Supplementary Material for: Gastrointestinal Beriberi and Wernicke’s Encephalopathy Triggered by One Session of Heavy Drinking

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.一名既往身体健康的30岁男性，在一次大量饮酒后罹患胃肠型脚气病（gastrointestinal beriberi），随后并发韦尼克脑病（Wernicke’s encephalopathy）。恶心、呕吐及食欲减退呈进行性加重。患者于发病2个月后出现眼外肌麻痹（external ophthalmoplegia）。静脉给予1000mg硫胺素（thiamine）后，其神经与胃肠道症状在数小时内得以逆转。由于该病症症状缺乏特异性，胃肠型脚气病的诊断颇具难度。在2个月内，该患者先后11次急诊就诊、3次住院治疗，并接受了腹腔镜膀胱切除术（laparoscopic cystectomy），但胃肠道症状仍持续进展。胃肠道症状出现2个月后，患者出现眼外肌麻痹，遂予以静脉注射硫胺素治疗。此次衰弱性胃肠道症状与眼外肌麻痹同时缓解的表现较为罕见。硫胺素缺乏症仍存在诊断不足的情况，对于出现不明原因胃轻瘫（gastroparesis）或消化系统自主神经功能衰竭的患者，即便无酗酒史，也应考虑该病症的可能。