"Dry" and "wet" beriberi mimicking critical illness polyneuropathy

Wernicke’s encephalopathy is caused by thiamine deficiency and has a range of presenting features, including gait disturbance, altered cognitive state, nystagmus and other eye movement disorders. In the past, Wernicke’s encephalopathy was described almost exclusively in the alcohol-dependent population. However, in current times, Wernicke’s encephalopathy is also well recognized in many other patient groups, including patients following bariatric surgery, gastrointestinal surgery, cancer and pancreatitis. Early recognition of Wernicke’s encephalopathy is vital, as prompt treatment can restore cognitive or ocular function and can prevent permanent disability. Unfortunately, Wernicke’s encephalopathy is often undiagnosed – presumably because it is relatively uncommon and has a variable clinical presentation. Clinical biochemists have a unique role in advising clinicians about potential nutritional or metabolic causes of unexplained neurological symptoms and to prompt consideration of thiamine deficiency as a potential cause in high-risk patient groups. The aim of this review is to summarize the clinical features, diagnosis and treatment of Wernicke’s encephalopathy and to highlight some non-traditional causes, such as after bariatric surgery.

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“…4,5 Although dry and wet forms of beriberi can occur in the same patient at the same time, this seems to be rare. 6…”

Section: Terminologymentioning

confidence: 99%

Don’t seek, don’t find: The diagnostic challenge of Wernicke’s encephalopathy

Kohnke

Meek

2020

Ann Clin Biochem

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“…In the current study, five patients were observed to have concomitant wet beriberi, and two exhibited co-occurring Wernicke encephalopathy and one presented with rhabdomyolysis. The presence of concomitant wet beriberi has been previously documented by Prakasha et al [25], who reported three cases with manifestations of right heart failure, shock, metabolic acidosis, and renal failure in varying combination with paraparesis, and successful recovery through prompt intervention with thiamine supplementation within a range of 24 h to several weeks. Furthermore, the co-occurrence of Wernicke encephalopathy and neuropathy has also been reported in research conducted by Söylemez et al [26], in a patient with a history of chronic daily alcohol consumption.…”

Section: Discussionmentioning

confidence: 68%

“…The presence of concomitant wet beriberi has been previously documented by Prakasha et al. [25], who reported three cases with manifestations of right heart failure, shock, metabolic acidosis, and renal failure in varying combination with paraparesis, and successful recovery through prompt intervention with thiamine supplementation within a range of 24 h to several weeks. Furthermore, the co‐occurrence of Wernicke encephalopathy and neuropathy has also been reported in research conducted by Söylemez et al.…”

Section: Discussionmentioning

confidence: 80%

Thiamine deficiency‐related neuropathy: A reversible entity from an endemic area

Nisar,

Yousuf wani,

Altaf

et al. 2023

Euro J of Neurology

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Background and purposeDespite thiamine deficiency being a lesser‐known entity in modern times, beriberi in various forms, including thiamine deficiency‐related neuropathy, remains endemic in Kashmir due to the consumption of polished rice as a staple food. This observational study investigates cases of peripheral neuropathy of unknown etiology and their potential responsiveness to thiamine administration.MethodsThis prospective study enrolled adult patients presenting to the emergency department with weakness consistent with thiamine deficiency‐related neuropathy and conducted a therapeutic challenge with thiamine on 41 patients. Response to thiamine therapy was monitored based on subjective and objective improvements in weakness and power. Patients were divided into thiamine responders (n = 25) and nonresponders (n = 16) based on their response to thiamine therapy and nerve conduction studies.ResultsMost of the baseline characteristics were similar between responders and nonresponders, except the responders exhibited lower thiamine levels and higher partial pressure of oxygen and lactate levels compared to nonresponders. All patients had a history of consuming polished rice and traditional salt tea. Although weakness in the lower limbs was present in both groups, nonresponders were more likely to exhibit weakness in all four limbs. Clinical improvement was observed within 24 h, but proximal muscle weakness persisted for an extended period of time.ConclusionsThiamine deficiency‐related neuropathy presents with predominant lower limb weakness, exacerbated by vomiting, poor food intake, psychiatric illness, and pregnancy. Thiamine challenge should be followed by observation of clinical and biochemical response.

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“…Few studies report patients presenting with symptoms of both wet beriberi and dry beriberi. In the available reports, symptoms involved right-sided heart failure and axonal polyneuropathy [5,6]. This case was previously presented at the annual University of Pittsburgh Medical Center Hamot Research Conference on April 29, 2022.…”

Section: Introductionmentioning

confidence: 99%

A Rare Case of Thiamine Deficiency Leading to Dry Beriberi, Peripheral Neuropathy, and Torsades De Pointes

Phinney,

Callenius,

Singh

et al. 2023

Cureus

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Thiamine (vitamin B1) is an essential nutrient and one of the eight B vitamins. As a water-soluble vitamin, thiamine is not stored; therefore, a balanced diet is required to ensure adequate intake of this essential vitamin. Thiamine deficiency is known to cause both wet and dry beriberi, but rarely in combination. Thiamine deficiency has also been known to cause QTc prolongation, but the mechanism remains unclear. In the most severe cases, this can lead to the lethal arrhythmia of torsades de pointes. This case describes a patient who became malnourished after a closed head injury and initially presented with seizure-like activity and syncopal episodes with nonspecific numbness. He was found to have prolonged QTc, leading to torsades de pointes requiring an implanted cardioverter defibrillator. With extensive workup, including genetic testing, the patient was found to have indetectable thiamine levels. With supplementation, the patient no longer had any recorded ventricular arrhythmias, and neurological function improved with only residual tingling in the hands. This case emphasizes the profound effects of thiamine deficiency and why this should be included in our differential diagnosis for patients presenting with the sequelae of the signs and symptoms discussed.

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"Dry" and "wet" beriberi mimicking critical illness polyneuropathy

Cited by 9 publications

References 5 publications

Don’t seek, don’t find: The diagnostic challenge of Wernicke’s encephalopathy

Don’t seek, don’t find: The diagnostic challenge of Wernicke’s encephalopathy

Thiamine deficiency‐related neuropathy: A reversible entity from an endemic area

A Rare Case of Thiamine Deficiency Leading to Dry Beriberi, Peripheral Neuropathy, and Torsades De Pointes

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