Wernicke Encephalopathy and Other Vitamin Deficiencies in a Patient with Home Parenteral Nutrition

Abstract

Wernicke Encephalopathy (WE) is an acute and serious secondary neurological syndrome
caused by a deficit of thiamine or vitamin B1. Although it rarely presents with the classic
triad, the most frequent presenting symptoms are: mental confusion, ocular-motor dysfunction
and ataxia. Laboratory and image studies can be useful, but diagnosis is fundamentally clinical,
and if this syndrome is suspected treatment must be started as soon as possible. The most
frequent cause in our setting is chronic alcoholism; however, there are increasing numbers of
reported cases secondary to parenteral nutrition not correctly supplemented with vitamins. Here
we present a case of WE secondary to parenteral nutrition not correctly supplemented with vitamins.
This patient presented the classic clinical triad and was therefore diagnosed and treated
rapidly, responding to treatment in an effective manner. Thus, the clinical presentation corresponded
to a deficit of other vitamins associated with the same vitamin complex iv that was not
administered, including a regenerative anemia and eczema craquele. This case emphasizes the
need to supplement parenteral nutrition with thiamine and other vitamins. At the same time, it
stresses the importance of suspecting this syndrome in all clinically compatible patients with
non-vitamin supplemented parenteral nutrition.