Thiamine Reverses Diuretic-Induced Beriberi Post-Gastrectomy

observational-study PMID: 17269213

Quick Summary: A case study found that a man with a history of stomach surgery and taking diuretics developed a severe Vitamin B1 (thiamine) deficiency. Giving him thiamine supplements quickly cleared his symptoms. This highlights a risk for people with similar conditions.

What The Research Found

A 66-year-old man developed severe swelling and nerve problems due to a Vitamin B1 deficiency (beriberi). He had stomach surgery years before and was taking water pills (diuretics). Doctors found his Vitamin B1 levels were low. Giving him Vitamin B1 supplements made his swelling disappear quickly and improved his nerve issues. The study suggests that diuretics can worsen Vitamin B1 deficiency, especially in people who have had stomach surgery.

Study Details

Who was studied: One 66-year-old man.

How long: The study followed the man's symptoms from April to October 2003.

What they took: The man was given Vitamin B1 supplements. The exact dose and form of the supplement were not specified in the study.

What This Means For You

If you've had stomach surgery and take diuretics, you may be at higher risk for Vitamin B1 deficiency. Talk to your doctor if you experience swelling or nerve problems. They may want to check your Vitamin B1 levels.

Study Limitations

This study only looked at one person, so the results may not apply to everyone. The study also didn't specify the exact amount of Vitamin B1 given. Other factors, like his thyroid condition, could have also played a role.

Key Findings

This case report identified severe thiamine deficiency (beriberi) as the cause of persistent edema and neurological symptoms in a 66-year-old male with a history of partial gastrectomy and diuretic use. Plasma thiamine concentration was confirmed low. Initiation of thiamine supplementation led to complete resolution of edema within days and gradual improvement in gait disturbance. The study concludes that diuretic therapy exacerbated pre-existing thiamine deficiency caused by gastrectomy, highlighting a critical drug-nutrient interaction.

Study Design

This is a single-patient observational case report (n=1). The study documented the clinical course of a 66-year-old male hospitalized in 2003. Key methodology included clinical examination (noting pitting edema, unsteady gait, stocking-and-glove sensory disturbance, and distal muscle weakness), blood analysis (revealing hypothyroidism and low plasma thiamine), and therapeutic intervention with thiamine. The observation period spanned from initial presentation in April 2003 to readmission in October 2003, with symptom resolution tracked after supplementation began.

Dosage & Administration

The specific dose, form (e.g., thiamine hydrochloride), route (e.g., oral, intravenous), and frequency of thiamine supplementation were not reported in the provided study summary. The abstract only states "vitamin B1 supplementation was initiated."

Results & Efficacy

Thiamine supplementation produced rapid and complete clinical resolution of the primary symptom: severe pitting edema disappeared within a few days. Neurological symptoms (unsteady gait, sensory disturbance, muscle weakness) showed gradual subsidence following treatment. No quantitative metrics (e.g., edema volume reduction percentage), statistical analyses (p-values, confidence intervals), or plasma thiamine level changes post-treatment were provided in the summary. Efficacy was assessed solely through clinical observation.

Limitations

Major limitations include: (1) Single-case design (n=1), preventing generalization or statistical analysis; (2) Lack of reported thiamine dosage and administration details; (3) Potential confounding factors, notably concurrent hypothyroidism treatment with levothyroxine which partially improved edema prior to thiamine; (4) No baseline or post-treatment quantitative thiamine level measurements provided in the summary; (5) Inability to establish causation definitively due to observational nature. Future research requires controlled studies on thiamine status monitoring in gastrectomy patients on diuretics.

Clinical Relevance

This case demonstrates that patients with prior gastrectomy are at high risk for latent thiamine deficiency, which can be unmasked or exacerbated by diuretic therapy (due to increased urinary thiamine excretion). Clinicians should proactively monitor thiamine status in such patients presenting with unexplained edema or neurological symptoms, even if initially attributed to other causes like hypothyroidism. Thiamine supplementation can yield rapid, dramatic symptom resolution in deficiency cases. Supplement users with gastrointestinal surgery history should be cautious with long-term diuretic use and discuss thiamine status with their healthcare provider.