Lessons of the month: Not just morning sickness

Tong, Chin Voon

doi:10.7861/clinmed.2020-0151

Cited by 4 publications

(6 citation statements)

References 7 publications

(5 reference statements)

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“…We are sensitive to this reality with three cases of HG‐related hallucinations, or ASG, from our institution 65 . In this study, hallucinations, altered mental status, and/or delirium were presenting symptoms in at least five (18.5%) women 21,23,24,26,36 …”

Section: Discussionmentioning

confidence: 81%

“…Administering thiamin in insufficient doses, <500 mg of intravenous thiamin three times per day until acute symptoms resolve is considered suboptimal treatment, which continues in current times 38 . In our series of 27 women with HG‐WE, 8 (29.8%) were undertreated with thiamin (24,25,27,28,32: cases 2,3,6; 37). We highlight the role of minerals in thiamin metabolism as critical, and whereas magnesium was assessed in many of these 18 reports, phosphorus was not.…”

Section: Discussionmentioning

confidence: 91%

“…We present our findings, representing 27 women, in Table 1. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] T A B L E 1 Description of pregnant women with HG deteriorating into WE…”

Section: Resultsmentioning

confidence: 99%

“…Tong, 2020, 24 Malaysia Teenage primigravida at 13 weeks with HG starting at week 8. Presented with giddiness and inability to walk due to involuntary movements of limbs and eyes for 2 days.…”

Section: Presenting Descriptions Of the Women Outcomesmentioning

confidence: 99%

“…65 In this study, hallucinations, altered mental status, and/or delirium were presenting symptoms in at least five (18.5%) women. 21,23,24,26,36 Many women with NVP are told it is a first-trimester issue and is normal, which it is. Extremely ill women ask how vomiting and weight loss can be healthy for their pregnancy and are reassured that having NVP leads to a lower risk of miscarriage, which is true but only in a cohort of women experiencing "morning sickness."…”

Section: Presenting Descriptions Of the Women Outcomesmentioning

confidence: 99%

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Gestational malnutrition, hyperemesis gravidarum, and Wernicke's encephalopathy: What is missing?

Erick

2022

Nut in Clin Prac

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Hyperemesis gravidarum (HG), or the severe nausea and vomiting of pregnancy, is one of the most dreaded complications of gestation, affecting between 1.5% and 3.0% of pregnant women. From the late 1800s to the mid-1980s, the etiology was frequently cited to have psychological and/or-laterperhaps hormonal origins, which have numbered at least 10. Current research has unearthed a genetic basis for HG that implicates growth differentiation factor 15, insulin-like growth factor binding protein 7, and hormone receptors (namely, glial cell line-derived neurogenic factor family receptor alpha-like and the progesterone receptor). Whatever the origins of this disease, it has caused immeasurable physiological and psychological damage to women, their fetuses, and their families. The psychological trauma includes a high rate of suicidal ideation as well as posttraumatic stress disorder. Whereas the healthcare costs are substantial for the mother with HG, the lifetime costs to the neonate include that which accompanies reduced employment earnings related to cognitive compromise. Another devastating outcome of severe HG can be Wernicke's encephalopathy (WE), which has a high fetal and maternal mortality rate. Our study explored 18 current reports of HG and WE. We highlighted additional presenting features we believe also accompany, and sometimes replace, the classically taught triad components of WE: ataxia, confabulation, and nystagmus. We agree with the conclusion made by Sheehan and Ironside in 1939 that thiamin alone may not reverse WE, and we offer possible explanations. Lastly, we offer suggestions for remediation.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Presenting Descriptions Of the Women Outcomesmentioning

confidence: 99%

Section: Presenting Descriptions Of the Women Outcomesmentioning

confidence: 99%

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Gestational malnutrition, hyperemesis gravidarum, and Wernicke's encephalopathy: What is missing?

Erick

2022

Nut in Clin Prac

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When time is brain: a systematic review about Wernicke encephalopathy as a dramatic consequence of thiamin deficiency in hyperemesis gravidarum

Fiorentini,

Nedu,

Dapoto

et al. 2023

The Journal of Maternal-Fetal & Neonatal Medicine

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Wernicke Syndrome: Case Report and Literature Review of Contributing Factors—Can Malpractice Dynamics Be Identified?

Mangione,

Vassiliadis,

Gullo

et al. 2024

JCM

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Wernicke Encephalopathy (WE) is a neurological acute syndrome related to vitamin B1 deficiency and is relatively common in patients with chronic alcoholism. In the case of Hyperemesis Gravidarum, thiamine body stores become unable to meet the increased demand, resulting in acute deficiency. WE is associated with typical clinical and radiological findings. Treatment pathways rely on thiamine replacement. The case herein reported is centered around a 33-year-old diabetic patient at 12 weeks of gestation, with WE due to hyperemesis gravidarum. The disease manifested itself with weakness, mental confusion, headache, and impaired vision. The diagnosis was established after the detection of typical findings by MRI. Thirty days after therapy was started, most of the patient’s neurological disorders were resolved. The patient was discharged 40 days later with instructions to continue daily thiamine supplementation. The pregnancy outcome was good. Unfortunately, mild ataxia persisted in 2-year follow-up as a long-term consequence. When diagnosed and treated, WE has a favorable prognosis. However, roughly 80% of patients experience memory loss, which may continue for a long time, while gait disorders reportedly affect about 35% of patients. Mild ataxia and dysmetria may persist, too. We reviewed the scientific literature on WE in women with HG until February 2023. Hardly any authors report data on long-term sequelae. Our report emphasizes how important it is to take into consideration this complication in clinical practice, referring to published guidelines and recommendations. Neurological maternal sequelae can demonstrably persist despite early diagnosis and appropriate management. For this reason, a long-term follow-up is recommended. Wernicke syndrome management cannot yet rely on well-established conclusive guidelines; hence, a cautionary approach ought to be prioritized in order to ensure medicolegal soundness.

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Lessons of the month: Not just morning sickness

Cited by 4 publications

References 7 publications

Gestational malnutrition, hyperemesis gravidarum, and Wernicke's encephalopathy: What is missing?

Gestational malnutrition, hyperemesis gravidarum, and Wernicke's encephalopathy: What is missing?

When time is brain: a systematic review about Wernicke encephalopathy as a dramatic consequence of thiamin deficiency in hyperemesis gravidarum

Wernicke Syndrome: Case Report and Literature Review of Contributing Factors—Can Malpractice Dynamics Be Identified?

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