Pontine Osmotic Demyelination Syndrome in a Pregnant Woman With Sepsis and Wernicke's Encephalopathy

A pregnant woman was brought to the emergency department looking starved and neglected. She was diagnosed with sepsis and started on intravenous antibiotics. She was also disoriented and hypernatremic. When the fetal heart sounds were found to be absent, the patient was diagnosed with septic miscarriage, which was managed by misoprostol, and after the expulsion of the products of conception, she was taken for evacuation of the uterus under anesthesia. Her brain CT was normal; however, due to her disorientation and altered mental status, a brain MRI was done, which revealed findings suggestive of Wernicke's encephalopathy and pontine osmotic demyelination syndrome (ODS), for which she received intravenous fluids, high doses of vitamins B, C and D, as well as other supplements like calcium, magnesium, and zinc. She received nasogastric feeding as she had difficulty swallowing and physiotherapy for the weakness in her upper and lower limbs. The patient was stable on discharge with good oral intake and was able to mobilize with a wheelchair.