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Encephalopathy after persistent vomiting: Three cases of non-alcohol-related Wernicke’s encephalopathy

Katherine Antel, Nevadna Singh, Briony Chisholm, Jeannine M Heckmann

Abstract


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. Our cases highlight the importance of recognising WE when undernutrition, which may be caused by gastrointestinal disease or surgery, or malignancy, is compounded by vomiting. Expert guidelines suggest that WE must be considered in the emergency room in any individual with disturbed consciousness of unknown cause. Treatment is with parenteral thiamine before glucose administration. 


Authors' affiliations

Katherine Antel, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Nevadna Singh, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Briony Chisholm, Medicines Information Centre, Division of Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Jeannine M Heckmann, Division of Neurology, Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

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Keywords

Thiamine deficiency; Wernicke's encephalopathy, vomiting

Cite this article

South African Medical Journal 2015;105(6):442-443. DOI:10.7196/SAMJ.9299

Article History

Date submitted: 2014-12-17
Date published: 2015-09-18

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