Dry Beriberi Research Articles

Descriptive spectrum of thiamine deficiency in pregnancy: Apotentially preventable condition.

Pregnancy, a nutritionally demanding situation in terms of macro- and micronutrient supply owing to heightened maternal, placental, and fetal needs, significantly affects thiamine reserves. Thiamine deficiency during pregnancy and the postpartum period, presenting with varied manifestations and outcomes, is a relatively common condition in our population. The study aimed to understand the various manifestations and outcomes of acute thiamine deficiency in pregnant and postpartum women, emphasizing the significance of early recognition and thiamine therapy to prevent serious complications during pregnancy and after childbirth. This prospective study conducted in a tertiary care center in North India enrolled consecutive pregnant and postpartum women presenting with clinical features consistent with thiamine deficiency disorders, such as thiamine deficiency-related neuropathy, high-output heart failure, heart failure with reduced ejection fraction, Wernicke's encephalopathy, gastric beriberi, and thiamine-responsive acute pulmonary hypertension. In addition to capturing medical history including drug intake, dietary consumption, and comorbidities, women underwent brief relevant clinical examinations and laboratory assessments, including whole-blood thiamine levels. Response to intravenous thiamine supplementation was also monitored. Data of 31 women (12 pregnant, 19 postpartum) with a diagnosis of acute thiamine deficiency and a mean age of 28.88 ± 2.69 years were analyzed. The mean thiamine level was 1.28 ± 0.44 μg/dL with mean blood lactate of 3.46 ± 3.33. The most common presentation was gastric beriberi (n = 10), followed by paraparesis (n = 6), high-output heart failure (n = 6), acute pulmonary hypertension, heart failure with reduced ejection fraction (n = 3 each), and an acute confusional state (n = 2). All patients responded to thiamine challenge. In the context of borderline thiamine status, particularly in our population with endemic thiamine deficiency and heightened demand for thiamine during pregnancy and the peripartum period, the deficiency can have varied and serious manifestations of dry and wet beriberi. Early recognition of the clinical features and thiamine therapy can be life-saving. There is a need for validated clinical criteria owing to the non-availability of thiamine testing in resource-limited settings.

Anaesthesia and intensive care management of shoshin beriberi in perioperative period in young adult.

Thiamine deficiency presents as dry and wet beriberi. Wet beriberi is a complication of the cardiovascular system. Acute form of wet beriberi known as Shoshin beriberi is an acute presentation of cardiogenic shock which is rapidly reversed with thiamine administration. Here we present successful management of intraoperative acute decompensated heart failure, probably due to thiamine deficiency.

