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thiamine in hyperemesis gravidarum

Fiona T Nhari, Narcisious B T Dzvanga
We report two cases of Wernicke-Korsakoff syndrome (WKS) secondary to hyperemesis gravidarum. Oral thiamine was administered (intravenous unavailable locally). However, both the patient's condition improved in the first 48 h and progressively over a month. Initially, WKS is missed due to rare feature of full classical triad of symptoms, especially in nonalcoholics.
May 2018: Clinical Case Reports
Tülay Kamaşak, Sibel Kul, Mustafa Tuşat, Nezir Ozgun, Ali Cansu
Wernicke encephalopathy is an acute neurological problem resulting from thiamine deficiency and manifesting with mental confusion, oculomotor dysfunction, and ataxia. It is associated with alcohol dependence in adults. Preparatory factors include hyperemesis gravidarum, prolonged diarrhea, prolonged parental nutrition without vitamin support, absorption disorders, anorexia, cancer, and chemotherapy. Failure to consider the clinical findings and preparatory factors of this disease, which is rare in children, can delay diagnosis...
March 28, 2018: Pediatric Emergency Care
Kenzo Hokazono, Francisco Geminiani, Debora Bertholdo
Purpose: To describe a case of sudden onset of nystagmus in a pregnant patient with hyperemesis gravidarum. Observations: Sixteen days after onset of persistent nausea and uncontrollable vomiting, a 12 week pregnant woman presented up-beating nystagmus, mild memory impairment and reduced sensitivity in the lower limbs. Laboratory tests presented thiamine deficiency and magnetic resonance imaging showed bilateral medial thalami and midbrain lesions. Because of suspected Wernicke's encephalopathy, the patient was treated with thiamine replacement and significant improvement of symptoms took place...
June 2017: American Journal of Ophthalmology Case Reports
Rajesh Verma, Vipul Garg
Wernicke's encephalopathy is a rare neurological disorder caused by thiamine deficiency, characterised by ocular motor dysfunction, ataxia and impairment in consciousness. It predominantly affects brain regions with a high metabolic rate such as mammillary bodies, medial thalamic nuclei, the tectal region and the cerebellum. Although chronic alcoholism is the most common cause of Wernicke's encephalopathy, various other conditions not related to alcohol consumption such as bariatric surgery, acute pancreatitis, hyperemesis gravidarum, prolonged fasting and gastrointestinal surgery have been implicated in its aetiology...
July 31, 2017: BMJ Case Reports
Pamela Tozzo, Luciana Caenazzo, Daniele Rodriguez, Matteo Bolcato
INTRODUCTION: Wernicke's encephalopathy (WE) is a neurological syndrome caused by thiamine deficiency, and clinically characterized by ophthalmoplegia, ataxia and acute confusion. In developed countries, most cases of WE have been seen in alcohol misusers. Other reported causes are gastrointestinal tract surgery, hyperemesis gravidarum, chronic malnutrition, prolonged total parenteral nutrition without thiamine supplementation, and increased nutrient requirements as in trauma or septic shock...
2017: International Journal of Surgery Case Reports
Noorazizah Arsad, Kah Teik Chew, Nur Azurah Abdul Ghani, Hui Jan Tan, Norasyikin A Wahab, Nor Azlin Mohd Ismail
Wernicke's encephalopathy (WE) is a rare life-threatening complication following severe hyperemesis gravidarum. Early recognition of this condition and prompt thiamine administration is the key to preventing devastating sequelae. We report a successful delivery of a small-for-gestational-age (SGA) baby by a patient with WE and thyrotoxicosis in pregnancy.
November 15, 2016: Hormone Molecular Biology and Clinical Investigation
V V Ashraf, J Prijesh, R Praveenkumar, K Saifudheen
Hyperemesis gravidarum-induced Wernicke's encephalopathy (WE) is an underestimated condition. The purpose of this study is to improve its awareness and early diagnosis. We report five cases of WE secondary to hyperemesis gravidarum. Classic triad of encephalopathy, ataxia, and ocular signs was seen in four out of five patients. Two unusual features noted in this series were papilledema in one patient and severe sensory-motor peripheral neuropathy in one patient. Magnetic resonance imaging (MRI) was abnormal in all the five patients, and high signal in medial thalamus and surrounding the aqueduct was the most common abnormality (5/5)...
