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Cureus Jul 2022Thiamine, also known as vitamin B1, plays a fundamental role in energy metabolism. The organs most sensitive to thiamine deficiency are the cardiovascular and nervous...
Thiamine, also known as vitamin B1, plays a fundamental role in energy metabolism. The organs most sensitive to thiamine deficiency are the cardiovascular and nervous systems. The usual presentations include Wernicke's encephalopathy, polyneuropathy (known as "dry beriberi"), and the cardiovascular form (known as "wet beriberi"). Wet beriberi-induced acute severe pulmonary hypertension has rarely been previously described. Here we present a case of wet beriberi with severe right heart failure due to acute pulmonary hypertension. The underlying physiologic derangements dramatically improved after thiamine treatment. No other possible causes of pulmonary hypertension could be identified, with the exception of thiamine deficiency. This case illustrates the importance of considering wet beriberi as a possible cause of acute pulmonary hypertension with right heart failure.
PubMed: 36046304
DOI: 10.7759/cureus.27376 -
Cureus Jul 2022Wernicke's encephalopathy (WE) is a manifestation of thiamine deficiency. The majority of affected patients are alcoholics and are adults. Often, clinicians fail to...
Wernicke's encephalopathy (WE) is a manifestation of thiamine deficiency. The majority of affected patients are alcoholics and are adults. Often, clinicians fail to recognize that WE can also be found in non-alcoholic patients at risk for thiamine deficiency. Sometimes patients may not present with all the classic features, or the individual clinical signs may be treated as single problems and not a constellation of signs that form a diagnosis of WE. We present a unique case of a four-year-old male with a past medical history of food aversion who presented with intractable vomiting and weakness. The patient's clinical features showed signs of severe dehydration and weight loss. His clinical state subsequently progressed to having ophthalmoplegia and gait ataxia. Brain MRI demonstrated mamillary body changes, and serum thiamine level was significantly below the normal limit. Based on the patient's clinical assessment, deficient serum thiamine, and MRI findings, WE was diagnosed. The patient was evaluated by Pediatric Neurology and started on treatment with high dose IV thiamine. He showed an excellent response to thiamine treatment and had a significant resolution in his symptoms before discharge.
PubMed: 36039248
DOI: 10.7759/cureus.27260 -
Case Reports in Surgery 2022Gallbladder disease is a common condition after gastric bypass surgery. Even after weight loss, many bariatric patients continue to suffer from comorbid conditions....
BACKGROUND
Gallbladder disease is a common condition after gastric bypass surgery. Even after weight loss, many bariatric patients continue to suffer from comorbid conditions. Takotsubo cardiomyopathy is a rare condition that mimics acute cardiac ischemia but seems to be caused by a catecholamine storm triggered by intense stress. . A 62-year-old female presented with acute right upper quadrant (RUQ) pain to the ER. She had a history of laparoscopic gastric bypass 5 years ago and had been noncompliant for 2 years. This noncompliance included missing follow-up appointments, gaining weight which caused poorly controlled DM, and not taking her vitamin supplements. Upon presentation, her WBC was elevated, her LFTs were normal, and imaging showed acute calculous cholecystitis. She was admitted and started on antibiotics with plans for laparoscopic cholecystectomy. The next day, she developed acute chest pain, and troponins were elevated with ST changes on EKG. Echocardiography showed a ballooned left ventricle indicative for Takotsubo cardiomyopathy. Symptomatic treatment including antibiotics, betablocker, and thiamine infusion was initiated. At three-month follow-up, ejection fraction had improved from <20% to >50%. The patient underwent interval laparoscopic cholecystectomy, which was technically very challenging due to severe ongoing acute and chronic cholecystitis. There were no cardiac issues, but the patient developed an abscess in the gallbladder fossa, which was successfully treated with oral antibiotics.
CONCLUSIONS
Takotsubo cardiomyopathy complicating acute cholecystitis has thus far not been reported. Our patient had a history of gastric bypass and was noncompliant with vitamin supplementation. Thiamine deficiency may have contributed to the cardiac condition (wet beriberi).
PubMed: 35845615
DOI: 10.1155/2022/5416092 -
International Journal of Surgery Case... Jul 2022Sleeve gastrectomy (SG) is a popular surgery for morbid obesity because of minimal complications, while somewhere uncommon micronutrient deficiencies occur that make...
