Search

A 78-year-old man presented to the emergency department with symptoms and signs suggestive of heart failure. Only after a long interview we discovered that the patient has been eating, for over 20 years, only chestnut honey and chestnut jam produced by himself. He refused any other foods, because of the fear of being poisoned; he did not drink alcohol at all. The clinical picture was attributable to Beriberi, and the patient recovered promptly after treatment with thiamine. A high clinical suspicion and an early thiamine supplementation might shorten the duration of work-up and hospital length of stay, as well as prevent extensive and expensive diagnostic work-up, thus simplifying the clinical management.

The authors report a case of beriberi due to a deficit in thiamine, which became apparent in a young Chinese woman with polyneuropathy, distal oedema and epigastralgia. Parenteral administration of thiamine lead to the virtually complete resolution of symptoms.

The Authors have followed several cases of alcoholic patients and studied their cardiocirculatory conditions, pointing out the fundamental differences between the Anglo-saxon alcoholic described by Evans and the Mediterranean patient observed and studied in our hospitals. Tachycardia, in a subject that presents, at first, a heart of normal dimension, is an element commonly observed. In the course of time electrocardiographic alterations may appear in the ventricular repolarization and therefore an expansion of the cardiac area and insufficient pumping. It is not common to find pure forms of this disease that more often is a concomitant factor for the rising of myocardium infirmities with remarkable contractile insufficiency. In other cases, however, and this has no valid justification, the alcoholic patient, though presenting remarkable liver damage, does not show signs of heart implication. In the light of this knowledge, we stress the utility of educating the alcoholic patient to the just evaluation of the poison he is ingesting.

The AA. report a case of thymine acute deficiency in a 35 year old chronic alcoholic and malnourished male, who was admitted to the hospital because of high-output heart failure, peripheral polyneuropathy, cortico-cerebellar atrophy (associated with RMN), ataxia and peripheral edema. The diagnosis of wet Beri-beri combined with Wernicke-Korsakoff syndrome was made and appropriate therapy with pulse daily dose of parenteral thymine instituted. At the fifth day of therapy the cardio-circulatory hyperkinetic syndrome was markedly improved and after three weeks neurological damage was also alleviated. The AA. outline the importance of early diagnosis and treatment for this form of high-output heart failure, which has a poor prognosis and, if left untreated, can determine the death of the patient in a few days.