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[Acute cardiovascular beriberi (shoshin-beriberi)]
Osvaldo D López Gastón1, Eduardo R Malvino, Diego McLoughlin
1División Terapia Intensiva, Policlínica Bancaria, Buenos Aires, Argentina. odlopez@intramed.net.ar
Medicina
|September 28, 2002
Summary
Shoshin beriberi, a severe form of thiamine deficiency, presents with cardiovascular collapse. Early thiamine administration is crucial for recovery in patients with lactic acidosis and high-output heart failure.
Area of Science:
- Cardiology
- Neurology
- Nutritional Science
Background:
- Beriberi, caused by thiamine deficiency, presents as "dry" (neurologic) or "wet" (cardiovascular) forms.
- Wet beriberi includes "classic" wet BB with right-sided heart failure and "shoshin" BB with severe biventricular failure and metabolic acidosis.
Observation:
- A 58-year-old alcoholic woman presented with dyspnea, edema, high-output cardiac failure, metabolic acidosis, and renal dysfunction.
- Neurological examination revealed peripheral neuropathy and cognitive impairment.
- Serum lactate levels were elevated at 5.6 mEq/L.
Findings:
- Intravenous thiamine administration (100 mg loading dose) led to improved urine output and corrected acidosis.
- Hemodynamic parameters improved, with reduced pulmonary-capillary wedge pressure.
- The patient showed a significant positive response to thiamine treatment.
Implications:
- Shoshin beriberi is an underrecognized but critical diagnosis in patients with unexplained lactic acidosis or hyperdynamic circulation.
- Vitamin B1 (thiamine) deficiency should be considered in such cases.
- Prompt thiamine administration can prevent rapid deterioration and sudden death.