[en] Severe accidental hypothermia has been demonstrated to affect ventricular systolic and diastolic functions, and rewarming might be responsible of cardiovascular collapse. Until now, there have been only a few reports on severe accidental hypothermia, none of which involved children. Herein, we describe here a rare case of heart failure in a 6-year-old boy admitted to the emergency unit owing to severe hypothermia and malnutrition. After he was warmed up (core temperature of 27.2 degrees C at admission), he developed cardiac arrest, requiring vasoactive amines administration, and veno-arterial extracorporeal membrane oxygenation. Malnutrition and refeeding syndrome might have caused the thiamine deficiency, commonly known as beriberi, which contributed to heart failure as well. He showed remarkable improvement in heart failure symptoms after thiamine supplementation. High-dose supplementation per os (500 mg/day) after reconstitution of an adequate electrolyte balance enabled the patient to recover completely within 2 weeks, even if a mild diastolic cardiac dysfunction persisted longer. In conclusion, we describe an original pediatric case of heart failure due to overlap of severe accidental hypothermia with rewarming, malnutrition, and refeeding syndrome with thiamine deficiency, which are rare independent causes of cardiac dysfunction. The possibility of beriberi as a cause of heart failure and adequate thiamine supplementation should be considered in all high-risk patients, especially those with malnutrition. Refeeding syndrome requires careful management, including gradual electrolyte imbalance correction and administration of a thiamine loading dose to prevent or correct refeeding-induced thiamine deficiency.
Disciplines :
Cardiovascular & respiratory systems Pediatrics
Author, co-author :
Vicinanza, Alfredo
De Laet, Corinne
Rooze, Shancy
Willems, Ariane
Beretta-Piccoli, Xavier
Vens, Daphne
Voglet, Cedric
JACQUEMART, Caroline ; Centre Hospitalier Universitaire de Liège - CHU > Département de Pédiatrie > Service de pédiatrie
Massin, Martial
Biarent, Dominique
Language :
English
Title :
Shoshin Beriberi and Severe Accidental Hypothermia as Causes of Heart Failure in a 6-Year-Old Child: A Case Report and Brief Review of Literature.
Filseth OM, How OJ, Kondratiev T, Gamst TM, Tveita T. Post-hypothermic cardiac left ventricular systolic dysfunction after rewarming in an intact pig model. Crit Care. (2010) 14:R211. doi: 10.1186/cc9334
Darocha T, Sobczyk D, Kosinski S, Jarosz A, Galazkowski R, Nycz K, et al. New diastolic cardiomyopathy in patients with severe accidental hypothermia after ECMO rewarming: a case-series observational study. Cardiovasc Ultrasound. (2015) 13:31. doi: 10.1186/s12947-015-0027-2
Hiffler L, Rakotoambinina B, Lafferty N, Martinez Garcia D. Thiamine deficiency in tropical pediatrics: new insights into a neglected but vital metabolic challenge. Front Nutr. (2016) 3:16. doi: 10.3389/fnut.2016.00016
Leite HP, Peixoto de Lima LF, Konstantyner T. Commentary: thiamine deficiency in tropical pediatrics: new insights into a neglected but vital metabolic challenge. Front Nutr. (2017) 3:58. doi: 10.3389/fnut.2016.00058
Maconochie IK, Bingham R, Eich C, López-Herce J, Rodríguez-Núñez A, Rajka T, et al. Paediatric life support section Collaborators. European Resuscitation Council Guidelines for Resuscitation 2015: section 6. Paediatric life support. Resuscitation. (2015) 95:223-48. doi: 10.1016/j.resuscitation.2015.07.028
Kondratiev TV, Wold RM, Aasum E, Tveita T. Myocardial mechanical dysfunction and calcium overload following rewarming from experimental hypothermia in vivo. Cryobiology. (2008) 56:15-21. doi: 10.1016/j.cryobiol.2007.09.005
Tveita T, Ytrehus K, Myhre ES, Hevrøy O. Left ventricular dysfunction following rewarming from experimental hypothermia. J Appl Physiol. (1998) 85:2135-9
Zafren K, Giesbrecht GG, Danzl DF, Brugger H, Sagalyn EB, Walpoth B, et al. Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2014 update. Wilderness Environ Med. (2014) 25:S66-85. doi: 10.1016/j.wem.2014.10.010
Dasgupta S, Aly AM. Dilated cardiomyopathy induced by chronic starvation and selenium deficiency. Case Rep Pediatr. (2016) 2016:8305895. doi: 10.1155/2016/8305895
Costa NA, Gut AL, de Souza Dorna M, Pimentel JA, Cozzolino SM, Azevedo PS. Serum thiamine concentration and oxidative stress as predictors of mortality in patients with septic shock. J Crit Care. (2014) 29:249-52. doi: 10.1016/j.jcrc.2013.12.004
Donnino MW, Andersen LW, Chase M, Berg KM, Tidswell M, Giberson T, et al. Randomized, double-blind, placebo-controlled trial of thiamine as a metabolic resuscitator in septic shock: a pilot study. Crit Care Med. (2016) 44:360-7. doi: 10.1097/CCM.0000000000001572
Bello S, Neri M, Riezzo I, Othman MS, Turillazzi E, Fineschi V. Cardiac beriberi: morphological findings in two fatal cases. Diagn Pathol. (2011) 6:8. doi: 10.1186/1746-1596-6-8
Imamura T, Kinugawa K. Shoshin beriberi with low cardiac output and hemodynamic deterioration treated dramatically by thiamine administration. Int. Heart J. (2015) 56:568-70. doi: 10.1536/ihj.15-033
Attas M, Hanley HG, Stultz D, Jones MR, McAllister RG. Fulminant beriberi heart disease with lactic acidosis: presentation of a case with evaluation of left ventricular function and review of pathophysiologic mechanisms. Circulation. (1978) 58:566-72
Wildschut ED, Ahsman MJ, Allegaert K, Mathot RA, Tibboel D. Determinants of drug absorption in different ECMO circuits. Intensive Care Med. (2010) 36:2109-16. doi: 10.1007/s00134-010-2041-z
Estensen K, Shekar K, Robins E, McDonald C, Barnett AG, Fraser JF. Macro-and micronutrient disposition in an ex vivo model of extracorporeal membrane oxygenation. Intensive Care Med Exp. (2014) 2:29. doi: 10.1186/s40635-014-0029-7
Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. BMJ. (2008) 336:1495-8. doi: 10.1136/bmj.a301
Maiorana A, Vergine G, Coletti V, Luciani M, Rizzo C, Emma F, et al. Acute thiamine deficiency and refeeding syndrome: similar findings but different pathogenesis. Nutrition. (2014) 30:948-52. doi: 10.1016/j.nut.2014.02.019