Combined deficiencies of vitamins b1 and C in well-nourished patients

Vitamin deficiencies such as scurvy and Wernicke's encephalopathy are poorly recognized in Western populations. Inadequate intake of these micronutrients and low levels when measured are more frequent than expected. Cases of combined vitamin deficiencies such as that of ascorbic acid and thiamine are seldom reported. Two patients with clinical and biochemical evidence of vitamin deficiencies are described. Signs and symptoms rapidly responded to vitamin replacement. Neither patient was overtly malnourished, but nutritional histories and physical examination were strongly suggestive. Vitamin replacement may require large intravenous doses but is inexpensive and potentially of great benefit.