| | - Didier Thevenin
- 1 Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier du Dr. Schaffner de Lens, Lens Cedex, France ; 2 Intensive Care Unit, Centre Hospitalier d'Arras, Arras, France
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31
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Yamamura M, Murai H, Kaneko S, Usui S, Furusho H, Takamura M. Case report: pericardial effusion with constrictive physiology in a patient with wet beriberi. Nutr J 2016; 15:37. [PMID: 27059308 PMCID: PMC4826515 DOI: 10.1186/s12937-016-0156-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/05/2016] [Indexed: 12/01/2022] Open
Abstract
Wet beriberi-induced pericardial effusion has rarely been previously described. Little is known about the effect of beriberi-induced pericardial effusion on hemodynamics. Here we present a case of wet beriberi with pericardial effusion that exhibited constrictive physiology, which was dramatically improved after treatment. A 61-year-old male patient was admitted to our hospital for progressive leg edema, dyspnea on exertion, and lower-extremity muscle weakness. Echocardiography showed a hyperkinetic left ventricle and a moderate amount of pericardial effusion. Hemodynamic measurements, including simultaneous measurement of left and right ventricular pressures, revealed high output heart failure and constrictive physiology. Blood test showed lactic acidosis, and low level of serum thiamine levels; consistent with a diagnosis of wet beriberi. After thiamine replacement therapy, the patient’s hemodynamic state rapidly improved. Additionally, pericardial effusion decreased and constrictive physiology was successfully resolved. No other possible causes of pericardial effusion could be identified, with the exception of thiamine deficiency. This case illustrates the importance of considering wet beriberi as a possible cause of pericardial effusion with constrictive physiology.
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Affiliation(s)
- Minako Yamamura
- Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa, University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hisayoshi Murai
- Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa, University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Shuichi Kaneko
- Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa, University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Soichiro Usui
- Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa, University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hiroshi Furusho
- Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa, University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Masayuki Takamura
- Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa, University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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Abstract
High-output heart failure is not seen as commonly as low-output heart failure and some of the typical guideline recommendations may not benefit patients with high-output failure. High-output failure is caused by several diseases, including thyrotoxicosis and beriberi, highlighted in this article. Thyrotoxicosis, caused by excessive thyroid hormone production, has profound hemodynamic effects. Wet beriberi, affecting predominately the cardiovascular system, is caused by severe thiamine deficiency, most commonly seen in patients with chronic alcoholism or poor nutrition from other causes. Prompt recognition of these infrequently seen syndromes is essential. This article outlines the medical treatment and nursing care needed to return these patients to a normal state.
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