726 - A Beriberi Complicated Case of Thiamine Deficiency

Case Diagnosis: Thiamine deficiency with resulting heart failure, encephalopathy, uncontrolled diabetes, and hypothermia

Case Description: A thin 41-year-old woman with uncontrolled diabetes mellitus presented to the hospital with new-onset decompensated heart failure. Her hospitalization was notable for episodes of severe hyperglycemia and altered mental status. Brain MRI demonstrated evidence of a left cerebellar stroke and areas of acute diffusion restriction in the bilateral globi pallidi, concerning for sequelae of anoxic or toxic/metabolic injury. She was discharged to the inpatient rehabilitation facility (IRF), where, within an hour of her admission, she became unresponsive. She was hypothermic, with a rectal temperature of 90.6^°F, and hypoglycemic. A sepsis work-up and serum thiamine level were sent to evaluate the hypothermia. She was transferred to the intensive care unit, stabilized, and returned to the IRF one week later. Upon readmission, she remained somnolent and confused. Her serum thiamine level then resulted as low (52 nmol/L), prompting treatment with intravenous thiamine, with resulting significant improvements in mental status and glycemic control.



Discussions: Thiamine (Vitamin B1) deficiency, while uncommon in developed countries, should be considered in persons presenting with severe encephalopathy or heart failure of unclear etiology. It may also contribute to difficult to control diabetes mellitus and is an important cause of hypothermia. Persons with alcohol use disorder and malabsorption syndromes are at highest risk, but it may also occur in those with diets high in washed rice, which we believe was the cause of this patient’s deficiency. When individuals present with Wernicke’s encephalopathy, it is critical to begin treatment with thiamine as soon as possible to prevent Korsakoff syndrome, which may be irreversible.

Conclusions: This case serves as a compelling reminder of the multitude of potential clinical manifestations of thiamine deficiency, as well as the importance of providing prompt supplementation once it is diagnosed.