Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery

Abstract

Carl Wernicke described the disease bearing his name in 1881 and reported three cases characterized by the presence of mental confusion, ataxia, and ophthalmoplegia. Wernicke’s disease is mainly observed in alcoholic patients, due to decreased vitamin intake as a consequence of an unbalanced diet, and a reduction of absorption due to the effects of alcohol. Likewise, inadequate vitamin intake is prevalent in older patients. Wernicke’s encephalopathy due to inappropriate total parenteral nutrition (TPN) occurs infrequently; recently, there is an increase in the literature concerning Wernicke’s encephalopathy in patients after general and bariatric surgeries. We present two cases of Wernicke’s encephalopathy after oncologic gastrointestinal surgery by failure to administer vitamin B1 during TPN; to our knowledge, these are the first two cases of Wernicke’s encephalopathy after colorectal surgery for cancer. In our opinion, timely diagnosis and treatment are mandatory to avoid nonfunctional recovery and consequent malpractice legal actions as well as an increase in the health-care costs correlated with the prolonged hospital stay and with the nonfunctional recovery.

Beware of lethal Wernicke's encephalopathy after cytoreductive surgery with HIPEC for peritoneal pseudomyxoma: Case report of morbidity and mortality review

“…Chronic dietary thiamine deficiencies include poor absorption or low intake and are found in: recurrent vomiting, celiac disease, pyloric obstruction, or gravidic hyperemesis, TPN [25] . Cases of WE after complex gastrointestinal surgery are increasingly reported, and are due to similar mechanisms [25] , [26] , [27] , [28] , [29] .…”

“…Chronic dietary thiamine deficiencies include poor absorption or low intake and are found in: recurrent vomiting, celiac disease, pyloric obstruction, or gravidic hyperemesis, TPN [25] . Cases of WE after complex gastrointestinal surgery are increasingly reported, and are due to similar mechanisms [25] , [26] , [27] , [28] , [29] . Our patient had several plausible factors for WE: major cytoreductive surgery with HIPEC for a rapidly evolving tumor, a postoperative course marked by gastroparesis, severe vomiting and poor dietary intake requiring lengthy total parenteral nutrition.…”

Severe side effects caused by parenteral nutrition therapy with fat emulsion (10%)/amino acids (15)/glucose (20%) injection: 2 case reports

“…The liquid of PN is usually in the form of a mixture of several nutritional ingredients, such as fat emulsion, amino acids, and glucose. The application of PN may incur some side effects, including phlebitis, cholestasis, chills, nausea, vomiting, and Wernicke encephalopathy, according to the medicine instructions ( 6 , 7 ). Currently, the PN mixture of fat emulsion, amino acids, and glucose is widely applied in clinic; however, the related adverse reactions have been rarely reported.…”

Development of Wernicke’s Encephalopathy during Total Parenteral Nutrition Therapy without Additional Multivitamin Supplementation in a Patient with Intestinal Obstruction: A Case Report

“…WE is frequently reported in patients with hyperemesis gravidarum and dialysis-related loss of thiamine, in those who undergo chemotherapy or bariatric surgery and in people with long-term alcohol abuse [1,[7][8][9][10]. However, longterm total parenteral nutrition (TPN) therapy with insufficient multivitamin support can also cause WE iatrogenically [1,3,[7][8][9][10].…”

“…WE is frequently reported in patients with hyperemesis gravidarum and dialysis-related loss of thiamine, in those who undergo chemotherapy or bariatric surgery and in people with long-term alcohol abuse [1,[7][8][9][10]. However, longterm total parenteral nutrition (TPN) therapy with insufficient multivitamin support can also cause WE iatrogenically [1,3,[7][8][9][10]. Parenteral nutrition (PN) is often given to increase or ensure nutrient intake in malnourished patients, but it is a complex therapy that requires a robust system to ensure its safety and efficacy [11].…”