Vitamin deficiencies are an emerging concern in the management of children with autism spectrum disorder (ASD). Particular attention is required for recognizing the variable signs caused by unbalanced food intakes. We herein report two patients with multiple vitamin deficiencies who needed critical care showing different prognoses. Patient 1 with ‘Shoshin’ beriberi presenting with cardiac arrest had thiamine deficiency developed severe neurological sequelae despite rapid vitamin supplementation. Patient 2, who had leg pain and a limping gait, showed a rapid recovery with intravenous infusion and tube feeding after being diagnosed with scurvy. A literature search revealed several children with ASD with critically ill thiamine deficiency, but few reports documented a life-threatening condition in the form of cardiac arrest at the onset. Considering the high observation rate of food selectivity in children with ASD, early intervention is required to prevent the exacerbation of vitamin deficiencies to severe neurological disabilities.
Your institute does not have access to this article
Subscribe to Journal
Get full journal access for 1 year
only $9.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Get time limited or full article access on ReadCube.
All prices are NET prices.
Data are available within the article or its supplementary materials.
Sharp WG, Berry RC, McCracken C, Nuhu NN, Marvel E, Saulnier CA, et al. Feeding problems and nutrient intake in children with autism spectrum disorders: a meta-analysis and comprehensive review of the literature. J Autism Dev Disord. 2013;43:2159–73.
Yule S, Wanik J, Holm EM, Bruder MB, Shanley E, Sherman CQ, et al. Nutritional deficiency disease secondary to ARFID symptoms associated with autism and the broad autism phenotype: A qualitative systematic review of case reports and case series. J Acad Nutr Diet. 2021;121:467–92.
Adachi S, Torio M, Okuzono S, Motomura Y, Ichimiya Y, Sonoda Y, et al. Vitamin A deficiency-associated corneal perforation in a boy with autism spectrum disorder: a case report and literature review. Nutrition. 2021;90:111275.
Baird JS, Ravindranath TM. Vitamin B deficiencies in a critically ill autistic child with a restricted diet. Nutr Clin Pract. 2015;30:100–3.
Sechi G, Serra A. Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007;6:442–55.
Watanabe S, Yamakura S, Hirano K, Okumura Y, Aiba H. Case of infantile autism with pediatric Wernicke’s encephalopathy due to severe eating disorder. No To Hattatsu. 2009;41:43–46.
Ma NS, Thompson C, Weston S. Brief report: scurvy as a manifestation of food selectivity in children with autism. J Autism Dev Dis. 2016;46:1464–70.
Duvall MG, Pikman Y, Kantor DB, Ariagno K, Summers L, Sectish TC, et al. Pulmonary hypertension associated with scurvy and vitamin deficiencies in an autistic child. Pediatrics. 2013;132:e1699–1703.
Doseděl M, Jirkovský E, Macáková K, Krčmová LK, Javorská L, Pourová J, et al. Vitamin C-sources, physiological role, kinetics, deficiency, use, toxicity, and determination. Nutrients. 2021;13.
Golriz F, Donnelly LF, Devaraj S, Krishnamurthy R. Modern American scurvy - experience with vitamin C deficiency at a large children’s hospital. Pediatr Radiol. 2017;47:214–20.
We thank the patients and their families for cooperating with our study as well as Yuichi Mushimoto, Kanako Ishii, Ryoji Taira, Kousuke Yonemoto and the co-medical staff in our hospital for their helpful discussion. This study was supported by JSPS KAKENHI grant numbers JP19K10613 (Chong), JP19K08281 (Sakai); AMED under the grant number JP20ek0109411, JP20wm0325002h; a research grant for prion diseases from the Ministry of Health, Labour and Welfare of Japan (JP20FC1054, Sakai); The Japan Epilepsy Research Foundation, and Kawano Masanori Memorial Public Interest Incorporated Foundation for Promotion of Pediatrics (Sakai). The funders had no role in the study design, writing of the report or decision to submit the article for publication.
The authors declare no competing interests.
Ethics approval and consent to participate
This study was performed in stringent compliance with the protocol approved by the institutional review board at Kyushu University (#2021-306). Written informed consent was obtained from the parents for the content of this report. Multidisciplinary, repeated discussions were held before making a decision on tracheostomy for Patient 1. The members included physicians with different subspecialties, nurses, psychologists, medical social workers and the ethics board at Kyushu University Hospital.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Chong, P.F., Torio, M., Fujii, F. et al. Critical vitamin deficiencies in autism spectrum disorder: Reversible and irreversible outcomes. Eur J Clin Nutr (2022). https://doi.org/10.1038/s41430-022-01170-x