63 yo F  p/w AMS noted as AAOx2 w/o focal deficits. Pt appeared cachetic, thin, dry with following VS BP 148/70, HR 142, T 96.4, rr 20, o2 98%.

EKG showed sinus tachy with noted persistent lactate 4-5 despite aggressive IVF and remained AMS.

Pt was afebrile with negative sepsis workup, with neg CTH/CXR/labwork except as noted above.

Pt informs you that she is a strict vegan with limited diet.

What is the etiology of this patients altered mental status?

A: Beri Beri – thiamine def, more common amongst Etoh but can also present in those with dietary restrictions.

  • Dry beriberi and Wernicke-Korsakoff syndrome affect the peripheral and central nervous system respectively.
  • Wet beriberi affects the cardiovascular system, as well as other bodily systems.
  • Infantile beriberi affects mostly children in developing countries.


Thanks to Trevor for today’s clinical pearl. Pt’s vitamins were repleted (folate and thiamine) with resolution of symptoms.