Question:medium
A patient on long-term hydrochlorothiazide develops neuropathy, heart failure, and symmetrical paresthesia. Which nutrient deficiency is most likely responsible?
A patient on long-term hydrochlorothiazide develops neuropathy, heart failure, and symmetrical paresthesia. Which nutrient deficiency is most likely responsible?
Show Hint
Thiamine deficiency causes dry beriberi with neuropathy and wet beriberi with heart failure.
Updated On: May 14, 2026
- Selenium
- Thiamine
- Vitamin B12
- Zinc
Show Solution
The Correct Option is B
Solution and Explanation
Step 1: Understanding the Question:
The patient has signs of "Beriberi": symmetrical neuropathy (Dry Beriberi) and heart failure (Wet Beriberi).
We must link this deficiency to the long-term use of diuretics like hydrochlorothiazide.
Step 2: Detailed Explanation:
Clinical Presentation: Symmetrical paresthesia and peripheral neuropathy point to neurologic involvement, while heart failure (typically high-output) points to cardiovascular involvement. This classic combination defines Thiamine (Vitamin B1) deficiency.
Mechanism of Drug-Induced Deficiency: Thiamine is a water-soluble vitamin. Chronic use of diuretics (especially loop diuretics and thiazides like hydrochlorothiazide) increases the renal excretion of thiamine.
Role of Thiamine: Thiamine pyrophosphate (TPP) is a mandatory cofactor for Pyruvate Dehydrogenase and Alpha-ketoglutarate Dehydrogenase. Without it, aerobic metabolism is impaired, particularly in the brain and heart.
Beriberi Types:
Dry Beriberi: Predominantly neurological (polyneuritis, muscle wasting).
Wet Beriberi: Predominantly cardiovascular (dilated cardiomyopathy, edema, heart failure).
Evaluating other options: While B12 (C) causes neuropathy, it does not typically cause the acute high-output heart failure associated with this presentation and diuretic use. Selenium, Zinc, and B12 are not primarily depleted by thiazide use in this manner.
Step 3: Final Answer:
Thiamine deficiency (Beriberi) is a recognized complication of long-term diuretic therapy due to increased urinary loss of the vitamin.
The patient has signs of "Beriberi": symmetrical neuropathy (Dry Beriberi) and heart failure (Wet Beriberi).
We must link this deficiency to the long-term use of diuretics like hydrochlorothiazide.
Step 2: Detailed Explanation:
Clinical Presentation: Symmetrical paresthesia and peripheral neuropathy point to neurologic involvement, while heart failure (typically high-output) points to cardiovascular involvement. This classic combination defines Thiamine (Vitamin B1) deficiency.
Mechanism of Drug-Induced Deficiency: Thiamine is a water-soluble vitamin. Chronic use of diuretics (especially loop diuretics and thiazides like hydrochlorothiazide) increases the renal excretion of thiamine.
Role of Thiamine: Thiamine pyrophosphate (TPP) is a mandatory cofactor for Pyruvate Dehydrogenase and Alpha-ketoglutarate Dehydrogenase. Without it, aerobic metabolism is impaired, particularly in the brain and heart.
Beriberi Types:
Dry Beriberi: Predominantly neurological (polyneuritis, muscle wasting).
Wet Beriberi: Predominantly cardiovascular (dilated cardiomyopathy, edema, heart failure).
Evaluating other options: While B12 (C) causes neuropathy, it does not typically cause the acute high-output heart failure associated with this presentation and diuretic use. Selenium, Zinc, and B12 are not primarily depleted by thiazide use in this manner.
Step 3: Final Answer:
Thiamine deficiency (Beriberi) is a recognized complication of long-term diuretic therapy due to increased urinary loss of the vitamin.
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