Wernicke's encephalopathy due to total parenteral nutrition after jejunotomy: a case report

Wernicke's encephalopathy (WE) is an acute central nervous system disorder resulting from thiamine deficiency. It manifests with symptoms such as ophthalmoplegia, mental confusion, and ataxia. WE is frequently linked with alcoholism but can also arise from nonalcoholic factors like gastrointestinal surgery. In cases where WE is strongly suspected, empirical thiamine supplementation often yields favorable outcomes.

We present the case of a 46-year-old female who underwent total parenteral nutrition (TPN) following jejunotomy and left arm open reduction and internal fixation. On the fourth day of hospitalization, she exhibited symptoms including apathy, lethargy, delayed response, slurred speech, involuntary limb tremors, prominent spontaneous horizontal eye tremors, restricted binocular abduction, and impaired cognitive function. Prompt administration of thiamine resulted in significant improvement, leading to her discharge on the 13th day of hospital stay.

After a long period of fasting following jejunal resection, patients require thiamine supplementation through parenteral nutrition. Parenteral nutrition with high-glucose content can accelerate the consumption of thiamine, hypomagnesemia can impair thiamine activity, and magnesium and thiamine should be supplemented at the same time during TPN. Clinical symptoms are the most important evidence for the diagnosis of WE. Timely thiamine supplementation may prevent further progression of WE.

Patients undergoing TPN following gastrointestinal surgery should be promptly supplemented with thiamine and cautioned against receiving high-glycemic infusions prior to thiamine administration. Furthermore, regular monitoring of serum magnesium levels is advisable when thiamine supplementation is initiated. Timely provision of adequate thiamine supplementation may mitigate risk and enhance prognosis.