Iatrogenic Wernicke encephalopathy in a patient with severe hyperemesis gravidarum

Obstetrics and Gynecology
Lauren E GiugaleDavid C Streitman

Abstract

Hyperemesis gravidarum complicates 0.5-2.0% of pregnancies and may lead to substantial nutritional deficiencies. Total parenteral nutrition can be used in severe cases in an attempt to avoid such deficiencies. Rarely, thiamine deficiency resulting in Wernicke encephalopathy occurs, with significant maternal morbidity. We present the case of a 30-year-old woman with hyperemesis gravidarum at 13 4/7 weeks of gestation treated with prolonged total parenteral nutrition that lacked thiamine supplementation, resulting in iatrogenic Wernicke encephalopathy. After high-dose intravenous thiamine repletion, she experienced slow resolution of her symptoms. Pregnancies complicated by hyperemesis gravidarum treated with total parenteral nutrition represent potential high-risk clinical scenarios for thiamine deficiency. Compositions of total parenteral nutrition are not standardized. Thus, physicians must confirm repletion of all essential components to avoid significant morbidity.

References

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Citations

May 23, 2016·Autonomic Neuroscience : Basic & Clinical·Martha BustosSteve Caritis
Jun 22, 2016·Seminars in Immunopathology·Lars BremerGisa Tiegs
Jun 24, 2017·Pharmacology·Viktoriya LondonOvadia Abulafia
Oct 20, 2018·Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition·Kerstin AustinSumona Saha
Jan 31, 2020·Obstetrical & Gynecological Survey·Daniel SpinosaSarah Dotters-Katz

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