A STUDY OF THIAMINE DEFICIENCY IN PATIENTS WITH ACUTE ONSETENCEPHALOPATHY

Introduction:Vitamin B1, also known as thiamine, and its crucial role in energy metabolism and proper functioning of the nervous and cardiovascular systems. Thiamine is an essential vitamin that must be obtained through diet since the body does not produce it naturally. It is stored in the liver but only lasts for about 18 days. Thiamine is absorbed in the duodenum and transported across the blood-brain barrier. The recommended daily intake varies based on age, health condition, and life stages.Thiamine plays a vital role in various biochemical pathways in the brain, including energy production, lipid metabolism, neurotransmitter synthesis, and synaptic transmission. Thiamine deficiency can have diverse clinical effects, affecting the nervous and cardiovascular systems most severely and potentially leading to death if left untreated.Different thiamine deficiency syndromes are identified, including dry beriberi (peripheral neurologic manifestations), wet beriberi (cardiac effects), gastrointestinal beriberi (digestive symptoms), and Wernickes encephalopathy (neuropsychiatric condition). While alcohol abuse-associated malnutrition is a common cause of Wernickes encephalopathy in developed countries, it can also occur due to other factors such as decreased thiamine absorption, increased body requirements, or thiamine loss in certain medical conditions.Thiamine deficiency is considered a potential public health concern, particularly in communities in South Asia and West Africa, where diets heavily reliant on polished rice or cassava may contribute to the risk. Studies have shown varying prevalence rates of thiamine deficiency in different populations, including healthy adults and pregnant/lactating mothers in South-East Asia and India. While specific population-based studies are lacking in the Kashmiri population, preliminary evidence suggests the presence of thiamine deficiency disorders in infants, peripartum females, and adults with diverse presentations. Objectives: Early detection and treatment of Patients with Encephalopathy related to Thiamine deficiency Study Design/ Methodology:The study was hospital-based and prospective in nature, conducted in the Department of General Medicine, SMHS, GMC - Srinagar from May 2021 to September 2022. The study was done on patients aged more than 18 years of age attending emergency department of Government Medical College, Srinagar with acute onset encephalopathy. Observations And Results:In this study, 96 patients with acute onset encephalopathy were recruited based on CAM score criteria. The patients were divided into two groups: a low thiamine group and a normal thiamine group, based on their whole-blood thiamine levels. Among the patients, 15.6% had normal thiamine levels, while 84.4% had low thiamine levels. The mean thiamine level in the normal thiamine group was 5.46±4.44 ug/dL, and in the low thiamine group, it was 1.35±0.42 ug/dL (p=0.0001). Patients with normal thiamine levels were excluded from further analysis, leaving a group of 84.4% of patients with thiamine deficiency.Within the thiamine deficiency group, patients were further divided into responders and non-responders based on their response to a thiamine challenge. The responders group comprised 17 patients, including 11 males, 6 females (including 3 pregnant females), with a mean age of 36.25±9.44. Non-responders had a mean age of 61.8±15. Among responders, 70.58% had recurrent vomiting compared to 37.5% in non-responders. Confusion was the most common initial presentation in both groups, followed by lethargy. Behavioural changes were seen in a higher percentage of responders compared to non-responders. Ataxia was more prevalent in the responders group.Various laboratory parameters were analyzed between responders and non-responders. There was no significant difference in mean pH, sodium, potassium, total protein, serum albumin, and blood sugar levels between the two groups. However, lactate levels and the drop in lactate following thiamine therapy were higher in responders. Responders had lower levels of serum urea and serum creatinine compared to non-responders.MRI brain findings suggestive of Wernickes encephalopathy were observed in 53% of responders. Polished rice consumption was common among all patients, with 85% of responders and 62% of non-responders consuming polished rice as their main staple diet. Traditional salt tea intake was also prevalent in both groups. Conclusions: Thiamine deficiency can manifest in various clinical scenarios, including recurrent vomiting, hypoxia, electrolyte imbalances (such as hyponatremia and hypernatremia), and systemic diseases like uremia, hepatic encephalopathy, and septic shock. Pregnant women, who experience increased demand and may have thiamine loss due to vomiting, are also at risk of developing thiamine deficiency.The diagnosis of thiamine deficiency is primarily clinical and is confirmed by the response of neurological signs to high-dose intravenous thiamine treatment. MRI is considered the most valuable paraclinical study for diagnosis. Elevated serum lactate levels and the response of lactate to high-dose parenteral thiamine can serve as surrogate markers for thiamine-responsive encephalopathy. It is crucial to administer high doses of parenteral thiamine immediately to patients suspected of having encephalopathy due to thiamine deficiency to prevent complications associated with Wernicke-Korsakoff syndrome.

Just supplement Thiamine! A simple yet dramatic solution! (P9-4.004)

<h3>Objective:</h3> We present a case showing how while the diagnostic process in neuropathy may be long and cumbersome, the solution is usually simple, dramatic and life changing. <h3>Background:</h3> 55-year-old female with acute-on-chronic, rapidly progressive numbness and weakness. She first noted numbness and tingling in her feet over 8 years ago, but with rapid progression over the past year up to her trunk and hands. She presented to the ER after falling in the house, laying on the floor for hours, unable to be lifted by her husband. Examination revealed several bruises, symmetric wasting of upper and lower extremity muscles, proximal greater than distal weakness, loss of pinprick, vibration and temperature sensation from toes up to the thighs. She was areflexic with bowel and bladder incontinence and urine retention of 1L on arrival. She gave a history of excessive alcohol intake since her teenage years, with a heavy increase in intake over the COVID pandemic due to loss of employment and depression. Low folic acid, ESR 72, CT abdomen notable for steatohepatitis, fecal loading and urine retention. CSF analysis showed no albumino-cytological dissociation. Autoimmune workup, RPR, B12, serum copper, CSF paraneoplastic panel, CT chest, MRI brain and complete spine were unremarkable. EMG/NCV showed moderate, length dependent, sensory-motor axonal polyneuropathy. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> She was started on high dose thiamine and folic acid supplementation in hospital. Initially, she was unable to feed herself, turn in bed or sit without support. She slowly recovered, regained continence and can ambulate independently with a walker now. She can play the piano. <h3>Conclusions:</h3> Thiamine associated neuropathy or Dry Beri-Beri can present with axonal predominant sensorimotor polyneuropathy that can mimic Guillain Barre Syndrome. While workup for other etiologies of neuropathy should be simultaneously pursued in alcoholics, thiamine supplementation is a simple treatment that can lead to satisfying and dramatic results. <b>Disclosure:</b> Dr. Bhende has nothing to disclose. Dr. Zafar has nothing to disclose. Dr. Prabhu has nothing to disclose. Dr. Undavia has nothing to disclose.

