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.

一名既往健康的30岁男性，在一次大量饮酒后罹患胃肠道脚气病，继而并发韦尼克脑病（Wernicke’s encephalopathy）。患者出现恶心、呕吐及食欲减退，且症状呈进行性加重。发病2个月后，该患者出现眼外肌麻痹（external ophthalmoplegia）。经静脉注射1000mg硫胺素（thiamine）治疗后，其神经与胃肠道症状在数小时内即得到逆转。由于胃肠道脚气病的临床表现缺乏特异性，该病的诊断颇具挑战性。发病2个月内，该患者先后11次急诊就诊、3次住院治疗，并接受了腹腔镜胆囊切除术（laparoscopic cystectomy），但胃肠道症状仍持续进展。直至胃肠道症状出现2个月后，患者方才出现眼外肌麻痹，遂予静脉注射硫胺素治疗。此例患者中，虚弱性胃肠道症状与眼外肌麻痹同时得到缓解的表现较为独特。硫胺素缺乏症至今仍存在诊断不足的问题，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，即便并非酗酒人群，也应将该病症纳入鉴别诊断范畴。