Serum Thiamine Level Research Articles

Wernicke encephalopathy in a patient with medullary infarctions: a case report.

Wernicke encephalopathy (WE) is an acute life-threatening neurological condition caused by thiamine (vitamin B1) deficiency. Patients with WE often present with a triad of symptoms consisting of ophthalmoplegia, gait ataxia, and mental confusion. If WE is not treated in a timely manner, it can lead to serious complications such as confusion, coma, or death. Although alcohol abuse is the most commonly reported cause of WE, nonalcoholic causes-although rare-do exist. Herein, we present the case of a nonalcoholic woman with medullary infarctions who presented with intractable vomiting. Her clinical state subsequently progressed to include ophthalmoplegia and gait ataxia. A diagnosis of WE was suspected based on her clinical presentation; this was confirmed by brain magnetic resonance imaging (MRI) and the finding of decreased serum thiamine levels. Brain magnetic resonance imaging demonstrated the complete resolution of abnormal hyperintensities during a follow-up visit, 6 months after treatment.

Identification and characterization of an endogenous biomarker of the renal vectorial transport (OCT2-MATE1).

The renal tubular organic cation transporter 2 (OCT2) and multidrug and toxin extrusion protein 1 (MATE1) mediate the vectorial elimination of many drugs and toxins from the kidney, and endogenous biomarkers for vectorial transport (OCT2-MATE1) would allow more accurate drug dosing and help to characterize drug-drug interactions and toxicity. Human serum uptake in OCT2-overexpressing cells and metabolomics analysis were carried out. Potential biomarkers were verified in vitro and in vivo. The specificity of biomarkers was validated in renal transporter overexpressing cells and the sensitivity was investigated by Km . The results showed that the uptake of thiamine, histamine, and 5-hydroxytryptamine was significantly increased in OCT2-overexpressing cells. In vitro assays confirmed that thiamine, histamine, and 5-hydroxytryptamine were substrates of both OCT2 and MATE1. In vivo measurements indicated that the serum thiamine level was increased significantly in the presence of the rOCT2 inhibitor cimetidine, and the level in renal tissue was increased significantly by the rMATE1 inhibitor pyrimethamine. There were no significant changes in the uptake or efflux of thiamine in cell lines overexpressed OAT1, OAT2, OAT3, MRP4, organic anion transporting polypeptide 4C1, P-gp, peptide transporter 2, urate transporter 1, and OAT4. The Km for thiamine with OCT2 and MATE1 were 71.2 and 10.8μM, respectively. In addition, the cumulative excretion of thiamine at 2 and 4h was strongly correlated with metformin excretion (R2 >0.6). Thus, thiamine is preferentially secreted by the OCT2 and MATE1 in renal tubules and can provide a reference value for evaluating the function of the renal tubular OCT2-MATE1.

Traversing Antepartum Wernicke’s Encephalopathy: In-Depth Insights and Strategies

Antepartum Wernicke’s encephalopathy (WE) is a severe neurological disorder caused by a deficiency of thiamine (Vitamin B1), essential for glucose metabolism, and neuronal function. This review aims to provide an in-depth analysis of WE during pregnancy, highlighting its pathophysiology, risk factors, clinical presentation, diagnostic challenges, and management strategies. Thiamine is critical in the Krebs cycle and neurotransmitter production, and its deficiency leads to substantial biochemical disruptions and neuronal damage. Pregnant women are particularly susceptible due to their increased nutritional demands to support fetal growth and maternal metabolic changes, making them prone to thiamine deficiency and its severe neurological consequences. The clinical manifestations of WE include ophthalmoplegia, ataxia, confusion or altered mental state, peripheral neuropathy, and cardiovascular issues. Diagnosing WE during pregnancy is challenging due to its atypical presentation, requiring a high degree of clinical suspicion and awareness of risk factors. Diagnostic limitations include variable clinical symptoms and challenges in interpreting serum thiamine levels and neuroimaging findings. While neuroimaging can show characteristic brain lesions, its utility is limited by variability. Managing WE during pregnancy requires prompt recognition, immediate thiamine supplementation, continued supportive measures, and careful monitoring. Severe or refractory cases may require advanced management strategies. Pharmacological treatments include standardized thiamine administration protocols, guided by clinical guidelines and recommendations. Early detection and management of WE in pregnant women are vital to prevent irreversible neurological damage and improve maternal and fetal outcomes. Adherence to clinical guidelines is crucial to mitigate the impact of this condition.

