RT Journal Article SR Electronic T1 Lessons of the month 1: Shoshin beriberi: A case report of fulminant cardiovascular collapse, intractable hyperlactatemia and deteriorating consciousness JF Clinical Medicine JO Clin Med FD Royal College of Physicians SP e670 OP e672 DO 10.7861/clinmed.2021-0550 VO 21 IS 6 A1 Marie SH Lim A1 Wutyee Win A1 Anna Von Essen A1 David Gannon A1 Mohamed Ramali YR 2021 UL http://www.rcpjournals.org/content/21/6/e670.abstract AB Shoshin beriberi is a fulminant variant of thiamine deficiency, often presenting with severe lactic acidosis and cardiogenic shock. Due to the sparsity of this condition, delays in diagnosis can lead to fatality. However, rapid reversal of symptoms can be easily achieved through intravenous thiamine replacement.In this case report, we discuss a 57-year-old woman, who was previously fit and well, who presented to the emergency department with a 3-day history of extreme malaise, breathlessness and abdominal pain, with marked hypotension and tachycardia requiring vasopressor support and a severe rising lactic acidosis. Upon further questioning, a history of alcohol excess was noted. Rapid reversal of the marked haemodynamic instability was achieved upon administration of intravenous thiamine and the patient was discharged within 48 hours.