Wet beriberi. A 70-year-old male presented with dyspnoea, nausea and appetite loss in the emergency room. He presented with normal blood pressure (101/71 mmHg) but tachycardia (heart rate: 107 bpm). Arterial blood gas analysis revealed acidosis (pH: 7.256 [normal range: 7.36–7.44]), a decreased pressure of CO2 (10 mm Hg [normal range: 35–45 mm Hg]), a decreased base excess (−20 mEq/L [normal range: −2—+2 mEq l−1 ]), an increased lactate level (12 mmol l−1 [normal range:80 mm Hg]), which means metabolic acidosis due to elevated lactic level. His cardiac index was 3.0, and his pulmonary capillary wedge pressure was 23 mm Hg, which signified Forrester Class II heart failure. Laboratory tests revealed a decreased vitamin B1 level (17 ng ml−1 [normal range: 24–66 ng ml−1]). CT demonstrated bilateral pleural effusion (asterisks), cardiomegaly and a collection of pericardial fluid effusion that was more highly attenuated than pleural effusion (arrows).