Effect of alcohol-dependence on cognitive performance in middle-aged men: Preliminary results

Objectives: The understanding of the relationship between alcohol-related neuropathology, cognitive impairment, and various factors such as alcohol consumption, thiamine levels, and age vulnerability is still poorly understood. Therefore, this study aims to examine the effect of alcohol dependence on cognitive performance in middle-aged men with psycho-biochemical evidence. Materials and Methods: A cross-sectional pilot study with a comparison group including 82 right-handed participants with and without alcohol dependence (n = 41 each). Alcohol dependence was diagnosed clinically by the International Classification of Disease Tenth Edition along with the use of alcohol use disorder identification test (AUDIT) and cognitive screening tests, that is, the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE). The serum levels of thiamine (Vitamin B1) were determined using an enzyme-linked immunosorbent assay. Results: The MoCA scores, MMSE scores, and serum thiamine levels were significantly low for alcohol-dependent men (1509.43 ± 898.63 pmol/L) versus non-alcohol-dependent men (1862.81 ± 741.30 pmol/L; P = 0.021). The cognitive sub-domains including orientation, execution, calculation, visuoconstructional skills, and recall functions were also significantly (P < 0.05) affected for the alcohol-dependent patients when compared to non-alcohol-dependent men. Serum thiamine levels showed a positive (P < 0.05) correlation with MoCA scores whereas serum thiamine levels showed a significant (P < 0.05) negative correlation with AUDIT scores. Conclusion: Based on the significant positive association between serum thiamine levels with MoCA scores; therefore, both may be used as a screening tool for the early detection of cognitive impairment in patients with alcohol dependence.

Atypical Clinical Presentations and Neuroimaging Findings of Wernicke Encephalopathy (P4-4.004)

<h3>Objective:</h3> Wernicke encephalopathy is an acute neurological disorder secondary to thiamine deficiency with a clinical triad of confusion, eye disorders, and ataxia. Typical MRI Findings show symmetric hyperintensities in T2-weighted sequences predominantly affecting medial thalami, periaqueductal area, mammillary body, and the tectal plate. We describe two atypical cases of Wernicke encephalopathy. <h3>Background:</h3> N/A <h3>Design/Methods:</h3> Retrospective chart review. <h3>Results:</h3> <h3>First Case:</h3> 50-year-old female with history of endometrial cancer presented with altered mental status (AMS), truncal ataxia, neck titubation, and incomplete external ophthalmoplegia, progressing rapidly to stupor. She had recently undergone chemoradiation, complicated by chronic radiation enteritis causing poor oral intake, recurrent emesis, and weight loss. After an extensive negative infectious workup, MRI Brain with contrast was performed, which revealed restricted diffusion and T2-FLAIR sequence hyperintensities of bilateral cerebella, bilateral dorsomedial thalami, fornix with contrast enhancement of mammillary bodies concerning for Wernicke Syndrome. Thiamine levels were confirmed to be 70 nmol/l. <h3>Second Case:</h3> 22-year-old female with history of Autism Spectrum Disorder presented with AMS and seizure-like activity after experiencing severe nausea and vomiting for one week. Infectious workup including CSF analysis was unremarkable. No seizures or epileptiform changes were captured on vEEG. MRI Brain showed T2 FLAIR hyperintensities with restricted diffusion throughout the posterior brainstem, bilateral thalami, caudate nuclei, left medial lentiform nucleus, bilateral periventricular basal ganglia, bilateral frontal and parietal lobes raising concerns for Wernicke encephalopathy. Serum thiamine level was less than 20, corroborating with the diagnosis. Both patients had significant clinical and radiographic improvement with high-dose thiamine supplementation. <h3>Conclusions:</h3> The classic triad of symptoms of Wernicke encephalopathy is usually present in only 16% of patients. Atypical MRI Brain findings include involvement of the cerebral cortex and cerebellum which are more commonly seen in non-alcoholic patients. Mortality rate ranges from 10–20% so prompt recognition of the condition and early treatment is vital especially in atypical cases. <b>Disclosure:</b> Dr. Biyani has nothing to disclose. Dr. Verma has nothing to disclose. Dr. Arulprakash has nothing to disclose. Dr. Shah has nothing to disclose. Dr. Patrice has nothing to disclose.