Thiamine responsive high output heart failure of adults: an under-recognized entity.

Thiamine deficiency, commonly presenting as dry and wet beriberi, a lesser-known entity in the present era, is increasingly being reported from Kashmir, a north Indian state. The present study aims to present the clinical profile of patients presenting with high-output heart failure (HOHF). Subjects with a primary diagnosis of denovo heart failure and features suggestive of HOHF were recruited; those who responded to intravenous administration of thiamine alone (responders) were adults with no co-morbidities and those who required other medications particularly diuretics (non-responders) were elderly with co-morbidities and underlying heart disease. Responders showed considerably lower mean thiamine pyrophosphate (TPP) levels and higher mean lactate and venous oxygen saturation than non-responders. More importantly, the mean drop in lactate and SVO2 following thiamine therapy was more in responders. In a setting of high risk for thiamine deficiency, features suggestive of HOHF along with elevated lactate and higher venous oxygen saturation, a response to thiamine challenge may serve as surrogate marker of thiamine deficiency.

Beriberi Disease: Forgotten but Not Gone!

Beriberi is a Sinhalese phrase that means “I cannot, I cannot,” in reference to the profound weakness that may accompany the disorder, it is currently considered as an uncommon disease [1], caused by thiamine (vitamin B1) deficiency, this may result in under recognition of potentially treatable cases. Beriberi has two major sub-types or possible manifestation: Wet beriberi, when the predominant symptoms are related to the cardio-circulatory system leading to a high-output heart failure and even cardiogenic shock, and Dry beriberi in which the peripheral or central nervous systems are affected, but it is more likely to not see a full classic example of wet or dry beriberi, but rather a combination of symptoms that may lead in the absence of adequate treatment to the full picture of thiamine deficiency. One of the most important elements of diagnosis is the medical history, to look for factors that may cause or participate in the disorder (diet, alcohol consumption, pregnancy, hyperthyroidism, liver disease..) and eventually help treating the underlying causes. We report a case of an atypical beriberi disease associated with ST segment elevation with no obstructive coronary artery disease.

Dry beriberi at the pain clinic – B1 deficiency neuropathic pain post gastric bypass

Dry beriberi at the pain clinic – B1 deficiency neuropathic pain post gastric bypass

Thiamine Deficiency in the Pathophysiology and Diagnosis of Wernicke-Korsakoff Syndrome: Case Report and Literature Review

Thiamine deficiency is associated with life-threatening pathologies, as Wernicke syndrome (WS), Korsakoff syndrome (KS), Marchiafava-Bignami (MB) disease, and wet or dry beri-beri (BB). Among the etiological factors, the thiamine deficiency may be suspected in subjects at risk for malnutrition (decreased nutrient intake, increased nutrient losses, or impaired nutrient absorption). Computed tomography (CT) but especially magnetic resonance imaging (MRI) is the best method to detect diencephalic and mesencephalic cytotoxic edematous lesions in patients with acute WS, with hyperintense on long-TR spin-echo MRI imaging and low-density signal abnormalities on CT scans. We report a case of WS in an 82-year-old woman with the history of cancer and eating disorder, who presented a neurological worsening during recovery, associated with low serum thiamine levels and the presence of symmetrical areas of hyperintense signal in the long-TR sequences of MRI. After parenteral thiamine supplementation, we observed a rapid improvement of ocular and language disorders occurred, with a low and incomplete improvement of peripheral neuropathy, supporting the WS diagnosis. Our case report presented the clinical picture of WS and KS and the diagnosis was confirmed by both the laboratory tests and the brain imaging techniques. The dosage of the vitamin was useful and accurate when performed before the beginning of the supplementation therapy. This case is important in bringing to light a clinical picture often observed in many medical recovery units.

Acute Cognitive Dysfunction in a Patient With Traumatic Brain Injury: A Clinical Vignette.

Acute Cognitive Dysfunction in a Patient With Traumatic Brain Injury: A Clinical Vignette.

Dry beriberi after sleeve gastrectomy: An undiagnosed case report.

