Thiamine (vitamin B1) serves as an important cofactor in body metabolism and energy production. It is related with the biosynthesis of neurotransmitters and the production of substances used in defense against oxidant stress. Thus, a lack of thiamine affects several organ systems, in particular the cardiovascular and nervous system. The cardiac insufficiency caused by thiamine deficiency is known as cardiac beriberi, with this condition resulting from unbalanced nutrition and chronic excessive alcohol intake. Given that the disease is now very rare in developed nations such as Korea, it is frequently missed by cardiologists, with potentially fatal consequences. Herein, we present a case study in order to draw attention to cardiac beriberi. We believe that this case will be helpful for young cardiologists, reminding them of the importance of this forgotten but memorable disease.
Beriberi ; Cardiovascular System ; Developed Countries ; Korea ; Nervous System ; Thiamine ; Thiamine Deficiency

Wernicke encephalopathy is usually accompanied with peripheral neuropathy, known as dry beriberi. In contrast, wet beriberi presenting as cardiovascular symptoms rarely occurs. The acute type of wet beriberi can be fatal, if untreated quickly. It is reported that the cerebellar vermis has a role of the coordination and control of cardiovascular and autonomic reflex activities. We report a 58-year-old man showing acute wet beriberi in Wernicke encephalopathy with cerebellar vermis lesion.
Beriberi* ; Cerebellar Vermis ; Humans ; Middle Aged ; Peripheral Nervous System Diseases ; Reflex ; Wernicke Encephalopathy*

High cardiac output heart failure (HCOHF) occurs in the setting of increased cardiac output, such as with chronic anemia, hyperthyroidism, beriberi, pregnancy, and an arteriovenous (AV) fistula. Of these, chronic anemia is a rare cause of HCOHF and its pathophysiology remains unknown. This report is about a patient with chronic anemia who presented with heart failure and severe tricuspid regurgitation. The severity of the tricuspid regurgitation and the patient's symptoms and signs were improved on correcting the anemia.
Anemia ; Beriberi ; Cardiac Output ; Cardiac Output, High ; Fistula ; Heart ; Heart Failure ; Humans ; Hyperthyroidism ; Pregnancy ; Tricuspid Valve Insufficiency

Wet beriberi and Wernicke's encephalopathy (WE) are caused by thiamine deficiency and are potentially lethal and serious diseases. Thiamine deficiency occurs mainly due to poor oral intake or inadequate provision of thiamine in enteral or parenteral nutrition therapy. We report cases of wet beriberi and WE that developed after surgery in a surgical intensive care unit. The first patient, who was diagnosed with wet beriberi, underwent right total mastectomy and radical subtotal gastrectomy, simultaneously. The second was diagnosed with irreversible WE, respectively, due to long-term malnutrition. In both cases, intravenous replacement of thiamine was initiated after the admission to the surgical intensive care unit. However, comatose mentality of the second patient did not improve. As a result, we conclude that, if a patient's clinical feature is suspected to be thiamine deficiency, prompt intravenous thiamine replacement is needed.
Beriberi ; Coma ; Critical Illness ; Gastrectomy ; Humans ; Critical Care ; Malnutrition ; Mastectomy, Simple ; Parenteral Nutrition ; Thiamine ; Thiamine Deficiency ; Wernicke Encephalopathy

Cardiac beriberi is caused by thiamine deficiency. Shoshin beriberi is a rare and fulminant form of cardiac beriberi characterized by hypotension, high output heart failure, lactic acidosis and anuria. Without early recognition and immediate treatment, most of these patients will be fatal. Therefore clinical diagnosis of shoshin beriberi is most important in emergency situation. We report a case of shoshin beriberi with clinical features mimicking acute coronary syndrome. Fifty year old male patient with chronic alcoholism was presented with shock, hypoxia, right heart failure and severe acidosis. Electrocardiogram showed abnormal Q in V1-3 and mild ST elevation and level of troponin I was slightly elevated. All manifestations including lactic acidosis were dramatically subsided in 18 hours by thiamine infusion. Even in developed country, shoshin beriberi can be occurred in patients with malnutrition and/or chronic alcoholism and should be differentiated with acute coronary syndrome.
Acidosis ; Acidosis, Lactic ; Acute Coronary Syndrome* ; Alcoholism ; Anoxia ; Anuria ; Beriberi* ; Developed Countries ; Diagnosis ; Electrocardiography ; Emergencies ; Heart Failure ; Humans ; Hypotension ; Male ; Malnutrition ; Shock* ; Thiamine ; Thiamine Deficiency ; Troponin I

