Vibrio vulnificus sepsis

Disease Description (Causes and Symptoms)

• Cause: Caused by thiamine (vitamin B1) deficiency. Impaired function of enzymes essential for carbohydrate metabolism (pyruvate dehydrogenase, α‑ketoglutarate dehydrogenase, transketolase) disrupts energy metabolism in tissues, particularly the nerves and heart.
• Pathophysiology summary: Thiamine deficiency → abnormal glucose metabolism, lactate accumulation, energy deficiency in nerve cells and cardiac muscle → peripheral nerve damage (reduced sensation·muscle weakness), high-output heart failure·congestion, etc. May be associated with Wernicke’s (베르니케) and Korsakoff syndromes.
• Main symptoms (representative)
  • General: Fatigue, loss of appetite, weight loss
  • Nervous system (dry beriberi): Numbness in the hands and feet, reduced sensation, muscle weakness, gait disturbance, proximal weakness, confusion·short-term memory impairment (in severe cases)
  • Cardiovascular system (wet beriberi): Lower-extremity edema, tachycardia, shortness of breath (with activity or at night), cardiomegaly due to pulmonary congestion/congestive heart failure
  • Other: Vomiting, abdominal pain, nystagmus, etc.
• Classification: Dry — predominantly peripheral nerve·muscle symptoms; wet — predominantly cardiovascular symptoms (edema·heart failure). If neurological symptoms are severe, suspect Wernicke syndrome.

Treatment Methods and Precautions

• Basic treatment
  • Thiamine supplementation (priority treatment): Generally, initial injectable therapy (IV/IM) is followed by a switch to oral medication.
    • Standard (recommended as presented): 100 mg by intravenous/intramuscular injection daily for the first 7 days, followed by oral medication at 10 mg/day until symptoms improve.
    • Severe neurological symptoms (suspected Wernicke syndrome) or clinically very severe cases: Administration of a higher dose (e.g., 200–500 mg IV, 1–3 times daily) may be recommended, depending on the physician’s judgment.
  • Concurrent supplementation with other water-soluble vitamins: Because concurrent deficiencies are common, consider multivitamin supplementation.
  • In wet beriberi (heart failure): Combine with heart failure treatment (diuretics·oxygen·inotropes if necessary, etc.). (However, because diuretics may cause additional thiamine loss, management should be guided by the attending physician.)
  • Rehabilitation for neurological symptoms: Physical therapy·gradual increase in activity, and symptomatic treatment for pain·abnormal sensations.
• Emergency and supportive treatment
  • In cases of severe hypoxia·heart failure, hospitalization·monitoring and cardiac·respiratory support if necessary.
  • During nutritional re-feeding: Because rapid carbohydrate administration increases the demand for thiamine, thiamine supplementation is necessary before or at the same time as feeding.
• Precautions and risk of complications
  • If treatment is started promptly, cardiovascular·ocular muscle symptoms may improve within several hours to 1 day, but neurological·memory impairments may persist for several weeks to months or remain permanent (particularly psychiatric illness related to Wernicke–Korsakoff syndrome).
  • Hypersensitivity reactions to thiamine injections are rare, but allergic reactions are possible.
  • If alcohol dependence is present, the risk of recurrence is high → cessation of alcohol consumption and nutritional management are necessary.

Checklist Before an Outpatient Visit (Items and Records to Prepare)

• Items/records to bring
  • List of currently used medications·supplements (including doses)
  • Recent weight-change records and food diary (staple foods·amount consumed)
  • Alcohol history (frequency·amount, whether consumed recently), smoking history
  • Onset and course of symptoms (when they began, aggravating factors, relieving factors)
  • Record of fluid retention (edema), shortness of breath, fainting·dizziness
  • Bring previous test results if available (ECG, chest X-ray/echocardiography, blood tests, erythrocyte transketolase activity·urinary thiamine concentration, etc.)
  • History of previous surgery (especially gastrointestinal·bariatric surgery), chronic vomiting·malabsorption
• Information helpful for the doctor to know
  • Recent changes in nutritional status (fasting·prolonged diarrhea·vomiting, etc.)
  • Whether diuretics·anticancer drugs·antituberculosis drugs (such as isoniazid) are being taken
  • Neurological symptoms (when they began, affected areas, degree of pain·numbness·muscle weakness), and a video of changes in gait (if possible)

Examples of General Questions to Ask the Doctor

• "What is the cause of this disease, and which form (dry/wet) applies to my case?"
• "What treatment is recommended (thiamine dose·route of administration), and what are the side effects?"
• "What is the expected recovery period, and how likely are permanent sequelae?"
• "What should I change in my lifestyle (diet, alcohol consumption)?"
• "Do I need additional tests or care from another specialty (cardiology·neurology)?"

Examples of Disease-Specific Questions

• "Is my condition severe enough that I need to receive high-dose thiamine intravenously (IV) right now?"
• "Is there a possibility that my neurological symptoms (reduced sensation·gait disturbance) will fully recover? How should rehabilitation proceed?"

(The treatment dose and outlook may vary depending on the examination and test results, if needed. Consult your attending physician for an accurate evaluation and treatment plan.)