Introduction and importanceSleeve 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 presentationA 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 discussionSG 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.ConclusionThiamine 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.

Historical Features Regarding the Neuropathic Outbreaks in Brazilian Troops in the Paraguayan War.

During the Paraguayan War, Brazilian army and navy officers attributed outbreaks of combatant limb weakness with particular features such as tingling to palustrian causes. A dietary basis was not fully suspected at the time, and the popular name beriberi had not been coined. During wartime, there was a shortage in the food supply in addition to poor environmental conditions and diarrheal diseases, and many reports of "palustrian cachexia" were made. There are also reports of the use of native flora to feed troops, as well as alcoholism. There are also accounts of the death of horses with symptoms similar to those of combatants. It was reported that black soldiers were more resistant to "palustrian cachexia." This article presents the disease ecology and clinical manifestations of beriberi at wartime, linked to starvation and consumption of pickled food and native flora. These military explorations and operations in the Paraguayan War happened more than 150 y ago and present some aspects of wilderness medicine in the past.

Efficacy of Thiamine in Patients with Clinically Suspected Dry Beriberi: An Open Labeled Hospital Based Study

Background: Thiamine deficiency-related disorders are increasingly being reported in countries where polished rice is the main dietary constituent and diet is not balanced in calorie, protein, and micronutrient contents. Thiamine deficiency often associated with sensory-motor neuropathy (dry beriberi) without Wernicke’s encephalopathy and cardiac dysfunction. Objectives: The objective of our study is to evaluate the efficacy of thiamine in patients with suspected dry beriberi. Methods: This study was a prospective, open-labeled, self-controlled clinical trial (quasi-experimental study) carried out in the Neurology and Medicine Ward of Chittagong Medical College Hospital from May 2018 to April 2019. Fifty-five (55) patients of suspected dry beriberi were recruited as per inclusion and exclusion criteria. All patients were given 200mg IV Thiamine HCl per day for 1 week, then oral Tab. Thiamine 100mg twice daily for the remaining 11week. They were evaluated clinically before treatment and followed up at the end of 1 week, 6 weeks, and 12 weeks after treatment. Results: There is a significant improvement of leg swelling (p&lt;0.001), muscle cramp (p&lt;0.001), muscle power (p&lt;0.001), the total score of the Overall Neuropathy Limitation Scale (ONLS) (p&lt;0.001) within 1 week of thiamine replacement. The treatment also successfully reduced individual components of sensory impairment (i.e., pain, touch, position, vibration) from baseline to 12 weeks (p&lt;0.001). Only deep tendon reflexes did not return to normal in all patients within 12 weeks. Long-time follow-up is needed for this. Conclusion: Thiamine deficiency should be actively considered as a possible cause of peripheral neuropathy and variability of its clinical features should be taken into consideration. Thiamine is highly effective in reversing most of the clinical features of its deficiency-related peripheral neuropathy. Creating public health awareness about this disease in the community will lead to early diagnosis and treatment.

Severe Nutritional Myelopathy After Roux-En-Y Gastric Bypass: A Case Report

Abstract Objectives Roux-en-y gastric bypass (RYGB) is a surgical procedure for weight loss via volume restriction and malabsorption. Without adequate postoperative nutrition, patients can develop micronutrient deficiencies. Methods A 48-year-old male with a history of RYGB nine years ago presented with lower extremity weakness. Patient lost over 150 lbs after surgery and did not consistently take vitamin supplementation. He reported worsening lower extremity weakness accompanied by paresthesias, swelling, and ataxia along with daily episodes of nausea and vomiting, constipation and incomplete bladder emptying. MRI showed signal abnormality of the dorsal columns and lateral corticospinal tracts of the cervical and thoracic spine concerning for copper deficiency. Vitamin testing found copper, vitamin B12 and methylmalonic acid levels to be normal, but vitamin E, thiamine and vitamin D levels were low. Patient was given oral vitamin supplementation with subsequent normalization of lab values; however, his neurologic symptoms did not improve. Results RYGB can cause significant vitamin deficiencies in the absence of adequate postoperative supplementation. Although patient's B12 and copper levels were normal at the time of testing, MRI and physical exam findings of hyperreflexia were most consistent a deficiency in either one (or both). Patient's ataxia (dry beriberi) and peripheral edema (wet beriberi) were also consistent with thiamine deficiency. Conclusions Micronutrient deficiencies are a preventable complication of RYGB, and patients should be regularly screened postoperatively. Although vitamin B12 and copper are the most common causes of nutrition-related myelopathy in the setting of bariatric surgery, vitamin E, thiamine and copper deficiencies are other potential causes to consider. Funding Sources N/A.