INTRODUCTION AND IMPORTANCE
Sleeve gastrectomy (SG) is a popular surgery for morbid obesity because of minimal complications, while somewhere uncommon micronutrient deficiencies occur that make problems. One of these rare complications is dry beriberi (BB).
CASE PRESENTATION
A 20-year-old girl with obesity that a few months after SG had non-specific symptoms like nausea, vomiting, debilitating weakness, burning, and tingling in her feet, which led to more tests and imaging and confused the physicians. During the next two months, she had a 40 kg weight loss. The critical test that helped diagnosis was Electromyography and Nerve Conduction Velocity (EMG/NCV), which showed subacute axonal sensory-motor polyneuropathy and decreased level of vitamin B1, proved the patient's diagnosis was dray BB.
CLINICAL DISCUSSION
SG may contribute to vitamin and trace elements deficiency development. One of the micronutrients that deficiencies can disturb the patient is vitamin B1 deficiency. Vitamin B1 deficiencies could be demonstrated with peripheral polyneuropathy, beriberi, or Wernicke-Korsakoff syndrome. Based on decreased vitamin B1 and EMG/NCV results, the diagnosis had been dry beriberi corrected with supplement therapy.
CONCLUSION
Thiamine deficiency should be suspected in all patients with vomiting, neurological symptoms, and rapid weight loss post-bariatric surgery (BS), even after restrictive surgery. Especially when a patient reports substantial weight loss and vomiting in short order. Hopefully, this case report will make any patient hospitalized with similar conditions evaluated for beriberi and again multivitamin supplementation therapy after SG is emphasized.
PubMed: 35779318
DOI: 10.1016/j.ijscr.2022.107357 -
Cureus May 2022A 30-year-old Turkish male was found lethargic and surrounded by vomit. At the hospital, severe hypernatremic dehydration and acute kidney failure were evident. His...
A 30-year-old Turkish male was found lethargic and surrounded by vomit. At the hospital, severe hypernatremic dehydration and acute kidney failure were evident. His conscious level improved with fluid resuscitation. A differential diagnosis of altered mental status was considered. A complete clinical triad of Wernicke encephalopathy (WE), supported by MRI findings, was compatible with thiamine deficiency. Previous bariatric surgery was later confirmed. Despite no clinical signs of heart failure, a high level of NT-proBNP (N-terminal prohormone brain natriuretic peptide) and a dilated, hypokinetic myocardiopathy detected on the echocardiogram led us to assume beri-beri heart disease. High-dose intravenous thiamine, ACE (angiotensin conversing enzyme) inhibitors, beta-blockers, and physical therapy were initiated with remarkable improvement in his clinical condition.
PubMed: 35663705
DOI: 10.7759/cureus.24692 -
The American Journal of Case Reports Mar 2022BACKGROUND Thiamine deficiency often occurs in patients with alcohol abuse and unbalanced diets. However, gastric surgery and/or use of diuretics can also cause this...
BACKGROUND Thiamine deficiency often occurs in patients with alcohol abuse and unbalanced diets. However, gastric surgery and/or use of diuretics can also cause this situation. Importantly, thiamine deficiency can cause pulmonary hypertension, which is completely reversible. This report is of a case of a 67-year-old woman who presented with pulmonary hypertension and thiamine deficiency following partial gastrectomy and exacerbated by diuretics. CASE REPORT A 67-year-old woman with histories of partial gastrectomy because of non-Hodgkin lymphoma (at age 36 years) and sigmoid colectomy because of colon cancer (at age 58 years) presented with bilateral leg edema and dyspnea on exertion. Electrocardiography and right heart catheterization revealed pulmonary hypertension. Despite diuretic administration (initially indapamide, then changed to torsemide), the symptoms gradually worsened. Although she was neither an alcohol drinker nor a fussy eater, we found that her blood thiamine concentration was extremely low. We diagnosed her as having thiamine deficiency caused by gastrectomy and administered diuretics. After intravenous thiamine administration, her symptoms showed immediate improvement, associated with the normalization of the pulmonary hypertension. After detailed analysis of the cause of her pulmonary hypertension, including Swan-Ganz catheterization and echocardiography, we concluded that her pulmonary hypertension was caused by thiamine deficiency following partial gastrectomy and exacerbated by diuretics. CONCLUSIONS This case highlights the importance of recognizing that thiamine deficiency can be a cause of pulmonary hypertension, and that thiamine deficiency can be associated with gastrectomy and the use of diuretics.
