A case report is described of a child whose clinical course imitated that of the peracute form of cardiac beriberi known as Shoshin. The nature of the disorder, certain symptoms of which started in infancy, was such that it strongly indicated a metabolic rather than a nutritional etiology, involving energy metabolism. Because autopsy was refused by the parents, it was not possible to study the exact nature of the pathology. Thus, no particular known disease label could be attached. The case illustrates, however, the use of a nutrient supplement approach even in a life threatening disease by using knowledge derived from the study of classical nutritional disease.