Shoshin beriberi with severe lactic acidosis and haemodynamic collapse due to long-term diuretic therapy.

Authors

Anees C K, Jeevan Jacob, Arjun C, Jitha Devan

Published in

BMJ case reports. Volume 19. Issue 8. Aug 25, 2026. Epub Aug 25, 2026.

Abstract

A patient on long-term diuretic treatment for pulmonary arterial hypertension presented with acute haemodynamic instability and profound high anion gap metabolic acidosis. Investigations showed severe lactic acidosis with no evidence of sepsis, hypoxia, diabetic ketoacidosis, acute pulmonary embolism or mesenteric ischaemia. Despite fluid resuscitation, vasopressor support and ventilatory support, the metabolic derangement persisted. Since she was on prolonged diuretic use and no other cause was identified, thiamine deficiency was suspected. Empirical intravenous thiamine administration led to rapid and sustained improvement in acid-base status and haemodynamics, allowing tapering of vasopressors. This case highlights thiamine deficiency as an under-recognised but readily reversible cause of severe lactic acidosis and cardiovascular collapse, particularly in patients receiving chronic diuretic therapy.

PMID:
42642096
Bibliographic data and abstract were imported from PubMed on 26 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.