Case Study

A good example of the specific effect of thiamin in the treatment of beriberi is illustrated by the response of a 29-year-old male who was admitted with an unexplained acute renal failure and had been anuric for 24 h. The physicians' report on his symptoms should be compared with the common clinical features of wet beriberi shown in Table 4. The patient's physical state and voice were extremely weak but speech was copious and confused. He complained intermittently of severe central chest and epigastric pain. A central cyanosis was present and he had a respiratory rate of 36 beats per minute. His temperature was normal and peripheries were lukewarm. He had gross generalised oedema. The jugular venous pressure became grossly elevated (Figure 2). Pulse rate was 100 beats per minute, regular, and weak at the wrist, although the carotid pulses were visibly bounding. Blood pressure was 80/60. There was a marked parasternal heave present, with a loud pulmonary second heart sound. The chest was clear; the abdomen was obese.

The father reported that the patient's usual beer intake was 6-12 pints daily and his one regular meal was usually no more than a sausage roll or a pie. Prior to admission, for 6 weeks he had felt too

Table 6 Clinical features of Wernicke-Korsakoff syndrome and frequency of occurrence

Features Frequency (%)a

Table 6 Clinical features of Wernicke-Korsakoff syndrome and frequency of occurrence

Features Frequency (%)a

Ocular disorders

Nystagmus (ocular ataxia — rhythmical oscillation of the eyeballs), almost always horizontal and in 50% of cases associated with vertical nystagmus on upward gaze

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