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Related Experiment Videos

[Postgastrectomy beriberi exaggerated by diuretic use: a case report].

Hirokuni Akahori¹, Takeshi Tsujino, Mitsuo Masutani

¹Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine, Hyogo.

Journal of Cardiology

|February 3, 2007

Summary

This case highlights that severe edema and neurological symptoms can indicate thiamine (vitamin B1) deficiency, especially in patients with a history of gastrectomy and diuretic use. Prompt vitamin B1 supplementation effectively resolved these symptoms.

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Area of Science:

Internal Medicine
Neurology
Nutritional Science

Background:

A 66-year-old male with a history of gastric and oropharyngeal cancer presented with chronic, severe pitting edema.
The patient had been treated with loop diuretics and levothyroxin for edema and hypothyroidism, with partial symptom relief.

Observation:

The patient developed unsteady gait, sensory disturbances (stocking-glove pattern), and muscle weakness.
Blood analysis revealed low plasma vitamin B1 (thiamine) concentration, leading to a diagnosis of beriberi.

Findings:

Thiamine deficiency was confirmed by low plasma vitamin B1 levels.
Intravenous vitamin B1 supplementation resulted in complete resolution of edema and gradual improvement of gait disturbance.

Implications:

Diuretics can increase urinary thiamine excretion, posing a risk for deficiency in susceptible individuals.
Patients with a history of gastrectomy and those on diuretic therapy require vigilant monitoring for latent thiamine deficiency.
This case underscores the importance of considering beriberi in patients presenting with edema and neurological deficits, particularly those with risk factors.