{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:22:58Z","timestamp":1791559378489,"version":"4.3.4"},"reference-count":21,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,6]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2026-272300","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:05:20Z","timestamp":1787655920000},"page":"e272300","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Shoshin beriberi with severe lactic acidosis and haemodynamic collapse due to long-term diuretic therapy"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3887-2069","authenticated-orcid":false,"given":"Anees","family":"C K","sequence":"first","affiliation":[{"name":"Internal Medicine, Dr Moopen's Medical College, Wayanad, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1968-9277","authenticated-orcid":false,"given":"Jeevan","family":"Jacob","sequence":"additional","affiliation":[{"name":"Pharmacology, Dr Moopen's Medical College, Wayanad, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9576-8500","authenticated-orcid":false,"given":"Arjun","family":"C","sequence":"additional","affiliation":[{"name":"Internal Medicine, Dr Moopen's Medical College, Wayanad, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jitha","family":"Devan","sequence":"additional","affiliation":[{"name":"Internal Medicine, Dr Moopen's Medical College, Wayanad, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"2026082504051002000_19.8.e272300.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjms.2018.06.015"},{"key":"2026082504051002000_19.8.e272300.2","first-page":"155","article-title":"Metabolic failure due to thiamine deficiency during critical illness","volume":"27","author":"Cobilinschi","year":"2024","journal-title":"Curr Opin Clin Nutr Metab Care"},{"key":"2026082504051002000_19.8.e272300.3","doi-asserted-by":"crossref","unstructured":"Hong J , Cho D , Kim HJ , et al . Reversible Severe Acute Lactic Acidosis Caused by Thiamine Deficiency in Intensive Care Unit. Case Rep Crit Care 2025;2025. doi:10.1155\/crcc\/3211626","DOI":"10.1155\/crcc\/3211626"},{"key":"2026082504051002000_19.8.e272300.4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.clnu.2024.09.002","article-title":"Effect of intravenous thiamine administration on critically ill patients: A systematic review and meta-analysis of randomized controlled trials","volume":"43","author":"Nakanishi","year":"2024","journal-title":"Clin Nutr"},{"key":"2026082504051002000_19.8.e272300.5","article-title":"Shoshin beriberi induced by long-term administration of diuretics: a case report","volume":"2014","author":"Misumida","year":"2014","journal-title":"Case Rep Cardiol"},{"key":"2026082504051002000_19.8.e272300.6","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/j.amjmed.2016.01.037","article-title":"Does Long-Term Furosemide Therapy Cause Thiamine Deficiency in Patients with Heart Failure? A Focused Review","volume":"129","author":"Katta","year":"2016","journal-title":"Am J Med"},{"key":"2026082504051002000_19.8.e272300.7","doi-asserted-by":"crossref","first-page":"503","DOI":"10.4103\/1947-2714.102003","article-title":"Clinical correlates and outcome of Shoshin Beriberi","volume":"4","author":"Saya","year":"2012","journal-title":"North Am J Med Sci"},{"key":"2026082504051002000_19.8.e272300.8","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.psym.2012.01.010","article-title":"A case of Shoshin Beriberi: lessons old and new for the psychiatrist","volume":"54","author":"Brown","year":"2013","journal-title":"Psychosomatics"},{"key":"2026082504051002000_19.8.e272300.9","doi-asserted-by":"crossref","first-page":"569","DOI":"10.4070\/kcj.2013.43.8.569","article-title":"A case of cardiac beriberi: a forgotten but memorable disease","volume":"43","author":"Lee","year":"2013","journal-title":"Korean Circ J"},{"key":"2026082504051002000_19.8.e272300.10","article-title":"Clinical history and colliquative myocytolysis are keys to the diagnosis of shoshin beriberi","volume":"2014","author":"Kuno","year":"2014","journal-title":"Case Rep Pathol"},{"key":"2026082504051002000_19.8.e272300.11","first-page":"e1","article-title":"A case of shoshin beriberi presenting as cardiogenic shock with diffuse ST-segment elevation, which dramatically improved after a single dose of thiamine","volume":"25","author":"Kim","year":"2014","journal-title":"Cardiovasc J Afr"},{"key":"2026082504051002000_19.8.e272300.12","doi-asserted-by":"crossref","DOI":"10.1186\/s12937-015-0039-7","article-title":"Shoshin Beriberi in Critically-Ill patients: case series","volume":"14","author":"Dabar","year":"2015","journal-title":"Nutr J"},{"key":"2026082504051002000_19.8.e272300.13","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1536\/ihj.15-033","article-title":"Shoshin Beriberi With Low Cardiac Output and Hemodynamic Deterioration Treated Dramatically by Thiamine Administration","volume":"56","author":"Imamura","year":"2015","journal-title":"Int Heart J"},{"key":"2026082504051002000_19.8.e272300.14","doi-asserted-by":"crossref","first-page":"e670","DOI":"10.7861\/clinmed.2021-0550","article-title":"Lessons of the month 1: Shoshin beriberi: A case report of fulminant cardiovascular collapse, intractable hyperlactatemia and deteriorating consciousness","volume":"21","author":"Lim","year":"2021","journal-title":"Clin Med (Lond)"},{"key":"2026082504051002000_19.8.e272300.15","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1536\/ihj.23-459","article-title":"Clinical Features and Outcomes of Shoshin Beriberi","volume":"65","author":"Mizuguchi","year":"2024","journal-title":"Int Heart J"},{"key":"2026082504051002000_19.8.e272300.16","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/nyas.14536","article-title":"Thiamine deficiency disorders: a clinical perspective","volume":"1498","author":"Smith","year":"2021","journal-title":"Ann N Y Acad Sci"},{"key":"2026082504051002000_19.8.e272300.17","doi-asserted-by":"crossref","DOI":"10.3389\/fnut.2025.1633864","article-title":"An easily overlooked cause of pulmonary arterial hypertension-thiamine deficiency","volume":"12","author":"Zhao","year":"2025","journal-title":"Front Nutr"},{"key":"2026082504051002000_19.8.e272300.18","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.ihj.2016.07.015","article-title":"Shoshin beriberi-thiamine responsive pulmonary hypertension in exclusively breastfed infants: A study from northern India","volume":"69","author":"Bhat","year":"2017","journal-title":"Indian Heart J"},{"key":"2026082504051002000_19.8.e272300.19","doi-asserted-by":"crossref","unstructured":"Vicinanza A , De Laet C , Rooze S , et al . Shoshin Beriberi and Severe Accidental Hypothermia as Causes of Heart Failure in a 6-Year-Old Child: A Case Report and Brief Review of Literature. Front Pediatr 2019;7. doi:10.3389\/fped.2019.00119","DOI":"10.3389\/fped.2019.00119"},{"key":"2026082504051002000_19.8.e272300.20","doi-asserted-by":"crossref","DOI":"10.1111\/petr.13493","article-title":"Acute Shoshin beriberi syndrome immediately post-kidney transplant with rapid recovery after thiamine administration","volume":"23","author":"Elias","year":"2019","journal-title":"Pediatr Transplant"},{"key":"2026082504051002000_19.8.e272300.21","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.jdcr.2020.02.031","article-title":"Shoshin beriberi in a patient with oral and cutaneous graft-versus-host disease","volume":"6","author":"Hodgkinson","year":"2020","journal-title":"JAAD Case Rep"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-272300","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:05:23Z","timestamp":1787655923000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-272300"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":21,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,25]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bcr-2026-272300"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-272300","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}