Case Report
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Clin Cases. Sep 16, 2013; 1(6): 205-207
Published online Sep 16, 2013. doi: 10.12998/wjcc.v1.i6.205
Use of central venous saturation monitoring in a patient with pediatric cardiac beriberi
Nozomi Majima, Osamu Umegaki, Masako Soen
Nozomi Majima, Masako Soen, Department of Anesthesiology, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan
Osamu Umegaki, Department of Critical Care Medicine, Osaka Medical College, Osaka 569-8686, Japan
Author contributions: All authors contributed to the manuscript writing.
Correspondence to: Nozomi Majima, MD, Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan. ma393@y4.dion.ne.jp
Telephone: +81-72-6831221 Fax: +81-72-6846552
Received: June 16, 2013
Revised: July 28, 2013
Accepted: August 5, 2013
Published online: September 16, 2013
Abstract

The patient was a 1-year-and-4-mo-old boy. He had drunk about 1 L of an isotonic drink for infants daily since about 10 mo after birth. He was examined by a local doctor due to anorexia and vomiting, found to have cardiomegaly, and transported to our hospital with suspected myocarditis. After admission, the patient showed polypnea, a decreased level of consciousness, and marked metabolic acidosis and lapsed into circulatory insufficiency, requiring catecholamine administration, endotracheal intubation, and extracorporeal membrane oxygenation. Initially, low-output heart failure due to acute myocarditis was suspected, but the central venous oxygen saturation was high, at 82%. Considering high-output heart failure to be more likely, we evaluated its cause and noted, by urinary organic acid analysis, increases in lactate, pyruvate, 3-OH-butyrate, acetoacetate, metabolic products of branched-chain amino acids, 2-ketoglutarate, 2-OH-glutarate, 2-keto-adipate, and 2-OH-adipate. Since the vitamin B1 level was reduced to 12 ng/mL (normally 20-50 ng/mL), a diagnosis of cardiac beriberi due to vitamin B1 deficiency was made. When unexplained heart failure is observed in children, cardiac beriberi must be excluded as a differential diagnosis of myocarditis and cardiomyopathy. The measurement of the central venous oxygen saturation may be useful for the diagnosis.

Keywords: Cardiac beriberi, Central venous saturation, Pediatric

Core tip: When unexplained heart failure is observed in children, cardiac beriberi must be excluded as a differential diagnosis of myocarditis and cardiomyopathy. The measurement of the central venous oxygen saturation may be useful for the diagnosis. Although beriberi is a rare disease today, it is necessary to remember that it may still be caused by an unbalanced diet.