[Pancreatic encephalopathy and Wernicke encephalopathy]

3 cases of acute severe pancreatitis with symptoms of central nervous system were presented and 30 Chinese articles of acute pancreatitis (AP) with encephalopathy found in the literature were reviewed in CNKI.

There were 185 cases of AP with encephalopathy altogether, 84% of them being severe cases, with male slightly outnumbering female and biliary pancreatitis as the predominating type. Encephalopathy appeared in the early course of AP was a part of multiple organ failure which results from acute systemic inflammatory reaction. This is, in fact, pancreatic encephalopathy (PE). There were altogether 107 cases of PE and 61 of them died (57%). Encephalopathy appeared in the later course of AP (> 2 weeks or in recovery period) was caused by deficiency of Vit B(1). This is Wernicke encephalopathy (WE). There were 78 cases of WE and 26 died (33%). The difference between the two groups was significant (P < 0.01). Supplement of thiamine in time was the reason for lower mortality in WE. Of the 78 cases with WE, 17 having supplement of Vit B(1) all survived. Among those who did not receive Vit B(1), the mortality was 43%; this was not so much different with the mortality of PE (P > 0.05).

This article discussed in detail the pathogenesis, diagnosis and management of PE and WE. Treatment of PE includes early diagnosis and comprehensive intensive therapeutic measures in intensive care unit. Patients who have been in fasting for a long time (more than 10 days) should be given thiamine intramuscularly in case WE occurs. As soon as WE is diagnosed, a large doses of Vit B(1) should be given immediately, is the key to reduce the mortality of encephalopathy complicating AP.