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Clinical nutrition

Atypical presentation of a forgotten disease: refractory hypotension in beriberi

Abstract

Background/Objectives

Thiamine deficiency is a treatable disease with an excellent prognosis. However, it is often unrecognized because of the diversity of its clinical presentations.

Subjects/Methods

Herein, we report two atypical cases of nonalcoholic thiamine deficiency that presented with refractory hypotension in the absence of lactic acidosis.

Results

Case 1 developed recurrent hypotension, right-sided heart failure, and a classic triad of Wernicke’s encephalopathy (WE) after gastrointestinal surgery. Case 2 had decreased dietary intake and diuretic abuse, and had multiple episodes of syncope prior to present admission with refractory hypotension and mental status changes. The diagnosis of both cases was confirmed by undetectable pretreatment serum thiamine and dramatic improvement with thiamine replacement.

Conclusions

In this report, we highlight refractory hypotension as a complication of, not only cardiovascular, but also neurologic beriberi. Moreover, thiamine replacement should be considered without delay in hypotensive patients with signs of WE and/or risk factors for beriberi.

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Authors and Affiliations

Authors

Contributions

PP was involved in patient care, responsible for extracting the clinical data, describing the case, involved in literature review and writing the manuscript. ST contributed to literature review and writing the manuscript. AM was involved in literature review and provided feedback on the report. JDP critically reviewed the report. KN was involved in patient care and critical review of the report.

Corresponding author

Correspondence to Kenneth Nugent.

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The authors declare that they have no conflict of interest.

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Pachariyanon, P., Thakolwiboon, S., Motes, A. et al. Atypical presentation of a forgotten disease: refractory hypotension in beriberi. Eur J Clin Nutr 73, 1598–1600 (2019). https://doi.org/10.1038/s41430-019-0469-y

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  • DOI: https://doi.org/10.1038/s41430-019-0469-y

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