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.

Correlation of Serum Thiamine with Physical and Biochemical Parameters among Type 1 and Type 2 Diabetes

Objective: Thiamine or vitamin B1 is a fundamental vitamins and minerals and enzyme cofactor that are needed for most of the anabolic and catabolic reaction that occurs in organisms. Deficiency of Thiamine has been associated with numerous complications in diabetes mellitus (DM) patients. Therefore, this study was intended to assess various biochemical and anthropometric parameters with serum thiamine levels in patients with type I and type II diabetes.&#x0D; Methodology: This was a case-control study carried out in outpatient department (OPD) of Diabetes Department of Jinnah post graduate medical institute, Karachi by using non-probability convenient sampling technique. This study comprised of 6 months duration after approval of synopsis. A total of 60 participants with type I and II diabetes mellitus of both genders with age &lt; 25 to &gt; 46 years were selected; 30 participants with type I diabetes whereas 30 participants had type II diabetes. The Pearson’s correlation test was used to interpret correlation between thiamine levels and height, weight, heart rate, temperature, Total cholesterol, Triglycerides, creatinine, urea in type I and II diabetic patients.&#x0D; Results: The results showed that among type I diabetics, none of the patient characteristics studied were significantly correlated with the thiamine levels of these patients. On the other hand, among type II diabetics, significantly negative correlation was observed between height and thiamine level (p=0.045) where patients with greater height had lower thiamine level and vice versa. Moreover, both heart rate and total cholesterol were marginally insignificantly correlated with thiamine level (p=0.065 and p=0.069), respectively.&#x0D; Conclusion: This study concluded that all anthropometric and biochemical parameters were insignificantly correlated with thiamine levels in type I and II diabetes patients. However, height had significant negative correlation with the thiamine level among type II diabetics reflecting patients with more height had lower thiamine level.

Clinical profile of patients presenting with thiamine-responsive upper-gastrointestinal upset: A pointer toward gastric beriberi

ObjectivesAlthough beriberi is considered a forgotten disease in the West, Kashmir has a rice-eating population that has beriberi in endemic proportions. Patients with a thiamine deficiency (TD) occasionally present with gastrointestinal (GI) symptoms, including nausea, recurrent vomiting, loss of appetite, and abdominal discomfort. Together these often respond to thiamine, which points to gastric beriberi. MethodsPatients with GI symptoms suggestive of TD were recruited from the Department of Medicine at the Government Medical College and its associated hospital, SMHS, in Srinagar, India. Patients were evaluated for serum thiamine levels, serum lactate, biochemical parameters, and transabdominal ultrasonography after ruling out the usual causes of acute abdominal pain and vomiting. ResultsA total of 27 patients were recruited with a mean age of 47.28 ± 20.84 y. The mean lactate of patients at the time of admission was 6.43 ± 5.22 mmol/L, and the mean lactate at the time of discharge was 1.23 ± 0.50 mmol/L. All patients had a history of consuming polished rice, washed two to three times before cooking, as the staple diet. The most common GI symptoms were recurrent vomiting, nausea, and loss of appetite. All of the patients responded to the thiamine treatment, and showed improvement in their GI symptoms and decreased serum lactate levels within 2 to 6 h of their hospital stay. ConclusionsGastric beriberi is a rare presentation of TD that can lead to severe GI symptoms and lactic acidosis. Given the rapid response to thiamine, it is the standard-of-care treatment in such cases. Thus, clinicians should suspect TD when patients present with either mild or moderate-to-severe GI symptoms and raised blood lactate.

