title: Acute pernicious beriberi in a patient receiving parenteral nutrition. A case report.
abstract: Parenteral nutrition is being used increasingly in the treatment of the critically ill patient but it causes complications and metabolic derangement. A patient receiving parenteral nutrition in whom protracted vomiting from intestinal obstruction led to the development of acute cardiovascular beriberi (Shoshin) with severe metabolic acidosis--probably lactic--is described. The acidosis was refractory to bicarbonate infusion and inotropic support but the administration of intravenous thiamine 100 mg resulted in a dramatic recovery. Biochemical confirmation of thiamine deficiency was obtained by the measurement of an elevated thiamine pyrophosphate level (24.4%). The patient received thiamine 2.4 mg weekly, a dose that proved insufficient. Thiamine deficiency should be considered when patients receiving parenteral nutrition develop metabolic acidosis with a wide anion gap, even if vitamin supplementation appears adequate.
authors.affiliation: Department of Medicine, University of Natal, Durban.
authors.forename: D P
authors.initials: DP
authors.lastname: Naidoo
authors.forename: B
authors.initials: B
authors.lastname: Singh
authors.forename: A
authors.initials: A
authors.lastname: Haffejee
authors.forename: J
authors.initials: J
authors.lastname: Aitcheson
authors.forename: E M
authors.initials: EM
authors.lastname: Barker
mesh_terms: D000138:Acidosis / Q000150:complications; D000208:Acute Disease; D000328:Adult; D001602:Beriberi / Q000209:etiology*; D002303:Cardiac Output, Low / Q000150:complications; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000150:complications; D010288:Parenteral Nutrition / Q000009:adverse effects*