SHM Converge Scientific Abstract ePoster Gallery-When Shock Is Not Cardiac: Thiamine-Responsive Mixed Beri-Beri in the Setting of Clostridium Difficile Colitis

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This poster presents a 64-year-old woman with hypertension, alcohol use disorder, malnutrition, and lymphangioleiomyomatosis who recently suffered severe C. difficile colitis with profuse diarrhea and electrolyte disturbances. She returned with rapidly worsening confusion, hypotension, hypoxia, diffuse edema, pulmonary edema, and large pleural effusions, requiring intubation, vasopressors, and thoracenteses. Initial concerns included septic, cardiogenic, or obstructive shock.<br /><br />Extensive evaluation found no infectious, structural, or neurologic cause. Brain imaging, EEG, CSF studies, cultures, and infectious panels were unrevealing. Echocardiography showed a hyperdynamic ejection fraction of 70%, arguing against cardiogenic shock. Laboratory findings included lactic acidosis, hypoalbuminemia, macrocytosis, and normal folate and vitamin B12 levels. Given her malnutrition risk, alcohol use, and recent gastrointestinal losses, thiamine deficiency was suspected.<br /><br />High-dose intravenous thiamine was started at 500 mg every 8 hours. Within 24 hours, the patient improved dramatically: vasopressors were stopped, mental status normalized, lactate resolved, respiratory failure improved, and she was extubated successfully. This rapid response confirmed thiamine-responsive mixed beriberi, combining wet beriberi (high-output heart failure, edema, pulmonary findings) and dry beriberi/Wernicke spectrum encephalopathy.<br /><br />The poster emphasizes that thiamine deficiency is an underrecognized but reversible cause of shock, lactic acidosis, encephalopathy, and high-output heart failure, especially in critically ill patients with malnutrition, alcohol use, or gastrointestinal losses. Because classic signs and diagnostic tests are often absent, diagnosis is frequently clinical. Early empiric thiamine is safe, inexpensive, and potentially lifesaving when shock does not fit typical septic or cardiogenic patterns.

Asset Subtitle

Amit Kumar

Meta Tag

Author List Ahmed Shah, Amit Kumar, James Rasmussen, Naman Suroya, Sourabh Singh

Category Clinical Vignettes

Concept Thiamine Deficiency

Concept Shock

Concept High-Dose Thiamine Replacement

Concept Pulmonary Edema

Concept Lactic Acidosis

Distinguished Non-Finalist

Presenter Organization Midwestern University

Presenting Author Amit Kumar

Track Adult

Keywords

thiamine deficiency

beriberi

Wernicke encephalopathy

shock

lactic acidosis

malnutrition

alcohol use disorder

high-output heart failure

pulmonary edema

pleural effusion

Thiamine Deficiency

Shock

High-Dose Thiamine Replacement

Pulmonary Edema

Lactic Acidosis