Association of Age, Gender and Type of Diabetes with Thiamine Level: A Cross-Sectional Analysis

Objective: Diabetes Mellitus has been observed to be related with low thiamine levels in the body, as it affects directly on carbohydrate metabolism. Therefore, this study was intended to assessdemographic characteristics and serum thiamine levels in type I and type II diabetic patients and healthy control group.&#x0D; Methodology: This was a case-control study carried out in diabetic outpatient department (OPD) of Urban Health Center and New Karachi, Hospital. The duration of the study was about six months after approval of synopsis. The study sample included 90 participants and divided into three groups, 30 participants each in the control, type I diabetes and type II diabetes groups. Patients with type I and II diabetes mellitus of both genders with age &lt; 25 to &gt; 46 years were included in the study. One Way ANOVA was applied to find out the significance of differences among the groups.&#x0D; Results: The study results showed that out of 90 participants, 33(36.7%) were males and 57(63.3%) were females; 1(1.1%) of them had low thiamine level, 17(18.9%) had normal thiamine level whereas 72(80.0%) had high thiamine level. It was observed that significant association found between thiamine levels and age groups (p&lt;0.001). Furthermore, 18(60.0%) had Low/Normal thiamine level and 12(40.0%) had high thiamine level in type I diabetes patients while 30(100%) in control group and Type II Diabetic patients had high thiamine level with significant association between them (p&lt;0.001). On the other hand, an insignificant association was found between gender and low and high thiamine levels (p=0.743).&#x0D; Conclusion: This study concluded that both the age and group types were significantly associated with thiamine levels of the participants. Furthermore, type I Diabetes patients had significantly lower thiamine levels as compared to type II Diabetes and controls. On the other hand, there was no significant relationship of gender with thiamine levels.

Thiamine deficiency after sleeve gastrectomy

The prevalence of morbid obesity has risen to global epidemic proportions. Bariatric surgery has been proven to be a safe and effective treatment for obesity with weight reduction, resolution of obesity-related co-morbidities, improved quality of life and an increased life expectancy. Sleeve gastrectomy (SG) is the most commonly performed bariatric procedure worldwide. Obesity is associated with micronutrient deficiencies that results in the high prevalence of deficient vitamins status prior to bariatric surgery. After bariatric surgery, these micronutrient and vitamins deficiencies increase or occur de novo, and they may be threatening when left unattended. This presented clinical case demonstrates the clinical features of thiamine deficiency as well as the principles of laboratory and instrumental diagnostics. Electromyo­graphy is an informative method for diagnostic of muscle weakness. The lower serum thiamine level, neurological symptoms and electromyography results are the most important for the diagnosis of thiamine deficiency. Pathogenetic treatment can improve the patient’s condition in a short period of time. Although the SG is a purely restrictive procedure with no malabsorptive component, microelement or vitamin deficiency can occur in patients after procedure. The presented clinical case demonstrates the importance of timely thorough diagnosis and correct treatment of thiamine deficiency in patients after SG. Thus, patients after the LRS in deficiency of vitamin B1 may cause the development of neurological comp­lica­tions of varying severity, in particular dysmetabolic polyneuropathy. This condition is reversed and administration of an adequate and timely substitution therapy in patients with thiamine insufficiency allows be avoided the development of fatal complications.&#x0D;

Association between thiamine decrease and neuropsychiatric symptoms in gastrointestinal and hematological cancer patients receiving chemotherapy

BackgroundClinical evidence of thiamine-related neuropsychiatric symptoms, including the initial stage, is limited because serum thiamine levels tend to be evaluated only for patients who develop severe neuropsychiatric symptoms suspected to be related to severe thiamine deficiency. This study aimed to evaluate the relationship between thiamine decline and neuropsychiatric symptoms, including initial symptoms, and the effect of chemotherapy on serum thiamine levels in gastrointestinal and hematological cancer patients receiving chemotherapy. MethodWe retrospectively identified 87 patients who were diagnosed with gastrointestinal and hematological cancers at our hospital. We evaluated the risk factors associated with neuropsychiatric symptoms, including initial symptoms (neuropsychiatric symptoms), the relationship between the presence of neuropsychiatric symptoms and serum thiamine levels, and changes in serum thiamine levels after chemotherapy. ResultsLogistic regression analysis identified thiamine decline as a significant factor associated with neuropsychiatric symptoms (p < 0.001, odds ratio = 0.040, 95% confidence interval [CI]: 0.010–0.163). The Mann-Whitney U test showed that patients with neuropsychiatric symptoms had significantly lower serum thiamine levels (19.5 ± 5.4 ng/mL, n = 39) than patients without neuropsychiatric symptoms (31.9 ± 14.2 ng/mL, n = 48) (p = 0.001). In hematological cancer patients, serum thiamine levels gradually declined after chemotherapy, with the lowest levels at 5–8 weeks (23.5 ± 7.6 ng/mL, P = 0.035 vs. 0 weeks, Wilcoxon rank sum test). ConclusionOur study showed that a decrease in serum thiamine levels can be a risk factor for neuropsychiatric symptoms, and chemotherapy can lead to a decrease in serum thiamine levels.