High-output heart failure may occur in anemia, thyrotoxicosis, Beriberi heart disease, arteriovenous fistula, congenital arteriovenous malformation, Paget's disease of the bone, fibrous dysplasia, polycythemia vera, multiple myeloma, and renal diseases such as glomerulonephritis, carcinoid syndrome, pregnancy and obesity. Among these conditions, reports on heart failure resulting from an arteriovenous malformation are rare. We report a case of high-output heart failure resulting from Cobb's syndrome (cutaneomeningospinal angiomatosis), which improved with spinal artery embolization.
Anemia ; Arteries ; Arteriovenous Fistula ; Arteriovenous Malformations ; Beriberi ; Carcinoid Tumor ; Embolization, Therapeutic ; Glomerulonephritis ; Heart Diseases ; Heart Failure* ; Heart* ; Multiple Myeloma ; Obesity ; Polycythemia Vera ; Pregnancy ; Thyrotoxicosis

Cardiovascular beriberi is caused by thiamine deficiency and usually presents as high cardiac output failure associated with predominantly right-sided heart failure and rapid recovery after treatment with thiamine. Because of its rarity in developed countries, the diagnosis can often be delayed and missed. We recently experienced a case of cardiovascular beriberi with pulmonary hypertension which successfully treated with thiamine infusion. A 50-year-old man with chronic heavy alcoholics was refered to our department for dyspnea with mental change. Echocardiography showed marked right ventricular (RV) dilatation and flattening of the interventricular septum with a D-shaped deformation of the left ventricle. Moderate tricuspid valve regurgitation was found and estimated RV systolic pressure was 52 mm Hg. Because of his confused mentality and history of chronic alcohol intake, neurological disorder due to thiamine deficiency was suspected and intravenous thiamine was administered and he continuously received a daily dose of 100 mg of thiamine. Follow up echocardiography showed marked reduction of RV dilatation and improvement of a D-shaped deformation of the left ventricle. He finally diagnosed as cardiovascular beriberi on the basis of dramatic response to intravenous thiamine. Thiamine deficiency can cause reversible pulmonary hypertension, and can still be encountered in the clinical setting. Thus high index of suspicion is critically needed for diagnosis.
Alcoholics ; Beriberi* ; Blood Pressure ; Cardiac Output, High ; Developed Countries ; Diagnosis ; Dilatation ; Dyspnea ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Heart Ventricles ; Humans ; Hypertension, Pulmonary* ; Middle Aged ; Nervous System Diseases ; Thiamine ; Thiamine Deficiency ; Tricuspid Valve Insufficiency

Severe hyperemesis gravidarum (HG) is a rare but potentially devastating complication of pregnancy. It can cause dehydration, electrolyte imbalance, malnutrition (especially, thiamine deficiency), and compromised renal function. We report a case of acute renal failure (ARF) with Wernicke's encephalopathy and beriberi due to severe HG. A 35-year-old woman at 16 weeks of gestation presented with confused mentality, quadriparesis, nystagmus, peripheral neuropathy, and tachycardia after prolonged nausea and vomiting. Her initial serum creatinine and blood urea were 2.6 mg/dL and 100 mg/dL, respectively. FLAIR image of the initial MR examination demonstrated bilateral symmetric high signal intensities in the medial and dorsal thalami. Echocardiography showed left ventricular dilatation and dysfunction. We thought that ARF, Wernicke's encephalopathy and beriberi were resulted from dehydration and thiamine deficiency due to HG. She was managed with intravenous fluid and 100-200 mg of parenteral thiamine. ARF was improved within one week and echocardiographic findings were normalized within 1 month. MR examination at the 21st week of pregnancy showed a decreased size of the lesion. After 4 months, her neuroloic status was recovered.
Acute Kidney Injury* ; Adult ; Beriberi* ; Creatinine ; Dehydration ; Dilatation ; Echocardiography ; Female ; Humans ; Hyperemesis Gravidarum* ; Malnutrition ; Nausea ; Peripheral Nervous System Diseases ; Pregnancy ; Quadriplegia ; Tachycardia ; Thiamine ; Thiamine Deficiency ; Urea ; Vomiting ; Wernicke Encephalopathy*

