Shoshin beri-beri precipitated by intravenous glucose

A thiamine deficient patient presented to the emergency department with an acute confusional state, becoming unconscious and hypotensive following the administration of 32 g of intravenous glucose over 4 hr. A dramatic clinical improvement in his cardiovascular and neurological status followed a single intra-venous dose of 250 mg of thiamine. Profound thiamine deficiency was confirmed on biochemical testing. A substantial proportion of hospital patients are thiamine deficient and intravenous dextrose may precipitate cardiovascular collapse and lactic acidosis due to the development of 'shoshin' beriberi. A rapid response to intravenous thiamine may confirm the diagnosis. All patients presenting with acute neurological dysfunction should receive thiamine before glucose-containing solutions are administered.