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Case of hypoactive delirium precipitated by thiamine deficiency
  1. Tiffany Truong1,
  2. Fredrick Hetzel2,
  3. Katherine M Stiff3 and
  4. Muhammad Ghazanfar Husnain4
  1. 1School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
  2. 2MetroHealth Medical Center, Department of Internal Medicine, Case Western Reserve University, Cleveland, Ohio, USA
  3. 3Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
  4. 4MetroHealth Medical Center, Hospital Medicnie, Case Western Reserve University, Cleveland, Ohio, USA
  1. Correspondence to Dr Muhammad Ghazanfar Husnain; husnainmg82{at}


Thiamine is an essential cofactor in the process of nucleic acid synthesis. Neuronal tissues are especially sensitive to thiamine deficiency, manifesting as Wernicke’s encephalopathy (WE). The typical triad of WE, encephalopathy, oculomotor dysfunction and gait ataxia, is only present in less than one-third of the cases. We present the case of a middle-aged man with hypoactive delirium due to presumed thiamine deficiency, who had a prolonged hospital course and a delayed diagnosis of the cause of altered mental status. The presentation of this disorder solely as a decreased level of consciousness is uncommon but has been reported in the literature. It is essential to recognise WE as a treatable condition that may manifest only as a hypoactive delirium. The delay in the diagnosis and treatment may lead to coma and death.

  • vitamins and supplements
  • delirium

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  • Contributors All authors were involved in the patient’s direct care and conceived the idea of writing a case report. TT, FH, and KMS wrote the introduction, summary, case presentation, performed a literature review and wrote the discussion of the manuscript. MGH substantially reviewed the whole manuscript and updated essential intellectual content. All authors read the manuscript and approved it for submission in its current form before submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.