A Case of Non-alcoholic Wernicke’s Encephalopathy and Dry Beri-beri with GI Involvement Following a Period of Prolonged Gastrointestinal Illness (1266)

A Case of Non-alcoholic Wernicke’s Encephalopathy and Dry Beri-beri with GI Involvement Following a Period of Prolonged Gastrointestinal Illness (1266)

Role of Thiamin in Health and Disease.

Thiamin is a hydrosoluble vitamin that plays a role in several biological processes, mainly in glucose metabolism. There are several risk factors for developing thiamin deficiency, such as malnutrition, refeeding syndrome, gastrointestinal surgery, and alcoholism. Recently, the role of thiamin in critically ill patients has gained prominence, and the prevalence of thiamin deficiency was found to be increased in patients with severe burns, major surgery, septic shock, end-stage renal disease, and heart failure. In adults, thiamin deficiency presents as encephalopathy, dry beriberi (with neurological signs and symptoms), or wet beriberi (with cardiovascular signs and symptoms). Thiamin deficiency can be diagnosed clinically, and all clinicians should be aware of this disease, especially in patients with risk factors for thiamin deficiency. Thiamin supplementation should be started as early as possible in patients suspected to have thiamin deficiency. Treatment is safe, inexpensive, simple, and life-saving. Diagnosis is confirmed on a positive response to treatment.

Thiamine deficiency - Beriberi – A forgotten disease

Thiamine (vitamin B1) was the first B vitamin which has been identified. It serves as a cofactor for several enzymes involved in energy metabolism. The thiamine-dependent enzymes are important for the biosynthesis of neurotransmitters and for the production of reducing substances used in oxidant stress defenses, as well as for the synthesis of pentose used as nucleic acid precursors. Thiamine also plays a central role in cerebral metabolism. There are 2 major manifestations of thiamine deficiency(TD): cardiovascular disease (wet beriberi) and nervous system disease (dry beriberi and Wernicke–Korsakoff syndrome). In wet beriberi, cardiomyopathy with edema and lactic acidosis and in dry beriberi, peripheral neuropathy occurs. Manifestations of Wernicke–Korsakoff syndrome, consist of nystagmus, ophthalmoplegia and ataxia evolving into confusion, retrograde amnesia, cognitive impairment and confabulation. Thiamine deficiency is now very rare in developed countries, but still common in South East Asia specially in developing countries like Bangladesh. It is an important public health problem with potentially fatal consequences. Now a days highly polished rice (Minicut rice) is a popular staple food and other primary dietary sources of thiamine are in short supply. In wet beriberi myocardial disease is prominent which causes a high cardiac output with peripheral vasodilation and warm extremities. Before heart failure, tachycardia, a wide pulse pressure, sweating, warm skin and lactic acidosis develop leading to salt and water retention by the kidneys. The resulting fluid overload leads to edema of the dependent extremities. If it is left untreated the severity of potential outcome will be increased even up to death. Therefore, makes it essential for physician, cardiologists and Paediatrician to have an understanding of this condition and its optimal treatment. Patients on a strict thiamine-deficient diet display a state of severe depletion within 18 days. The most common cause of thiamine deficiency in affluent countries is either alcoholism or malnutrition in nonalcoholic patients especially in children. Treatment by thiamine supplementation is beneficial for diagnostic and therapeutic purposes.&#x0D; Northern International Medical College Journal Vol.10(1) Jul 2018: 351-354

Beriberi disease in an 11-year-old girl with total colectomy

Beriberi or vitamin B1 deficiency is a rare disease in the developed world and more common in developing countries due to poverty and malnutrition. It usually presents with neurological manifestations (dry beriberi) or cardiovascular signs (wet beriberi). We report a case of dry beriberi in an 11-year-old girl with total colectomy who presented to our hospital with ataxic gait and muscle weakness. Her symptoms started 1 week after she underwent cholecystectomy for her chronic abdominal pain. Nerve conduction study showed sensory demyelinating neuropathy and she had low levels of serum vitamin B1. Her condition improved significantly after taking vitamin B1 supplementation. To the best of our knowledge, this is the first case report of thiamine deficiency in a child with a total colectomy.

