Wet beriberi in intestinal failure due to change from intravenous to enteral supplementation – Time to focus on water-soluble vitamins

Background: Thiamine deficiency is a rare but life-threatening complication for which children on long term parenteral nutrition (PN) are at higher risk. Case report: We describe a 13-year-old male with intestinal failure secondary to Filamin A mutation who presented with one-week of oedema and orthopnoea. He was fully dependent on PN and his intravenous multivitamin supplementation was replaced with enteral vitamins due to a national shortage. On presentation he was tachycardic, tachypnoeic, hypotensive, and fluid overloaded. Investigations revealed hyponatraemia, hypoalbuminaemia, metabolic acidosis, and a significantly elevated lactate. Chest radiography showed bilateral pleural effusions. Intravenous thiamine and oral vitamin C supplementation led to rapid clinical improvement and testing confirmed low thiamine and vitamin C levels. His presentation was consistent with wet beriberi due to thiamine deficiency. Conclusion: This case highlights the risk of water-soluble vitamin deficiency in PN-dependent children during intravenous vitamin shortages and the need for biochemical monitoring.