Tuesday, June 30, 2009

Tuesday June 30, 2009
Gastrointestinal Beriberi: A Previously Unrecognized Syndrome


I read your recent pearl about thiamine and lactic acidosis (
here). I have attached another pearl about this which talks about the high Sv02 seen in such cases. Recently, I actually saw two cases of this and both improved after I gave 100 mg of IV thiamine.

Tony Halat, MD

Clinical Instructor in Medicine
Department of Medicine, The Methodist Hospital
Weill Medical College, Cornell University



Gastrointestinal Beriberi: A Previously Unrecognized Syndrome

"In the 1940s, several separate experiments induced thiamine deficiency in humans; almost all participants reported nausea, vomiting, and abdominal pain. These early observations were not translated into a clinical syndrome and have essentially been forgotten. A case series documented the occurrence of "fulminant beriberi" in intensive care unit patients who were deprived of thiamine during administration of total parenteral nutrition. Eleven patients in that series had undergone laparotomy for abdominal pain; surgical findings were negative. All patients given intravenous thiamine recovered.... The current report of 2 cases is the first to recognize a primary gastrointestinal syndrome secondary to thiamine deficiency. Both patients were critically ill and recovered rapidly after receiving thiamine as the only therapeutic intervention. In patient 1, the abdominal pain was severe enough to warrant an operation. Both patients also displayed severe venous hyperoxia (central venous oximetry 93%), which indicates a mitochondrial defect in oxygen utilization consistent with thiamine deficiency. The rapid recovery from such profound venous hyperoxia and lactic acidosis (in the absence of other treated causes) can be explained only by thiamine repletion......Thiamine deficiency may lead to a gastrointestinal syndrome of nausea, vomiting, abdominal pain, and lactic acidosis. Further delineation of this potential syndrome is of paramount importance—failure to recognize and treat it may lead to unnecessary morbidity and death. Thiamine administration should be considered for all inadequately nourished patients who present with gastrointestinal symptoms and lactic acidosis 1."



References: Click to get abstract

1. Gastrointestinal Beriberi: A Previously Unrecognized Syndrome - 7 December 2004 Volume 141 Issue 11 Pages 898-899 (need registration to have access)

2. Observations on induced thiamine deficiency in man. Arch Intern Med. 1940;66:785-99

3. TPN-induced fulminant beriberi: a report on our experience and a review of the literature. Surg Today. 1996;26:769-76

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