Paralysis Due to Thiamine and Copper Deficiencies Following Sleeve Gastrectomy Complicated by Oral Intolerance With Recurrent Pancreatitis

Worsening obesity and widespread availability of laparoscopic surgery has led to an increase in bariatric weight loss procedures with long term consequences including nutritional deficiencies more common after malabsorptive procedures such as gastric bypass and biliopancreatic diversion. This is a case of a restrictive procedure that led to unexpected nutritional deficiencies with lasting disability. A 30 year old woman with a history of vertical sleeve gastrectomy 16 months prior had complications of oral intolerance due to several bouts of pancreatitis with prolonged hospitalization and total parenteral nutrition (TPN). Five weeks after surgery she developed ascending numbness and tingling of the feet leading to falls and inability to walk. She was treated for multiple vitamin deficiencies including Dry Beriberi and had several balloon dilations of her sleeve eventually tolerating enteral feeding again. She was improving with physical therapy but recurrence of oral intolerance led to progression of numbness, tingling, and weakness to include her face, hands, and abdomen causing her to present to the ED. Labs revealed deficiencies of copper and riboflavin with borderline thiamine levels as well as toxic levels of pyridoxine. Exam revealed motor and sensory polyneuropathies with an escutcheon sign to the umbilicus and weakness of lower extremities with loss of vibration and proprioception. Nystagmus and memory loss were consistent with Wernicke's Encephalopathy as well. Endoscopy was unrevealing and gastrointestinal symptoms resolved prior to discharge six days later with improvement of the neuropathy of the hands and face after IV and oral thiamine and copper supplementation. Although not often associated with sleeve gastrectomy, copper deficiency is associated with zinc supplementation and use of TPN as in this case. Currently, the ASMBS (American Society of Metabolic and Bariatric Surgery) only recommends checking levels in patients with suggestive symptoms who have had malabsorptive procedures, but not in restrictive. But in 2017, a small retrospective study of patients with gastric sleeves showed those with neuropathy displayed a pattern of low thiamine, copper, and riboflavin with toxic levels of pyridoxine which also causes neuropathy. Perhaps copper levels should be routine post-operatively in restrictive bariatric procedures. Consistent vitamin toxicities also speaks to the need for reevaluation of vitamin supplementation regimens.

Dry beriberi: a still existent and treatable condition in Western world. (P5.318)

Dry beriberi: a still existent and treatable condition in Western world. (P5.318)

Dry Beriberi Manifesting as Acute Inflammatory Demyelinating Polyneuropathy in a Patient With Decompensated Laennecʼs Cirrhosis

Vitamin B1 (thiamine) deficiency is uncommon in developed countries and is most often seen in chronic alcoholism, poor dietary intake, malabsorption syndromes, and total parenteral nutrition. The incidence of alcohol abuse is increasing and thus thiamine deficiency is likely an under-recognized and potentially reversible cause of neurologic dysfunction. We describe a case of dry beriberi manifesting as acute inflammatory demyelinating polyneuropathy in a patient with decompensated Laennec's cirrhosis. 28-year-old Nepalese female who recently immigrated to the United States was admitted with decompensated Laennec's cirrhosis with ascites, hepatic encephalopathy, and esophageal varices. She was severely malnourished with a BMI of 14. Her initial MELD score was 26 and she was evaluated by the liver transplant team and listed contingent on improvement in nutritional status. Patient developed profound bilateral lower extremity weakness, complete loss of sensation, and areflexia. She was unable to stand unassisted and was changed to transplant status 7. An electromyogram was consistent with severe sensorimotor axonal polyneuropathy with active denervation. Extensive evaluation including cerebrospinal fluid analysis ruled out vasculitis and Guillain-Barre Syndrome (GBS). Nutritional evaluation revealed a low serum vitamin B1 level and patient was started on thiamine replacement therapy. She dramatically improved as had been able to navigate greater than 100 feet with a walker within six months. Her transplant evaluation remains in process. Vitamin B1 (thiamine) deficiency is uncommon in developed countries and can manifest with neurologic symptoms (dry beriberi). It is critical to accurately differentiate dry beriberi from chronic alcoholic neuropathy and other causes of acute inflammatory demyelinating polyneuropathy, as it is reversible with thiamine supplementation. Our patient developed profound lower extremity neurologic symptoms causing her to be changed to liver transplant status 7. This case demonstrates the importance of diagnosing neurological manifestations of thiamine deficiency in the setting of Laennec's cirrhosis as these are reversible and can increase the potential for a successful liver transplantation outcome in these high-risk patients.