# See One, B1, Treat One: Identifying and Managing Thiamine Deficiency in a Patient With Altered Mental Status

## TL;DR

A patient with altered mental status was found to have thiamine deficiency, which improved rapidly with thiamine supplementation.

## Contribution

This case highlights the importance of considering thiamine deficiency in patients with altered mental status.

## Key findings

- The patient's symptoms rapidly improved with intravenous thiamine.
- Low serum thiamine levels confirmed the deficiency.
- Early recognition and treatment can prevent Korsakoff syndrome.

## Abstract

Nutritional deficiencies in the United States are relatively uncommon due to federal regulations surrounding the fortification of food. As a result, the clinical syndromes that result from nutritional deficiencies are not commonly seen, making them less likely to be encountered in the clinical setting. Thiamine deficiency in particular is an important nutritional deficiency to consider, as the presentation is highly variable and can include encephalopathy and multiple neurologic findings. We present a case of altered mental status that appears to be Wernicke’s encephalopathy due to the rapid improvement of symptoms with intravenous thiamine supplementation, corroborated by a low serum thiamine level. Assessing access to food is a critical piece of history in making this diagnosis, and early recognition can promote fully supplementing patients with thiamine to prevent ongoing thiamine deficiency and possible Korsakoff syndrome.