October 2016: Journal of Postgraduate Medicine
Nnabuike Chibuoke Ngene, Jack Moodley
Women with persistent vomiting during pregnancy need early referral to appropriate health facilities. Delayed referral and inappropriate management may lead to metabolic encephalopathy from a variety of causes, including electrolyte derangements or thiamine deficiency (Wernicke's encephalopathy) (WE). We present a case of persistent vomiting in pregnancy in which there was delayed referral, inappropriate treatment and failure to associate neurological signs such as terminal neck stiffness with WE, resulting in poor fetomaternal outcomes...
July 8, 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Mohamed Adnane Berdai, Smael Labib, Mustapha Harandou
Wernicke's encephalopathy is caused by severe thiamine deficiency; it is mostly observed in alcoholic patients. We report the case of a 28-year-old woman, at 17 weeks of gestational age, with severe hyperemesis gravidarum. She presented with disturbance of consciousness, nystagmus, ophthalmoplegia, and ataxia. The resonance magnetic imagery showed bilaterally symmetrical hyperintensities of thalamus and periaqueductal area. The case was managed with very large doses of thiamine. The diagnosis of Wernicke's encephalopathy was confirmed later by a low thiamine serum level...
2016: Case Reports in Critical Care
K Antel, N Singh, B Chisholm, J M Heckmann
Wernicke's encephalopathy (WE) is a medical emergency. Although WE is commonly viewed in the context of alcoholism, it can be caused by thiamine deficiency secondary to persistent vomiting. Non-alcohol-related WE may be more catastrophic in onset and less likely to present with the classic features than WE with alcoholism as a cause. We describe three cases of WE due to persistent vomiting without alcoholism in patients with hyperemesis gravidarum, drug-induced hyperlactataemia, and an acute gastrointestinal illness in an already malnourished individual...
June 2015: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Ayumi Iwashita, Yosuke Baba, Rie Usui, Akihide Ohkuchi, Shigeaki Muto, Shigeki Matsubara
A pregnant, non-Japanese-speaking Peruvian, and, thus, with communication difficulty, suffered hyperemesis gravidarum and had respiratory arrest, requiring cardiopulmonary resuscitation. The obese pregnant woman (prepregnancy weight: 107 kg) had vomited and lost 15 kg in bodyweight over appropriately 2 weeks prior to the arrest but had not complained due to communication difficulty, which, together with her obesity, prevented a Japanese obstetrician from noticing her severe condition. 1,000 mL of low potassium fluid plus thiamine was administered...
2015: Case Reports in Obstetrics and Gynecology
Derrick Lonsdale
Although it has been generally accepted that moving the infant from the prone to the supine position has solved the problem of sudden infant death syndrome (SIDS), it has been hypothesized that this is an insufficient explanation and that a mixture of genetic risk, some form of stressful incident and marginal brain metabolism is proportionately required. It is suggested that each of these three variables, with dominance in one or more of them, act together in the common etiology. Much has been written about the association of thiamin and magnesium but the finding of extremely high concentrations of serum thiamin in SIDs victims has largely caused rejection of thiamin as being involved in the etiology...
December 2015: Medical Hypotheses
Lauren E Giugale, Omar M Young, David C Streitman
BACKGROUND: 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. CASE: 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...
May 2015: Obstetrics and Gynecology
Laura L Frank
Thiamin is a water-soluble vitamin also known as vitamin B1. Its biologically active form, thiamin pyrophosphate (TPP), is a cofactor in macronutrient metabolism. In addition to its coenzyme roles, TPP plays a role in nerve structure and function as well as brain metabolism. Signs and symptoms of thiamin deficiency (TD) include lactic acidosis, peripheral neuropathy, ataxia, and ocular changes (eg, nystagmus). More advanced symptoms include confabulation and memory loss and/or psychosis, resulting in Wernicke's encephalopathy and/or Wernicke's Korsakoff syndrome, respectively...
