Gastrointestinal Beriberi and Wernicke’s Encephalopathy Triggered by One Session of Heavy Drinking

Abstract

An otherwise healthy 30-year-old male acquired gastrointestinal beriberi and subsequent Wernicke’s encephalopathy after 1 session of heavy drinking. Nausea, vomiting, and anorexia relentlessly progressed. The patient developed external ophthalmoplegia after 2 months. Intravenous 1,000 mg thiamine reversed both neurologic and gastrointestinal symptoms within hours. It is hard to diagnose gastrointestinal beriberi since the symptoms are nonspecific. The patient underwent 11 emergency room visits, 3 hospital admissions, and laparoscopic cystectomy within 2 months, but the gastrointestinal symptoms continued to progress. Two months after the onset of gastrointestinal symptoms, external ophthalmoplegia appeared, and, therefore, intravenous thiamine was given. The simultaneous resolution of the debilitating gastrointestinal symptoms and external ophthalmoplegia was unique. Thiamine deficiency remains underdiagnosed and should be considered in patients who develop unexplained gastroparesis or autonomic nervous failure of the digestive system, even in the nonalcoholic population.

Thiamine Dosing for the Treatment of Alcohol-Induced Wernicke’s Encephalopathy: A Review of the Literature

“…Another case report by Tjong and Peng presented a 30-year-old male who had predisposed beriberi and developed WE 2 months after a single heavy drinking session, which resulted in a neurologic emergency deeming prompt treatment. 23 The patient was clearly malnourished, due to his inability to tolerate solid foods and the previous diagnosis of beriberi. 23 The patient was given 500 mg of IV thiamine and did not respond appropriately; another 500 mg was given.…”

“…23 The patient was clearly malnourished, due to his inability to tolerate solid foods and the previous diagnosis of beriberi. 23 The patient was given 500 mg of IV thiamine and did not respond appropriately; another 500 mg was given. 23 It took 10 times the recommended dose to achieve clinical resolution, in which all neurologic symptoms were reversed within hours.…”

“…23 The patient was given 500 mg of IV thiamine and did not respond appropriately; another 500 mg was given. 23 It took 10 times the recommended dose to achieve clinical resolution, in which all neurologic symptoms were reversed within hours. 23…”

“…23 It took 10 times the recommended dose to achieve clinical resolution, in which all neurologic symptoms were reversed within hours. 23…”

“…25 This trend aligns with other subsequently conducted evaluations included in this review, in that patients who received high doses of thiamine experienced a shorter duration of symptoms associated with WE. 21-23,25…”