A 43-year-old woman with chronic alcoholism presents with shortness of breath and edema. On examination, her blood pressure is 100/60 mm Hg, pulse 110/min, JVP is 8 cm, the cardiac apex is displaced and enlarged, there are bilateral inspiratory crackles, and there is pedal edema.For the patient with vitamin deficiency or excess, select the most likely diagnosis
Thiamine deficiency can cause high-output cardiac failure (wet beriberi) or neurologic symptoms (dry beriberi). In North America, thiamine deficiency occurs in alcoholics or those with chronic disease. In alcoholics, deficiency is secondary to low intake, impaired absorption and storage, and accelerated destruction. Genetic factors are important as clinical manifestations occur only in a small proportion of chronically malnourished individuals. Beriberi heart disease is characterized by peripheral vasodilatation, sodium and water retention, and high-output CHF.
niacin
thiamine
pyridoxine
vitamin C
Endocrinology