Dry Beriberi and Drastic Weight Loss

Case Diagnosis: Dry Beriberi (Vitamin B1 deficiency)

Case Description or Program Description: Inpatient rehabilitation patient undergoing extreme weight loss measures, particularly fasting, that presented with severe neurological motor symptoms after having difficulty ambulating.

Setting: 38 year old female presented to inpatient rehabilitation after undergoing a thirty day water fast for weight loss, now presenting with bilateral lower extremity weakness and severe pain.

Assessment/Results: This patient presented initially to the emergency department after having progressive weakness with difficulty ambulating, followed by severe pain in her bilateral lower extremities. The patient underwent a full neurological and medical workup, and after a further history was taken, was found to have a severe vitamin B1 (Thiamine) deficiency caused by extreme fasting with only water for thirty days. The patient presented to inpatient rehabilitation unable to ambulate, with severe pain affecting her lower extremities, distally greater than proximally.

Discussion (relevance): In patients that undergo drastic weight loss, particularly through malnutrition, they may present with severe motor neurological impairments and pain that can affect their activities of daily living (ADLs). While the differential diagnosis can be broad based on patient history and clinical manifestations, the most lethal diagnosis may indicate Guillan-Barre syndrome. However, a full medical history including nutritional intake and lifestyle factors should be taken into consideration that a vitamin deficiency, particularly thiamine, may be the culprit of such neurological symptoms.

Conclusions: It is important to include vitamin deficiency differentials when neurological symptoms from fast and sudden weight loss via starvation methods occurs, as the long term impacts such as cardiovascular complications (C. Badii, 2021) and neurological complications can lead to permanent dysfunction that interferes with an individual's independence.