sir.—Beriberi, or thiamine (B1) deficiency, is commonly believed to be extremely rare in the United States today except among alcoholics. We treated a Southeast Asian (Hmong) youth with multisystem organ failure whose symptoms and metabolic abnormalities resolved after administration of thiamine. The low level of suspicion delayed the diagnosis, highlighting the necessity to incorporate nutritional assessment into the management of our patients.
Patient Report.—A 17-year-old Hmong refugee boy had a one-week history of anorexia, emesis, epigastric pain, weakness, dizziness, calf tenderness, and lowerextremity pain. He was moderately dehydrated and was admitted to the hospital for rehydration. The Hmong are a Southeast Asian ethnic group who reside in the northern mountainous regions of Laos and Thailand. The patient had been in the United States for seven years, and had 11 previous admissions for dehydration secondary to nausea and vomiting that initially was thought to be secondary to psychologic