科研之友
微信
新浪微博
Facebook
分享链接
摘要
A 59-year-old patient presented with prolonged abdominal pain, vomiting, and anorexia, which were finally found to be caused by an abscess in a previously resected kidney bed. After operation, vomiting continued, and the patient was treated with omeprazole when investigations revealed esophagitis. However, vomiting persisted with associated increasing lassitude, tachycardia, blood pressure lability (hypertension or episodic hypotension/syncope), leg pain, apathy, and somnolence. Nystagmus and areflexia were observed, suggesting thiamine deficiency and Wernicke encephalopathy. Prompt replacement led to marked improvement, but significant neurologic deficits remain. Thiamine deficiency is always considered in the setting of alcoholism, but awareness among clinicians of its potential to develop in many other common conditions remains poor. Once recognized, it is highly treatable, but diagnostic delays are hazardous. Our patient presents a clear example of the subtle misleading presentation of thiamine deficiency with its myriad of subtle physical findings, highlighting the diverse predisposing factors and the importance of timely recognition preferably in the emergency department setting.
- 出版日期2013-3