Beriberi, which is caused by thiamin deficiency, is a rare disease in recent years. But it has been described in the Eastern literature as far back as the 17th century. Early symptoms are fatigue, apathy, irritability, drowsiness, anorexia, nausea, vomiting and abdominal pain. Signs and symptoms of progression are peripheral neuritis, paresthesia, decreased tendon reflex and congestive heart failure. Thiamin deficiency remains as an important health care issue in many world population, specially in AIDS, pregnancy women and TPN associated patients. The best diagnostic test is assessing clinical response to administration of thiamin. We have experienced a case of Beriberi caused by continuous rice-soup feeding during one and half years in a 7-year-old boy.
Abdominal Pain ; Anorexia ; Apathy ; Beriberi* ; Child ; Delivery of Health Care ; Diagnostic Tests, Routine ; Fatigue ; Female ; Heart Failure ; Humans ; Male ; Nausea ; Neuritis ; Paresthesia ; Pregnancy ; Rare Diseases ; Reflex, Stretch ; Sleep Stages ; Vomiting

BACKGROUND: As socioeconomic status has improved, malnutrition has become rare in Korea and generally it is no longer considered as a serious problem in medical practice. However, contrary to the above general belief we managed four patients with beriberi in 1999 and it became apparent that malnutrition might remain a problem in certain groups of patients. In this study, we assessed the nutritional state, especially with respect to thiamine deficiency, in chronic alcoholics and in patients residing at a long-term care facility (LTCF). METHODS: Fourteen chronic alcoholic patients and twenty patients being hospitalized in a long-term care facility were assigned as the study groups. The subjects' mean ages and standard deviations were 48.9+/-10.2 and 50.6+/-6.7, respectively. Medical records were reviewed to determine other aspects of their nutritional status and their dietary patterns. Ten peoples who visited the health promotion center at Inha University Hospital, for routine check-ups were allocated to the control group. Blood total thiamine levels were measured by high-performance liquid chromatography. RESULTS: Body mass indices were significantly lower in chronic alcoholics and in patients at the LTCF than in the control group (p=0.0065). Serum albumin levels were within the reference range in all three groups, but were significantly lower in patients at the LTCF than in the control group (p=0.0013). Moreover, no difference was detected between the alcoholic group and the control group in terms of thiamine levels. However, the mean thiamine level in patients at the LTCF was statistically lower than that of the control group and four (20%) patients in the LTCF group showed subnormal blood thiamine levels. The thiamine level tended to decrease with age in both alcoholics and patients at the LTCF. No correlation was found between thiamine level and the other variables examined, namely, hospital stay, body mass index, and serum albumin level. CONCLUSION: A considerable portion of patients in a long term care facility showed thiamine deficiency, however, no evidence of thiamine deficiency was found among alcoholics. This result suggests that thiamine deficiency in patients at long-term care facility may be more prevalent and that thiamine supplementation may be warranted, especially for those with other thiamine deficiency risk factors.
Alcoholics* ; Alcoholism ; Beriberi ; Body Mass Index ; Chromatography, Liquid ; Health Promotion ; Humans ; Korea ; Length of Stay ; Long-Term Care* ; Malnutrition ; Medical Records ; Nutritional Status ; Reference Values ; Risk Factors ; Serum Albumin ; Social Class ; Thiamine Deficiency* ; Thiamine*