{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:02:17Z","timestamp":1756339337794,"version":"3.44.0"},"reference-count":17,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,3,5]]},"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:p>Thiamine is an essential cofactor in the process of nucleic acid synthesis. Neuronal tissues are especially sensitive to thiamine deficiency, manifesting as Wernicke\u2019s encephalopathy (WE). The typical triad of WE, encephalopathy, oculomotor dysfunction and gait ataxia, is only present in less than one-third of the cases. We present the case of a middle-aged man with hypoactive delirium due to presumed thiamine deficiency, who had a prolonged hospital course and a delayed diagnosis of the cause of altered mental status. The presentation of this disorder solely as a decreased level of consciousness is uncommon but has been reported in the literature. It is essential to recognise WE as a treatable condition that may manifest only as a hypoactive delirium. The delay in the diagnosis and treatment may lead to coma and death.<\/jats:p>","DOI":"10.1136\/bcr-2020-239886","type":"journal-article","created":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T12:21:28Z","timestamp":1615983688000},"page":"e239886","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Case of hypoactive delirium precipitated by thiamine deficiency"],"prefix":"10.1136","volume":"14","author":[{"given":"Tiffany","family":"Truong","sequence":"first","affiliation":[{"name":"School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fredrick","family":"Hetzel","sequence":"additional","affiliation":[{"name":"MetroHealth Medical Center, Department of Internal Medicine, Case Western Reserve University, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine M","family":"Stiff","sequence":"additional","affiliation":[{"name":"Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Ghazanfar","family":"Husnain","sequence":"additional","affiliation":[{"name":"MetroHealth Medical Center, Hospital Medicnie, Case Western Reserve University, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,3,17]]},"reference":[{"key":"2025082623263602000_14.3.e239886.1","doi-asserted-by":"publisher","DOI":"10.1177\/0148607114565245"},{"key":"2025082623263602000_14.3.e239886.2","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/agm144"},{"key":"2025082623263602000_14.3.e239886.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2010.03153.x"},{"key":"2025082623263602000_14.3.e239886.4","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.49.4.341"},{"key":"2025082623263602000_14.3.e239886.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j2047"},{"key":"2025082623263602000_14.3.e239886.6","first-page":"26","article-title":"Thiamine deficiency and delirium","volume":"10","author":"Osiezagha","year":"2013","journal-title":"Innov Clin Neurosci"},{"key":"2025082623263602000_14.3.e239886.7","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.pcad.2018.01.009","article-title":"Thiamine and cardiovascular disease: a literature review","volume":"61","author":"DiNicolantonio","year":"2018","journal-title":"Prog Cardiovasc Dis"},{"key":"2025082623263602000_14.3.e239886.8","doi-asserted-by":"publisher","DOI":"10.1111\/imj.12522"},{"key":"2025082623263602000_14.3.e239886.9","article-title":"Wernicke's encephalopathy: increasing clinician awareness of this serious, enigmatic, yet treatable disease","volume":"17","author":"Flynn","year":"2015","journal-title":"Prim Care Companion CNS Disord"},{"key":"2025082623263602000_14.3.e239886.10","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/S0140-6736(78)91867-6","article-title":"Coma in the Wernicke-Korsakoff syndrome","volume":"2","author":"Wallis","year":"1978","journal-title":"Lancet"},{"key":"2025082623263602000_14.3.e239886.11","article-title":"Thiamine for prevention and treatment of Wernicke-Korsakoff syndrome in people who abuse alcohol","volume":"2013","author":"Day","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"2025082623263602000_14.3.e239886.12","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.1097\/CCM.0000000000003402","article-title":"Incidence and prevalence of delirium subtypes in an adult ICU: a systematic review and meta-analysis","volume":"46","author":"Krewulak","year":"2018","journal-title":"Crit Care Med"},{"key":"2025082623263602000_14.3.e239886.13","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-015-2610-3"},{"key":"2025082623263602000_14.3.e239886.14","doi-asserted-by":"crossref","first-page":"483","DOI":"10.5694\/j.1326-5377.2011.tb03068.x","article-title":"Wernicke's encephalopathy in a non-alcoholic patient with a normal blood thiamine level","volume":"194","author":"Davies","year":"2011","journal-title":"Med J Aust"},{"key":"2025082623263602000_14.3.e239886.15","article-title":"Wernicke's encephalopathy","volume":"10","author":"Patel","year":"2018","journal-title":"Cureus"},{"key":"2025082623263602000_14.3.e239886.16","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A0827"},{"key":"2025082623263602000_14.3.e239886.17","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.psym.2015.10.001","article-title":"Nonalcoholic Thiamine-Related encephalopathy (Wernicke-Korsakoff syndrome) among inpatients with cancer: a series of 18 cases","volume":"57","author":"Isenberg-Grzeda","year":"2016","journal-title":"Psychosomatics"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-239886","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T06:26:46Z","timestamp":1756276006000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-239886"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3]]},"references-count":17,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3,17]]},"published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1136\/bcr-2020-239886"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-239886","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,3]]}}}