Background: Up to 12% of hospitalized patients require high dose parenteral thiamine treatment to prevent Wernicke’s Encephalopathy, a devastating and easily preventable neurologic disorder that can lead to death. Despite the fact that it is as simple and relatively inexpensive therapy with no known side effects, high dose thiamine continues to be underutilized. Attempts to [...]

Case Presentation: The patient is an immunosuppressed 57 year old male with small bowel and liver transplant due to trauma from a motor vehicle accident 20 years prior and end ileostomy due to anal carcinoma. His chief complaint was “dizziness,” consisting of lightheadedness and diplopia. His wife described three months of progressive forgetfulness and fabricating [...]

Case Presentation: The patient is a 34 y.o. female with a past medical history significant only for morbid obesity. She had a gastric sleeve placed 3 months ago, in order to promote weight loss. Two weeks ago, the patient experienced the onset of blurred vision, clumsiness, ambulatory dysfunction, and generalized weakness. At that time, she [...]

Case Presentation: A 31-year-old female with history of generalized anxiety disorder (GAD), morbid obesity, and eight weeks status-post sleeve gastrectomy presented with 50-pound weight loss and mental status changes. Other symptoms included nausea, vomiting, and poor oral intake. Days to weeks prior to admission she developed generalized weakness, gait disturbance, diplopia, vertigo, and slowed mentation [...]

Case Presentation: A 43-year-old male with roux-en-y gastric bypass fourteen years ago with complications and multiple adhesions, hiatal hernia associated with nausea and vomiting, and subsequent small bowel resection last year, started to experience cognitive changes and short-term memory loss. He has also experienced problems with balance, generalized weakness, and unintentional 60-pound weight loss. His [...]

Case Presentation: A 55-year-old man was found altered in his truck in front of an abandoned building.  Neighbors called EMS after noting that the patient had not moved from his position in 4 hours.  On evaluation, the patient reported that he had just left work.  He was afebrile with mild tachycardia (heart rate: 112 beats [...]

Case Presentation: A 39-year old female with a history of alcohol abuse presented with an eight-day history of numbness involving her bilateral lower extremities and hands which had progressed proximally to involve her chest wall. She reported perioral and perianal numbness, lethargy and difficulty ambulating. Examination was significant for decreased sensation in a glove-stocking distribution, [...]

Case Presentation: 30 year old female with HIV/AIDS, a recent CD4 count of 7 who presented with 4 weeks of diarrhea, nausea, vomiting and odynophagia. She reported weight loss of 190 lbs over the last 6 months. She had been recently admitted with similar complaints and diagnosed with Cryptosporidial diarrhea and esophageal candidiasis. She was [...]

Case Presentation: 60-year-old woman with a twelve-year history of presumed gastroparesis of unclear etiology, was admitted for worsening chronic abdominal pain, nausea and vomiting with unintentional weight loss of over 80 pounds over a year. Evaluation included normal laboratory findings and abdominal imaging. Upper endoscopy showed mild mucosal erythema with normal biopsies of the stomach. [...]

Case Presentation: A 48 year-old male with a past medical history of morbid obesity, hypertension, and poorly nutritious diet consisting strictly of “pizza and chips” who presented after he was found unresponsive and incontinent of urine at home. He reportedly did not consume alcohol. Four weeks prior to presentation, he developed an acute onset of [...]