What is dry beriberi and how is it connected to the patient's condition?

Dry beriberi is a severe form of thiamine deficiency, characterized by polyneuropathy and muscle weakness. This means the patient experiences nerve damage (polyneuropathy), and the muscles become weak. In the context of this case, the patient's symptoms, including weakness and diminished sensation in his limbs, and the progression of these issues over time, strongly indicated dry beriberi. The severity of the condition resulted in the patient's inability to walk.

How does gastric bypass surgery increase the risk of thiamine deficiency?

Gastric bypass surgery elevates the risk of thiamine deficiency due to potential malabsorption and a reduced capacity to absorb nutrients. After the surgery, the digestive system is altered which affects how the body processes food and absorbs vitamins like thiamine. This is further complicated by a lack of follow-up care and inconsistent adherence to prescribed supplements. The combination of these factors increases the likelihood of developing thiamine deficiency and related conditions such as dry beriberi.

What are the implications of thiamine deficiency, specifically dry beriberi?

Thiamine deficiency manifests in different ways, but dry beriberi is particularly dangerous. It can cause neurological and muscular issues. The patient's case highlights the progression of symptoms, starting with weakness in the legs and hands. Without timely intervention, thiamine deficiency can lead to severe long-term complications, including permanent neurological damage. The importance of recognizing risk factors and initiating early treatment is critical to prevent these outcomes.

Why did alcohol use and vomiting play a role in this patient's condition?

The patient's history of alcohol abuse and recent vomiting contributed to his thiamine deficiency. Alcohol can interfere with thiamine absorption, and vomiting can lead to the loss of thiamine from the body. In this specific case, these factors, in conjunction with the gastric bypass surgery and lack of follow-up care, increased the risk of thiamine deficiency. This highlights the need for a comprehensive understanding of the patient's medical history and lifestyle when assessing potential nutrient deficiencies.

What should be done if someone suspects they have thiamine deficiency?

If you suspect you have thiamine deficiency, prompt treatment is essential. Treatment typically involves administering thiamine intravenously, which helps replenish thiamine levels. In this instance, the patient began intravenous thiamine treatment, and his condition was closely monitored. The key takeaway is that recognizing the risk factors, such as a history of gastric bypass, alcohol abuse, and the presence of relevant symptoms, is crucial for early intervention. Early intervention can prevent the development of severe complications.

Symbolic image representing the risks of medical tourism and the development of beriberi.

Gastric Bypass Complications: When a Trip to Tijuana Leads to Beriberi

Nico Varela in Health & Wellness December 2025 • 4 min read.

"Uncovering the Risks of Medical Tourism: A Case Study on Thiamine Deficiency After Weight Loss Surgery"

Thiamine deficiency, while manifesting in diverse ways, poses a significant threat, with dry beriberi standing out as particularly devastating. Polyneuropathy and muscle weakness characterize this condition, typically impacting the lower extremities before advancing to the upper limbs. Recognizing the subtleties of thiamine deficiency is crucial for effective intervention.

Individuals undergoing gastric bypass procedures face an elevated risk of dry beriberi due to potential non-compliance with recommended nutritional supplements. Similarly, those with a history of alcohol abuse or persistent vomiting are more susceptible to developing this deficiency.

Here, we present the case of a 41-year-old male who sought gastric bypass surgery in Tijuana, Mexico, and subsequently presented with symptoms indicative of thiamine deficiency. This case underscores the critical importance of recognizing risk factors and initiating timely treatment to prevent long-term neurological complications.

A Medical Mishap: From Gastric Bypass to Neurological Deficit

Symbolic image representing the risks of medical tourism and the development of beriberi.

A 41-year-old man presented to the hospital with a troubling constellation of symptoms: diffuse weakness and diminished sensation in his legs and hands. Over three days, his condition had deteriorated to the point where he could no longer walk. Initially, the discomfort began in his feet and gradually ascended, affecting his fingers.

His medical history revealed a gastric bypass surgery performed four months prior in Tijuana, Mexico, without any follow-up care. Adding to the complexity, he admitted to weekend binge drinking and recent episodes of vomiting. Though prescribed a multivitamin, his adherence was inconsistent.

Physical examination revealed a significant decrease in strength: 3/5 in the right lower extremity and 4/5 in the left.
Finger grasp strength was measured at 3/5 bilaterally.
MRI scans showed central disc protrusion at T6-T7 with mild indentation of the spinal cord consistent with spinal stenosis, mild acquired congenital stenosis at L4-L5, and some spinal canal stenosis at C4-C7 with mild cord flattening.

While awaiting the spinal surgery, the patient's condition continued to decline. Dorsiflexion in the right foot decreased, he became unable to stand, and sensation diminished in the mid-torso bilaterally. Neurology was consulted, and a critical lab result revealed a low thiamine level of 19 µg/L (reference range 38–122). Subsequent EMG studies pointed toward axonal-dominant length-dependent neuropathy, aligning with a diagnosis of dry beriberi. Intravenous thiamine treatment was initiated at 100 mg three times daily.

Key Takeaways: Recognizing and Treating Thiamine Deficiency

This case underscores the importance of promptly initiating treatment for suspected thiamine deficiency, even before laboratory confirmation. Several risk factors converged in this patient, including chronic alcohol use, gastric bypass surgery, and recent vomiting. While MRI findings initially suggested spinal stenosis, the progressive polyneuropathy and muscle weakness ultimately pointed to beriberi.

The patient’s surgery in Tijuana highlights the importance of follow-up care and nutritional supplementation for patients undergoing bariatric surgery abroad. Non-compliance with vitamin regimens significantly elevates the risk of complications such as thiamine deficiency.

Progressive polyneuropathy in high-risk patients necessitates a timely evaluation for thiamine deficiency. While awaiting lab results may seem appropriate, initiating treatment is crucial for a positive outcome. Early recognition and appropriate management are paramount, even when other data and imaging suggest alternative diagnoses.