Elevated Lactate Secondary to Gastrointestinal Beriberi

Duca, James; Lum, C.; Lo, Angela M.

doi:10.1007/s11606-015-3326-2

Cited by 22 publications

(18 citation statements)

References 18 publications

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“…Patient 3 has had prominent gastrointestinal symptoms since the WE episode. Gastrointestinal manifestations of thiamine deficiency (“gastrointestinal beriberi”) have been reported ( 85 , 86 ). Short-term experimental thiamine deficiency in humans caused transient gastrointestinal symptoms and radiologically documented reduction in gastrointestinal motility ( 87 ).…”

Section: Discussionmentioning

confidence: 99%

Korsakoff Syndrome in Non-alcoholic Psychiatric Patients. Variable Cognitive Presentation and Impaired Frontotemporal Connectivity

Nikolakaros¹,

Kurki

Paju

et al. 2018

Front. Psychiatry

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Background: Non-alcoholic Wernicke's encephalopathy and Korsakoff syndrome are greatly underdiagnosed. There are very few reported cases of neuropsychologically documented non-alcoholic Korsakoff syndrome, and diffusion tensor imaging (DTI) data are scarce.Methods: We report clinical characteristics and neuropsychological as well as radiological findings from three psychiatric patients (one woman and two men) with a history of probable undiagnosed non-alcoholic Wernicke's encephalopathy and subsequent chronic memory problems.Results: All patients had abnormal neuropsychological test results, predominantly in memory. Thus, the neuropsychological findings were compatible with Korsakoff syndrome. However, the neuropsychological findings were not uniform. The impairment of delayed verbal memory of the first patient was evident only when the results of the memory tests were compared to her general cognitive level. In addition, the logical memory test and the verbal working memory test were abnormal, but the word list memory test was normal. The second patient had impaired attention and psychomotor speed in addition to impaired memory. In the third patient, the word list memory test was abnormal, but the logical memory test was normal. All patients had intrusions in the neuropsychological examination. Executive functions were preserved, except for planning and foresight, which were impaired in two patients. Conventional MRI examination was normal. DTI showed reduced fractional anisotropy values in the uncinate fasciculus in two patients, and in the corpus callosum and in the subgenual cingulum in one patient.Conclusions: Non-alcoholic Korsakoff syndrome can have diverse neuropsychological findings. This may partly explain its marked underdiagnosis. Therefore, a strong index of suspicion is needed. The presence of intrusions in the neuropsychological examination supports the diagnosis. Damage in frontotemporal white matter tracts, particularly in the uncinate fasciculus, may be a feature of non-alcoholic Korsakoff syndrome in psychiatric patients.

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Section: Discussionmentioning

confidence: 99%

Korsakoff Syndrome in Non-alcoholic Psychiatric Patients. Variable Cognitive Presentation and Impaired Frontotemporal Connectivity

Nikolakaros¹,

Kurki

Paju

et al. 2018

Front. Psychiatry

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“…Thiamine, a cofactor necessary for PDH complex activity, may play such a role in altering PDH activity in sepsis. Thiamine deficiency is not uncommon in sepsis (14,15), and previous case reports have found that administering thiamine to critically ill thiamine-deficient patients leads to rapid reversal of elevated lactate, as well as improvement in clinical symptoms (16)(17)(18). PDH and thiamine levels have also been found to fall with the physiologic stress of coronary artery bypass surgery in a small observational study in humans (19).…”

Section: Brief Communicationmentioning

confidence: 97%

Pyruvate Dehydrogenase Activity is Decreased in the Peripheral Blood Mononuclear Cells of Patients with Sepsis: A Prospective Observational Trial

Nuzzo¹,

Berg

Andersen

et al. 2015

Annals ATS

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Rationale: Rodent studies have shown that pyruvate dehydrogenase (PDH) levels are low in sepsis. This may cause cells to shift to anaerobic metabolism, resulting in increased lactate production. Alterations in PDH during sepsis have never been studied in humans.Objectives: The objective of this pilot study was to measure PDH activity and quantity in patients with severe sepsis. Methods:We conducted a pilot case-control study at a single urban tertiary care center. We compared PDH activity and quantity between patients with severe sepsis admitted to the intensive care unit and healthy control subjects. PDH activity and quantity were measured in isolated peripheral blood mononuclear cells. We measured PDH activity and quantity in control subjects at baseline and in patients with sepsis at 0 (baseline), 24, 48, and 72 hours. Measurements and Main Results:We enrolled 56 patients with sepsis and 20 control subjects with at least one blood sample being drawn from each patient. PDH activity and quantity in the sepsis group were significantly lower than the control group (P , 0.001). In multivariable linear regression adjusting for age, race, sex, and assay plate, the difference remained significant. Patients with sepsis who died had significantly lower PDH activity compared with those who survived (P = 0.03).Conclusions: PDH activity and quantity is decreased in peripheral blood mononuclear cells of humans with severe sepsis when compared with healthy control subjects, and may be associated with mortality. Whether decreased PDH activity plays a role in lactate metabolism or whether pharmacologic modification of PDH activity may improve outcomes remains unknown.

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“…In addition, hypothermia due to involvement of the posterior hypothalamus,13 acute kidney injury,16 leucocytosis and increased lactate14 also points to the diagnosis of WE. Korsakoff syndrome is a late manifestation of WE characterised by selective amnesia and apathy which were not observed in this patient 13 17…”

Section: Discussionmentioning

confidence: 61%

Starvation-induced diplopia and weakness: a case of beriberi and Wernicke’s encephalopathy

Tan¹,

Lim

Chung

et al. 2019

BMJ Case Rep

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A 56-year-old teetotaller man with hypertension and gout presented with a week duration of painless worsening diplopia on a background of loss of weight and appetite, generalised lethargy and weakness for 1 year. On examination, he was noted to be hypothermic and tachycardic with generalised muscle wasting. Proximal myopathy, lower limb fasciculations and areflexia, restricted bilateral eye abduction and nystagmus were observed. Blood investigations demonstrated compensated lactic acidosis, acute kidney injury and leucocytosis. A nerve conduction study showed severe length-dependent axonal sensorimotor polyneuropathy. This was a diagnostic dilemma until an MRI brain revealed symmetrical signal abnormality and enhancement in the periaqueductal area indicative of Wernicke’s encephalopathy, caused by thiamine deficiency from poor nutrition. Beriberi, also caused by thiamine deficiency, accounted for his tachycardia, polyneuropathy, areflexia, hypothermia and biochemical abnormalities. Both beriberi and Wernicke’s encephalopathy are medical emergencies, which were treated with intravenous thiamine to good effect.

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Elevated Lactate Secondary to Gastrointestinal Beriberi

Cited by 22 publications

References 18 publications

Korsakoff Syndrome in Non-alcoholic Psychiatric Patients. Variable Cognitive Presentation and Impaired Frontotemporal Connectivity

Korsakoff Syndrome in Non-alcoholic Psychiatric Patients. Variable Cognitive Presentation and Impaired Frontotemporal Connectivity

Pyruvate Dehydrogenase Activity is Decreased in the Peripheral Blood Mononuclear Cells of Patients with Sepsis: A Prospective Observational Trial

Starvation-induced diplopia and weakness: a case of beriberi and Wernicke’s encephalopathy

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