SHM Converge Scientific Abstract ePoster Gallery-An Unusual Case of Occidental Dry Beriberi With Disordered Eating

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This case report describes a 42-year-old woman with a history of bulimia nervosa who developed occult, or “occidental,” dry beriberi due to severe thiamine deficiency from disordered eating. She presented with several months of worsening confusion, disorientation, poor intake, nausea, vomiting, and progressive lower extremity weakness. Her daughter also reported minimal food intake and heavy consumption of soft drinks.<br /><br />On exam, she had normal vital signs and no cardiac findings, but neurologic evaluation showed weakness in all extremities, decreased light touch in both legs, and absent leg reflexes. Extensive workup was unrevealing, including normal CBC, CMP, TSH, ammonia, urine drug screen, MRI brain, lumbar puncture, and EEG without epileptiform activity. However, laboratory testing showed an extremely low thiamine level and low folate.<br /><br />She was treated with high-dose thiamine and folate supplementation. Over the following months, her confusion, disorientation, and weakness gradually improved, and her sensory and motor deficits resolved.<br /><br />The report emphasizes that beriberi is a potentially fatal disease caused by vitamin B1 deficiency. Dry beriberi primarily causes neurologic symptoms, while wet beriberi affects the cardiovascular system. Risk factors include alcoholism, malnutrition, starvation, gastric bypass surgery, and poor diet. Symptoms can include extremity weakness, sensory loss, memory problems, vertigo, fatigue, diplopia, and heart failure.<br /><br />The authors conclude that thiamine deficiency should be considered in patients with disordered eating or bulimia nervosa who present with neurologic deficits. Prompt thiamine replacement can lead to excellent recovery, and an interprofessional care approach is important to reduce morbidity.

Asset Subtitle

Keir F. MacKay

Meta Tag

Author List Allison Weaver, Keir F. MacKay

Category Clinical Vignettes

Concept Beriberi

Concept Thiamine

Concept Thiamine Deficiency

Concept Thiamine Therapy

Concept Dry Beriberi

Distinguished Non-Finalist

Presenter Organization Southwest Indiana Internal Medicine Residency (Indiana University)

Presenting Author Keir F. MacKay

Track Adult

Keywords

bulimia nervosa

thiamine deficiency

dry beriberi

vitamin B1 deficiency

neurologic deficits

malnutrition

confusion

lower extremity weakness

thiamine replacement

disordered eating

Beriberi

Thiamine

Thiamine Deficiency

Thiamine Therapy

Dry Beriberi