An Unusual Case of Thiamine Deficiency in a Total Parenteral Nutrition-Dependent Child Secondary to Munchausen by Proxy

An Unusual Case of Thiamine Deficiency in a Total Parenteral Nutrition-Dependent Child Secondary to Munchausen by Proxy

Development of Wernicke\u2019s encephalopathy long after subtotal stomach-preserving pancreatoduodenectomy: a case report

BackgroundWernicke’s encephalopathy (WE) is an acute neuropsychiatric disorder resulting from thiamine (vitamin B1) deficiency, frequently associated with chronic alcoholism and total parenteral nutrition without thiamine. However, only a few reports have focused on the relationship between WE and subtotal stomach-preserving pancreatoduodenectomy (SSPPD).Case presentationA 71-year-old woman underwent SSPPD for an adenocarcinoma of the ampulla of Vater. Although there had been no evidence of recurrence, the patient was treated with antibiotics for cholangitis at 12 and 31 months, respectively, post-surgery. Thereafter, the patient presented with vomiting and disorientation 33 months after surgery. Although she was admitted and underwent closer inspection by a neurologist and a psychiatrist, the exact cause of these syndromes remained unknown. The psychiatrist measured thiamine concentration to examine the cause of disorientation. After 6 days, her level of consciousness worsened. Magnetic resonance imaging of the head showed symmetrically multiple abnormal hyperintense signals on fluid-attenuated inversion-recovery and diffusion weighted image, compatible with WE. An administration of intravenous thiamine was immediately initiated. After 8 days of the measurement of the thiamine level, the patient’s serum thiamine level was found to be 6 µg/mL (reference range, 24–66 µg/mL). Accordingly, the patient was diagnosed with WE. Shortly after starting the treatment, blood thiamine value reached above normal range with significant improvement of her confusional state. However, short-term memory and ataxia remained.ConclusionsDevelopment of WE after SSPPD is uncommon. However, to prevent an after-effect, the possibility of development of WE after SSPPD should be recognized.

Subclinical thiamine deficiency identified by pretreatment evaluation in an esophageal cancer patient

Despite the fact that both thiamine deficiency (TD) and Wernicke encephalopathy (WE) have been observed to some degree in cancer patients, such cases of TD and/or WE reported to date have all been diagnosed after the initiation of treatment. We here report a case of TD that presented without the commonly accepted triad of WE symptoms based on a total nutritional evaluation prior to the onset of treatment for cancer. The patient was a 71-year-old man with esophageal cancer who was referred to the oncology outpatient clinic for evaluation to determine the treatment plan. Although he did not present with delirium, cerebellar signs, or ocular symptoms, TD was suspected based on a reduction in appetite lasting 2 months as thiamine stores in the body are depleted in as few as 18 days. Blood findings showed a marked decline in serum thiamine level supported, which the diagnosis of TD. This case revealed the existence of a cancer patient with subclinical TD prior to the onset of treatment for cancer. Due to the fact that TD can occur without the characteristic symptoms as in this case, we believe it is important that total nutritional evaluation of cancer patients always be considered.

Nutritional Care of Patients Admitted to Hospital for Alcohol Withdrawal: A 5-Year Retrospective Audit.

