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Early Signs of Thiamine Deficiency: A Case Report

Background: Recognition of early thiamine deficiency is necessary to avoid the risk for permanent neurologic deficits and early death. The Wernicke triad of encephalopathy, ataxia, and ophthalmoplegia (1) may be a late manifestation of thiamine deficiency. The Caine criteria require a history of malnutrition and 1 component of the Wernicke triad to consider the diagnosis of thiamine deficiency (2). Objective: To highlight “the earliest sign” of thiamine deficiency. Horizontal gaze–evoked nystagmus was the most common neurologic finding in large series of patients with thiamine deficiency (1, 3). Case Report: I was involved in the care of a 29-year-old woman with a history of bipolar disorder, migraine, and type 2 diabetes mellitus that was controlled with metformin. She developed panic attacks 2 weeks after tonsillectomy and had frequent vomiting (4 times daily) for 2 weeks, which prompted hospitalization for intravenous fluid replacement. She did not LETTERS