Objectives: Poly vitamin deficiency together with protein malnutrition and endocrinopathy may be encountered in individuals presenting with critical illness including sepsis. Poor socioeconomic status, poor dietary choices, drug and alcohol abuse as well as neglect have been identified as risk factors for this condition.
Methods: Following the surprise diagnosis of concomitant scurvy, Wernicke and hypothyroidism in an elderly woman presenting with a mix of atypical symptoms, a series of patients considered at risk were tested for TSH, Vitamin C, Thiamin and Zinc levels. A database was created including demographic, clinical and outcome data.
Results: The index patient ultimately succumbed due to her severe illness and as diagnosis was delayed. Between 2018 and 2022, 564 Vitamin C levels were measured and 28% were pathologic, 2787 Thiamin levels were measured and 32% were pathologic and 19574 TSH levels were determined and 12% were pathologic. In total nine female and three male surgical patients with elevated TSH and low Vitamin C or Thiamin levels were identified (42% combined Vitamin B1 and C deficient). The median age of study group was 62.5 (range 19.4 to 85.8) years; median BMI was 31.4 (range 20.0 to 49.8) kg/m2 with 66% being obese or morbidly obese. Two patients had cancer, two a history of bariatric surgery, one of partial gastrectomy. 50% had low pre-albumin and 54% low zinc levels. After diagnosis, aggressive replacement of Vitamins and thyroid hormones was initiated. Three patient were managed nonoperatively for their conditions, nine had surgeries including colectomy, appendectomy, abdominal explorations, skin incisions, amputations and foregut procedures. Two patients died from Scurvy (one also had Myxedema). One with a non healing perineal wound after APR for recurrent anal cancer died from tumor progression. All others are alive after a protracted clinical course.
Conclusion: Poly vitamin deficiency together with endocrinopathy may be under-diagnosed and should be considered in patients presenting with a mix of unclear symptoms. If appropriately diagnosed and aggressive treatment is initiated, full recovery can be achieved.