July 2015: JPEN. Journal of Parenteral and Enteral Nutrition
So Won Park, Yoon Young Yi, Jung Woo Han, Heung Dong Kim, Joon Soo Lee, Hoon-Chul Kang
Wernicke's encephalopathy is an acute neurological disorder characterized by mental confusion, oculomotor dysfunction, and ataxia. It has been reported in individuals with alcohol dependence, hyperemesis gravidarum, and prolonged parenteral nutrition without vitamin supplementation. Here we present the case of a 13-year-old male patient with neuroblastoma and a history of poor oral intake and nausea for 3 months. After admission, he showed gait disturbances, nystagmus, and excessive dizziness; his mental state, however, indicated he was alert, which did not fit the classical triad of Wernicke's encephalopathy...
November 2014: Korean Journal of Pediatrics
Kyung Pyo Cho, Jae Sung Lee, Ji Seok Seong, Yong Moon Woo, Young Jun Cho, Beom Jin Jeong, Jee Hoon Sohn, Su-Jung Kim
Wernicke's encephalopathy (WE) caused by thiamine deficiency is an acute neurological disorder. Clinically, the classic triad of WE consists of ophthalmoplegia, ataxia, and mental status changes. Thiamine deficiency is known to occur commonly in chronic alcoholic patients. Sometimes, it can occur in patients after gastrointestinal surgery and in those with malabsorption. In addition, patients undergoing renal dialysis, suffering from hyperemesis gravidarum, receiving total parenteral nutrition (TPN), and being treated with chemotherapeutic agents are also prone to develop thiamine deficiency...
September 25, 2014: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
Deep Shikha, Montish Singla, Bhavana Bajracharya, Nathaniel Winer
OBJECTIVE: To present a case of gestational thyrotoxicosis and hyperemesis gravidarum associated with Wernicke's encephalopathy. METHODS: We present a detailed case report with the clinical, imaging, and laboratory findings of the patient and review the pertinent literature. RESULTS: A 36-year-old woman at 14 weeks of gestation was admitted to the hospital for management of severe hyperemesis gravidarum (HG). While hospitalized, she developed low-grade fever, tachycardia, hypotension, and altered mentation...
December 2014: Endocrine Practice
Gaetana Manzo, Angela De Gennaro, Attilio Cozzolino, Antonietta Serino, Giacomo Fenza, Andrea Manto
Wernicke's encephalopathy (WE) is a severe neurological syndrome caused by thiamine (vitamin B1) deficiency and clinically characterized by the sudden onset of mental status changes, ocular abnormalities, and ataxia. Apart from chronic alcoholism, the most common cause of WE, a lot of other conditions causing malnutrition and decreasing thiamine absorption such as gastrointestinal surgical procedures and hyperemesis gravidarum must be considered as predisposing factors. Due to its low prevalence and clinical heterogeneity, WE is often misdiagnosed, leading to persistent dysfunctions and, in some cases, to death...
2014: BioMed Research International
A Maina, M Arrotta, L Cicogna, V Donvito, M Mischinelli, T Todros, S Rivolo
OBJECTIVE: To study the efficacy of transdermal clonidine in the treatment of severe refractory hyperemesis gravidarum (HG), the most severe illness of pregnancy. DESIGN: The study had a randomised, double -blind, placebo-controlled, cross-over design (RCT). SETTING: Single tertiary referral hospital after admission of patients. SAMPLE: Twelve women of gestational age 6-12 weeks and a major grade of HG clinical severity who were unresponsive to standard antiemetic treatment...
November 2014: BJOG: An International Journal of Obstetrics and Gynaecology
Anke Paula Ingrid Kleinert-Altamirano, Humberto Juárez-Jiménez
BACKGROUND: Wernicke's encephalopathy is an acute and reversible neurologic disorder due to deficiency of thiamin. Chronic alcoholism was the main cause in the past; currently, there are many other situations which favour this condition: prolonged intravenous feeding, hyperemesis gravidarum, anorexia nervosa, regional enteritis, malabsorption syndrome, hemodialysis, peritoneal dialysis, and abdominal surgery. CLINICAL CASE: We report six patients, three male and three female, who had in common total parenteral nutrition over two months, secondary to abdominal surgery complications and restriction to enteral nutrition...
January 2014: Revista Médica del Instituto Mexicano del Seguro Social
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