Document Type
Conference Proceeding
Publication Date
5-3-2024
Abstract
Introduction: Thiamine deficiency, historically known as Beriberi, poses diagnostic dilemmas due to its potential occurrence without overt malnutrition or alcohol dependence. This case report explores the intricate dynamics of cardiocirculatory collapse coupled with pericardial effusion, unveiling an underlying thiamine deficiency. Case Description: A 68-year-old male with a medical history of hypothyroidism, heart failure, and chronic mild pericardial effusion presented with worsening dyspnea, leg edema, and hypotension. The patient's physical evaluation disclosed notable findings, including marked obesity, distant heart sounds, an audible S4 sound, and swelling in the lower extremities. Laboratory results revealed chronic anemia. Brain natriuretic peptide (BNP) was mildly elevated at 286 pg/mL, accompanied by severe hypoalbuminemia (1.6 g/dL) and low pre-albumin levels (6 mg/Dl). The coagulation panel and cardiac ischemia workup were within normal limits. The patient underwent surgical pericardial effusion drainage with a pericardiocentesis drain. Despite the intervention, the patient developed hypotension unresponsive to fluid resuscitation, prompting a septic workup and initiation of vasopressors. We initiated thiamine replacement due to the patient's risk factors, including significant weight loss, frequent hospitalizations with parenteral nutrition, and chronic inflammation, as well as refractory hypotension, resulting in rapid and dramatic restoration of hemodynamics and resolution of effusions. We provided intravenous thiamine 100 mg three times daily according to the guidelines. Discussion: Thiamine deficiency can manifest in diverse clinical presentations, complicating timely diagnosis. Its deficiency disrupts adenosine triphosphate (ATP) production, which leads to adenosine accumulation. This accumulation causes direct vasomotor depression and reduced systemic vascular resistance. It eventually leads to hypotension and cardiovascular collapse unless thiamine is replaced. The challenges in diagnosing thiamine deficiency highlight the importance of a comprehensive clinical assessment and a high index of suspicion, particularly in critical care settings where rapid diagnostic tests may be lacking. This case contributes to the growing body of evidence emphasizing the potential for thiamine deficiency in patients without explicit risk factors. Clinical Significance: The presented case underscores the importance of recognizing thiamine deficiency in patients with refractory cardio-circulatory collapse. Timely initiation of thiamine replacement therapy proved pivotal in reversing the hemodynamic compromise and resolving pericardial effusion. This report advocates for increased awareness among clinicians, urging them to consider thiamine deficiency as a potential etiology in critical patients, even in the absence of overt malnutrition or alcohol dependence.
Recommended Citation
Arshad K, Mahameed Z, Latif R, Elteriefi R, Alamro Y. From collapse to recovery: thiamine intervention in cardiac beriberi. Presented at: American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2024 Resident and Medical Student Day; 2024 May 3; Troy, MI
Comments
American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2024 Resident and Medical Student Day, May 3, 2025, Troy, MI