Topics: Adult; Aged; Beriberi; Diuretics; Female; Gastrectomy; Humans; Hypertension, Pulmonary; Middle Aged; Thiamine Deficiency
PubMed: 35296632
DOI: 10.12659/AJCR.935308 -
Cureus Jan 2022Beriberi neuropathy (thiamine deficiency) and Guillian-Barre Syndrome (GBS) both can present with areflexia and progressive ascending weakness. A physical examination...
Beriberi neuropathy (thiamine deficiency) and Guillian-Barre Syndrome (GBS) both can present with areflexia and progressive ascending weakness. A physical examination can be equivocal between the two. In cases where GBS is suspected clinically but initial work-up with cerebral spinal fluid (CSF) studies and magnetic resonance imaging (MRI) of the spine are not diagnostic, nerve conduction study/electromyography (NCS/EMG) should be done to evaluate beriberi neuropathy. Presumptive treatment should be started while awaiting confirmation from nutritional laboratory investigations. Here we present a rare case of a GBS mimic involving a 17-year-old patient with food restriction that led to thiamine deficiency causing beriberi neuropathy and Wernicke encephalopathy.
PubMed: 35198322
DOI: 10.7759/cureus.21417 -
Internal Medicine (Tokyo, Japan) Oct 2022Biguanide 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...
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.
Topics: Acidosis, Lactic; Beriberi; Biguanides; Diabetes Mellitus, Type 2; Heart Diseases; Humans; Hypoglycemic Agents; Metformin; Renal Dialysis; Thiamine; Thiamine Deficiency
PubMed: 35135918
DOI: 10.2169/internalmedicine.8697-21 -
Frontiers in Psychology 2021Consumers often feel embarrassed when buying products like condoms, hemorrhoid cream, and beriberi cream in crowded pharmacies. There is an interesting phenomenon in...
Consumers often feel embarrassed when buying products like condoms, hemorrhoid cream, and beriberi cream in crowded pharmacies. There is an interesting phenomenon in life: Some beriberi creams use the images of a "real foot", while others use the images of a "cartoon foot." Imagine if a young woman needed to go to a retail store for beriberi cream that would embarrass her, she would choose a "real foot image" or a "cartoon foot image" beriberi cream? It has been shown that the embarrassment of these products has a strong negative impact on consumer buying behavior. Previous researches have explored how changing packaging elements of embarrassing products (e.g., color/design/image placement) can effectively reduce consumer embarrassment. However, few have examined the impact of different image types of embarrassing product packaging (artificial vs. natural) with embarrassment. Therefore, this research explores the effect of image types (artificial vs. natural) on consumers' willingness to purchase embarrassing products and reveals the mechanisms of the underlying effects. The results show that natural images can lead to lower purchase intention of embarrassing products when the advertisement uses first-person pronouns due to the mediating role played by negative body imagery. However, there is no significant difference in purchase intention between different image types in the third-person pronouns. Finally, this paper discusses its contributions and limitations.
PubMed: 35126246
DOI: 10.3389/fpsyg.2021.796998 -
Obstetric Medicine Dec 2021Thiamine (vitamin B1) is a sulfur-containing, water-soluble vitamin that plays an essential role in energy metabolism and the tricarboxylic acid cycle. There is an...
Thiamine (vitamin B1) is a sulfur-containing, water-soluble vitamin that plays an essential role in energy metabolism and the tricarboxylic acid cycle. There is an increased need for vitamin B1 (1-1.2 mg daily) during pregnancy and lactation. Hyperemesis during pregnancy can cause severe polyneuropathy (Wernicke's encephalopathy) as a result of thiamine deficiency. Thiamine deficiency has also been associated with beriberi. A number of atypical cases with reversible right heart failure and severe pulmonary hypertension have also been reported in non-pregnant individuals, but have never been reported in pregnancy. Here we present five such cases of thiamine deficiency with neurological and cardio-pulmonary manifestations.
PubMed: 34880943
DOI: 10.1177/1753495X20960906