The aim of this study was to describe the characteristics and the nutritional approaches implemented with patients undergoing alcohol withdrawal. A retrospective analysis of medical records for patients admitted to a tertiary hospital for alcohol withdrawal was completed over a 5-year period 2013-2017. Data on nutrition-related assessment and management were extracted and descriptively analysed. A total of 109 medical records were included (M=73, F=36), with the mean age of patients 47.3years (SD±11.2, range 22-70). The average length of stay was 3.7days (SD±3.9, range 0.70-27.8). Approaches towards nutritional care emerged from micronutrient assessment and supplementation and/or dietetic consultation. Nutrition-related biochemistry data was available for most patients, notably serum levels of sodium, urea and creatinine (102 patients; 93.5%) and magnesium and phosphate (66 patients, 60.5%). There was evidence of some electrolyte abnormalities on admission to hospital. Eight patients had serum micronutrient status assessed; no patients had serum thiamine levels assessed. Parenteral thiamine was provided to 96 patients (88.0%) for 1.9days (SD±1.1, range 1.0-6.0) with a mean dose of 2458.7mg (SD±1347.6, range 300-6700mg). Multivitamin supplementation was provided to 24 patients (22.0%). Only 23 patients (21.2%) were seen by a dietician of whom 16 underwent a comprehensive nutritional assessment and 3 were screened using the malnutrition screening tool. Inconsistent nutritional assessment and management practices were identified across a diverse population group, whilst nutritional professionals were underutilized. Future research should benchmark current guidelines and multidisciplinary approaches considering the role of nutritional specialists in the team.

Thiamine Level in Type I and Type II Diabetes Mellitus Patients: A Comparative Study Focusing on Hematological and Biochemical Evaluations.

ObjectiveDiabetes has been found to be associated with low levels of thiamine stores in the body, as thiamine directly affects carbohydrate metabolism. Amplified renal clearance of thiamine has been found in both type I and type II diabetic patients. It has been shown that high-dose thiamine therapy may have a therapeutic effect on early-stage diabetic nephropathy. The aim of this study was to evaluate various biochemical parameters and serum thiamine levels in type I and type II diabetic patients and compare them with a healthy control group.MethodsA case-control study was carried out in the diabetic out-patient multi-centers in Karachi. A total of 90 participants were selected by using a non-probability convenient sampling technique and divided into three groups, each with 30 subjects. Group A included healthy non-diabetic subjects, while group B included subjects with type I diabetes mellitus (DM), and group C included subjects with type II DM. After receiving informed consent, blood samples were collected from all the participants for hematological and biochemical evaluation. The duration of the study was eight months.ResultsThe study results revealed that the patients with type II DM had significantly higher mean fasting blood sugar (FBS), random blood sugar (RBS), and hemoglobin A1c (HbA1c) levels than those with type I DM or the control group (p<0.001 for all). Furthermore, the patients with type I or II DM had significantly higher mean levels of triglyceride (p<0.001) and total cholesterol (0.013) while significantly lower mean levels of high-density lipoprotein (HDL) (p=0.014) than controls. The study results further revealed that the patients with type I or II DM had significantly lower serum thiamine levels than controls (14.89±4.82 and 7.35±1.90 vs. 69.56±12.75, p<0.001).ConclusionThe study results revealed that FBS, RBS, HbA1c, triglyceride, and total cholesterol levels were significantly higher in both type I and type II diabetes patients compared to controls. Furthermore, HDL and serum thiamine levels were found to be significantly lower in both type I and type II diabetic patients than in controls.

SUN-596 A Rare Presentation of Early Onset Wernicke Encephalopathy Following Sleeve Gastrectomy

