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Wernicke's encephalopathy in hyperemesis gravidarum: association with abnormal liver function
P Rotman1, D Hassin, M Mouallem
1Department of Medicine E, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Israel Journal of Medical Sciences
|March 1, 1994
Summary
Wernicke
Area of Science:
- Neurology
- Obstetrics
- Biochemistry
Background:
- Hyperemesis gravidarum (HG) is characterized by severe nausea and vomiting during pregnancy.
- Wernicke's encephalopathy (WE) is a serious neurological complication.
- The link between HG and WE requires further investigation.
Observation:
- A pregnant patient with hyperemesis gravidarum developed Wernicke's encephalopathy.
- The patient experienced prolonged vomiting, significant weight loss, and abnormal liver function.
- Literature review identified 14 additional cases of WE complicating HG.
Findings:
- Forty percent of patients with HG-associated WE had elevated liver enzymes (AST > 100 U/l).
- This rate is significantly higher than typically seen in hyperemesis gravidarum.
- Prolonged vomiting and hepatic abnormalities appear to be key factors.
Implications:
- Parenteral thiamine supplementation is recommended for severe HG lasting over 3 weeks, particularly with liver dysfunction.
- Hepatic abnormality may play a crucial role in the pathogenesis of WE in HG.
- Early thiamine intervention is vital for preventing neurological damage in at-risk pregnancies.
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