Pulmonary artery catheter usage in diagnosis of Shoshin beriberi presented with unexplained lactic acidosis

Abstract

Wet beriberi is a rare but fatal disease in modern society. The nonspecific clinical manifestations, including symptoms of heart failure and recalcitrant lactic acidosis, can prevent timely diagnosis. The use of a pulmonary artery catheter can promptly confirm a high cardiac output state and plays a crucial role in rapidly deteriorating cases. Appropriate treatment with intravenous administration of thiamine leads to dramatic recovery within hours. We present two cases of Shoshin beriberi, a fulminant variant of wet beriberi, diagnosed in 2016 and 2022 at our institute. The patients experienced haemodynamic collapse and refractory lactic acidosis, which were successfully diagnosed with the use of a pulmonary artery catheter and reversed by thiamine supplementation. We also reviewed 19 cases of wet beriberi reported between 2010 and 2022.

Keywords: High-output heart failure; Lactic acidosis; Pulmonary artery catheter; Shoshin beriberi; Wet beriberi.

Figure 1

Liver and renal function significantly improved after thiamine administration in case 1. (ALT, alanine aminotransferase; vasoactive inotropic score, dopamine dose [μg/kg/min] + dobutamine dose [μg/kg/min] + 100 × epinephrine dose [μg/kg/min] + 10 × milrinone dose [μg/kg/min] + 10 000 × vasopressin dose [U/kg/min] + 100 × norepinephrine dose [μg/kg/min]).

Figure 2

Serial haemodynamic monitoring with pulmonary artery catheter before and after thiamine administration in case 1 and 2. CO, cardiac output; CI, cardiac index; PAWP, pulmonary artery wedge pressure; CVP, central venous pressure; PAPm, mean pulmonary arterial pressure; SVRI, systemic venous resistance index; PVRI, pulmonary venous resistance index.