Thiamine refractory Wernickes encephalopathy reversed with magnesium therapy

Coughlan, J J; Mross, Thomas; Wafer, Meghan; Liston, Richard

doi:10.1136/bcr-2016-218046

Cited by 4 publications

(4 citation statements)

References 3 publications

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“…Hypomagnesaemia has been associated with CF likely due to malabsorption and as well as exposure to aminoglycoside antibiotics. Magnesium is required for conversion of thiamine to its active form and there have been reports of Wernicke’s encephalopathy refractory to thiamine administration in the setting of hypomagnesaemia 18–21. It may be the case however, that as life expectancy improves in CF, vitamin deficiencies from chronic malnutrition may accumulate over time and the clinician taking care of adult CF patients should be attentive to this.…”

Section: Discussionmentioning

confidence: 99%

Cystic fibrosis associated with Wernicke’s encephalopathy in an older adult

2022

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Here we report the first case of an association between cystic fibrosis and Wernicke’s encephalopathy. The patient had a history of cystic fibrosis diagnosed in her early 60s associated with pancreatitis and chronic lung disease. She presented with a traumatic hip fracture requiring operative repair. On examination, she was found to have bilateral nystagmus. MRI revealed enhancement of the mammillary bodies. Laboratory results were notable for thiamine deficiency, which in context of the radiographic and physical examination findings, confirmed a diagnosis of Wernicke’s encephalopathy. The cause of her low thiamine was thought to be poor dietary intake, weight loss and malabsorption associated with exocrine pancreatic insufficiency in the setting of a history of recurrent pancreatitis. The patient had complete resolution of her symptoms with the initiation of thiamine supplementation and pancreatic enzymes. Although classically associated with fat soluble vitamin deficiencies, there are increasing reports of water-soluble vitamin deficiencies associated with cystic fibrosis.

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Section: Discussionmentioning

confidence: 99%

Cystic fibrosis associated with Wernicke’s encephalopathy in an older adult

2022

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“…Nevertheless, if an effective response is observed, 250 mg thiamine given intravenously or intramuscularly daily for 3-5 days, or until clinical improvement, should be continued. Associated magnesium supplementation is recommended, as it is a cofactor of vitamin B1 and magnesium deficiency is a cause of resistance to treatment [ 5 , 13 ]. In our cases, both of our patients received this supplementation directly after the MRI, with good outcomes and complete resolution of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Gayet-Wernicke Encephalopathy: An Unusual Complication of Vomiting

Delsa

Benfaida

Salimi

et al. 2021

Cureus

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Gayet-Wernicke encephalopathy (WE) is a serious and acute disease of the central nervous system caused by thiamine (vitamin B1) deficiency. Multiple etiologies are indicated, although alcohol abuse is the most reported cause. If not treated promptly, WE can lead to serious complications such as Korsakoff's syndrome, coma, or death. This diagnosis should be considered even without a history of alcohol dependence. We describe two cases of non-alcohol related WE complicating vomiting caused by different etiologies. The diagnosis was suspected on clinical presentation and confirmed by brain MRI and effective response to parenteral administration of thiamine.

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“…Магнитно-резонансные томограммы головного мозга без контрастирования пациента Н.: а, б -Т2-взвешенные (аксиальные) изображения головного мозга; в, г -диффузно-взвешенные (сагитальные) изображения головного мозга. Симметричное повышение МР-сигнала от зоны среднего мозга и таламуса (показано стрелками) [25,26]. Снижение сывороточной концентрации магния, связанное с торможением его канальцевой реабсорбции под влиянием ингибиторов кальциневрина, чаще встречается в раннем послеоперационном периоде, но возможно и в отдаленные сроки [27].…”

Section: Discussionunclassified

Non-alcoholic Wernicke’s encephalopathy in a kidney transplant recipient

Kantariya

Vetchinnikova

Vatazin

et al. 2021

RJTAO

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Background. Non-alcoholic Wernicke’s encephalopathy occurs in various somatic conditions with thiamine deficiency, excessive excretion of thiamine, or impaired thiamine metabolism. Very few cases of this pathology have been described in chronic kidney disease (CKD). We present a unique case of non-alcoholic Wernicke’s encephalopathy in a patient with a kidney transplant is presented.Past medical history. The patient underwent kidney transplantation in 2008. Outpatient follow-up by a nephrologist was irregular. Renal graft function remained relatively stable: blood creatinine 200–240 μmol/L, estimated glomerular filtration rate 40–30 mL/min, tacrolimus plasma concentrations tended to increase (5.7–7.6–8.4–10.4 ng/mL); repeated graft biopsy (in 2015 and in 2017) determined the chronic toxicity of calcineurin inhibitors. The patient’s condition worsened in late January 2020: body temperature increased to 38°C, nausea, vomiting, loose, watery stools for up to 5 times per day, 8 kg weight loss, decreased diuresis. A few days later, double vision, shaky gait and then immobility appeared. Biochemical examination results: potassium 3.8 mmol/L, sodium 139 mmol/L, alpha-amylase 159 units/L (norm 0–100 units/L), creatinine 242 mmol/L, urea 13.2 mmol/L; ultrasound signs of pancreatitis. Magnetic resonance imaging (MRI) of the brain: bilateral diffuse lesions of the midbrain, thalamus, and cerebellum. Based on the clinical picture and on brain MRI results, Wernicke’s encephalopathy was diagnosed. Parenteral administration of thiamine had a good effect.Conclusion. Possible mechanisms of the development of Wernicke’s encephalopathy in a patient were discussed. Vigilance is required regarding this disease when metabolic disorders occur in patients with CKD.

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Thiamine refractory Wernickes encephalopathy reversed with magnesium therapy

Cited by 4 publications

References 3 publications

Cystic fibrosis associated with Wernicke’s encephalopathy in an older adult

Cystic fibrosis associated with Wernicke’s encephalopathy in an older adult

Gayet-Wernicke Encephalopathy: An Unusual Complication of Vomiting

Non-alcoholic Wernicke’s encephalopathy in a kidney transplant recipient

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