SHM Converge Scientific Abstract ePoster Gallery-Nut-Milk Diet and Encephalopathy?

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This case describes a 5-year-old boy with autism, developmental delay, and severe oral aversion who developed profound malnutrition after an exclusive almond milk diet. He presented with lethargy, acute inability to walk, diffuse weakness, 23% weight loss, tachycardia, and ascites. Brain MRI showed thalamic hyperintensities consistent with thiamine- and pyridoxine-deficiency encephalopathy.<br /><br />He was started on nasogastric feeding with pediatric formula and vitamin B1 and B6 supplementation, with close monitoring for refeeding syndrome. His course was complicated by abdominal distention, fecal impaction, hypothermia, hypoxia, and ICU transfer for respiratory failure and bi-ventricular cardiac dysfunction requiring intubation and vasopressors. After treatment and ongoing supplementation, his cardiac function improved, with ejection fraction rising from 45% to 56%, and his weakness gradually improved with physical therapy.<br /><br />The report emphasizes that almond milk provides negligible thiamine and pyridoxine compared with recommended daily requirements for preschool-aged children. Thiamine deficiency can cause encephalopathy, neuropathy, and cardiac failure, while pyridoxine deficiency can contribute to neuropathy, seizures, and cognitive impairment. These deficiencies are potentially reversible if identified early.<br /><br />Management was challenging due to family resource limitations, reluctance to use home nasogastric feeds, and limited access to outpatient feeding and therapy services. Ultimately, the child was discharged on standard pediatric formula and daily thiamine and pyridoxine, with follow-up in cardiology, neurology, rehabilitation, speech, occupational therapy, physical therapy, and feeding clinic. The case highlights the importance of early nutritional assessment, multidisciplinary care, and prompt intervention in children with severe food aversions to prevent life-threatening but treatable deficiency states.

Asset Subtitle

Anika Kumar

Meta Tag

Author List Anika Kumar, Catherine Brown, Jonathan Lim, Mariana M. Coelho

Category Clinical Vignettes

Concept Restrictive Diet

Concept Malnutrition

Concept Vitamin Deficiency

Concept Thiamine Deficiency

Concept Vitamin B6 Deficiency

Distinguished Non-Finalist

Presenter Organization Cleveland Clinic Children's

Presenting Author Anika Kumar

Track Pediatric

Keywords

autism

developmental delay

malnutrition

almond milk diet

thiamine deficiency

pyridoxine deficiency

encephalopathy

cardiac dysfunction

refeeding syndrome

pediatric nutrition

Restrictive Diet

Malnutrition

Vitamin Deficiency

Thiamine Deficiency

Vitamin B6 Deficiency