J Emerg Med
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A case of acute fulminant cardiovascular beriberi, or "shoshin beriberi," is presented. Beriberi is classified as "dry" (neurologic) or "wet" (cardiovascular) and may be mixed. "Wet" beriberi refers to a spectrum of clinical manifestations ranging from a hyperdynamic state with high output cardiac failure to fulminant failure with collapsed peripheral circulation, lactic acidosis, and shock. ⋯ Beriberi is caused by thiamine deficiency and should be suspected in alcoholics who present with unexplained lactic acidosis, a hyperdynamic state, high output cardiac failure, or cardiogenic shock without electrocardiographic (EKG) evidence of myocardial necrosis. Shoshin beriberi is rapidly fatal without immediate treatment with thiamine.
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In this report, we review the Salter-Harris classification of pediatric fractures, including its histologic basis in the biomechanics of bone growth, and present a case of ankle injury. The case describes a unique subtype of pediatric growth plate injury, the Tillaux fracture, whose treatment is then discussed.