Background: Wernicke encephalopathy (WE) has been reported after malabsorptive bariatric surgeries but is an uncommon complication of sleeve gastrectomy. Since 2011, the number of patients receiving a sleeve gastrectomy has tripled, with almost 60% of patients undergoing bariatric surgery receiving a sleeve gastrectomy in 2017 (1). We present a case of WE in a young woman as a rare and early complication of sleeve gastrectomy. Clinical Case: A 32-year old female with a past medical history significant for hypertension, pseudotumor cerebri, and morbid obesity status post sleeve gastrectomy two months prior presented to the emergency department with complaints of blurry vision and lower extremity numbness. Physical examination showed sluggish light reflex and decreased extraocular movements. Given history of pseudotumor cerebri, patient underwent a therapeutic lumbar puncture with removal of 13 ml of CSF. Opening pressure was 20 cm of water and patient experienced no relief of her symptoms. Ophthalmology consult did not offer an explanation for the blurry vision. MRI-brain with and without contrast showed findings highly suggestive of WE. It showed faint linear symmetric hyperintensities along the bilateral mesial thalamus, dorsal midbrain and periaqueductal gray matter, which were determined to be acute in nature in comparison with a MRI performed three weeks prior. Upon further investigation, thiamine level was low at 43.6 nmol/L [66.5 – 200] confirming the diagnosis of WE. Thiamine supplementation was started immediately and patient reported improvement of her vision the next day with return to baseline in 3 days. Conclusion: There have been a handful of cases of WE reported in literature as a complication of sleeve gastrectomy. Zheng, L also reported a case of WE 7 weeks after sleeve gastrectomy (2). Although sleeve gastrectomy does not directly affect the primary absorptive pathway of thiamine in the gastrointestinal tract, it is imperative to consider WE in patients presenting with suspicious neurologic symptoms after a recent sleeve gastrectomy. WE was suspected in our case due to typical MRI findings and neurological presentation after bariatric surgery, which was later confirmed by low serum thiamine level. Early detection and thiamine supplementation resulted in complete reversal of symptoms in our patient. WE is a rare but severe and preventable consequence of bariatric surgery that warrants attention given its rapid onset and detrimental course. Reference: (1) Estimate of Bariatric Surgery Numbers, 2011-2017. (2018, June 26). Retrieved from https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. (2) Zheng, L. (2016).Wernicke Encephalopathy and Sleeve Gastrectomy. American Journal of Therapeutics, 23(6).

Potential thiamine deficiency in elderly patients with gastrointestinal cancer undergoing chemotherapy .

Gastrointestinal cancer and its treatment using fluorouracil-based anticancer agents are risk factors for thiamine deficiency (TD). Therefore, we aimed to determine the prevalence of TD among elderly patients with gastrointestinal cancer undergoing chemotherapy. We retrospectively reviewed the medical records of 12 elderly patients with gastrointestinal cancers who underwent chemotherapy. Median serum thiamine level was 22.5ng/mL (range, 17-42ng/mL). Four patients (33.3%) exhibited TD (&lt;20ng/mL). We found that the prevalence of TD among elderly patients with gastrointestinal cancer undergoing chemotherapy was high. For these patients, careful monitoring of thiamine levels is warranted because TD may not produce overt clinical symptoms.

Thiamine deficiency and oxidative stress induced by prolonged metronidazole therapy can explain its side effects of neurotoxicity and infertility in experimental animals: Effect of grapefruit co-therapy.

We aimed to explore the possible neurotoxicity and infertility mechanisms of prolonged metronidazole (MTZ) use and the effects of antioxidant grapefruit (GP) co-therapy on MTZ-induced complications. Sixty male albino Wistar rats were divided into four groups (n = 15 each). Group I (control group) received 1% dimethyl sulfoxide (27 ml/ kg/day), group II (MTZ group) received MTZ (400 mg/kg/day), group III (MTZ + GP) received MTZ (400 mg/kg/ day) plus GP juice (27 ml/kg/ day) and group IV (GP group) received GP juice (27 ml/kg) for 60 days. Semen analyses were performed. Free testosterone, gonadotrophin (follicle-stimulating hormone (FSH) and luteinizing hormone) and thiamine levels were measured. Samples of cerebellar, testicular and epididymal tissues were used for both colorimetric assays of oxidative stress markers and histopathological examinations. Significant decreases in the sperm count, percent total sperm motility, serum thiamine levels, free testosterone levels and FSH levels were observed in the MTZ and MTZ + GP groups (p < 0.05 for all parameters). Significantly higher oxidative stress levels (p < 0.05) were observed in the cerebellar and testicular tissue homogenates of these groups than in those of the control group, and associated disruptions in the cerebellar, testicular and epididymal structures were apparent compared to those of the control group. Although the GP group showed a significantly higher sperm count and significantly lower oxidative stress than the control group (p < 0.05), with histological similarity to the control group, the GP group exhibited significantly higher prolactin levels and lower free testosterone and FSH levels than the control group (p < 0.05). Oxidative stress and decreased thiamine levels could explain the MTZ-induced neurotoxicity and infertility side effects that aggravated by GP co-administration.