A worried patient recently started sertraline and reports leg tremors, weight loss, and GI upset after months of stress and heavy alcohol use. What is the most likely cause of these symptoms?

A worried patient recently started sertraline and reports leg tremors, weight loss, and GI upset after months of stress and heavy alcohol use. What is the most likely cause of these symptoms?

• A. Sertraline adverse effect
• B. Iron deficiency
• C. Thiamine deficiency
• D. Alcohol withdrawal

Answer: (C)

The key idea here is that chronic alcohol use commonly leads to thiamine (vitamin B1) deficiency, which disrupts glucose metabolism and energy production in the brain and nerves. Thiamine is a critical cofactor for enzymes in carbohydrate metabolism; when it's deficient, cells—especially in the nervous system and GI tract—struggle to generate enough ATP. This can produce a neuropathic picture with tremors, weight loss from poor intake and malnutrition, and GI upset from autonomic dysfunction and mucosal effects. In this patient, leg tremors, weight loss, and GI upset after long-term stress and heavy alcohol use fit thiamine deficiency better than a primary adverse effect of sertraline. Sertraline can cause GI upset or tremor, but it wouldn’t typically present together with significant weight loss and a nutrition-related deficiency pattern driven by alcohol intake. Iron deficiency tends to cause fatigue and pallor rather than tremors, and alcohol withdrawal would require stopping drinking and usually presents with tremors plus autonomic symptoms and agitation rather than a malnutrition-associated triad.

The key idea here is that chronic alcohol use commonly leads to thiamine (vitamin B1) deficiency, which disrupts glucose metabolism and energy production in the brain and nerves. Thiamine is a critical cofactor for enzymes in carbohydrate metabolism; when it's deficient, cells—especially in the nervous system and GI tract—struggle to generate enough ATP. This can produce a neuropathic picture with tremors, weight loss from poor intake and malnutrition, and GI upset from autonomic dysfunction and mucosal effects.

In this patient, leg tremors, weight loss, and GI upset after long-term stress and heavy alcohol use fit thiamine deficiency better than a primary adverse effect of sertraline. Sertraline can cause GI upset or tremor, but it wouldn’t typically present together with significant weight loss and a nutrition-related deficiency pattern driven by alcohol intake. Iron deficiency tends to cause fatigue and pallor rather than tremors, and alcohol withdrawal would require stopping drinking and usually presents with tremors plus autonomic symptoms and agitation rather than a malnutrition-associated triad.