Neurological disturbances and hyperdynamic shock in a patient with esophagocoloplasty.
A 39-year-old man, with no history of alcohol intake, who had had an esophago-ileo-colo-gastroplasty with ileotransversostomy, developed diplopia, seizures, metabolic acidosis, and cardiac failure and finally refractory hyperdynamic shock. He died 20 h after admission to our intensive care unit from cardiocirculatory collapse. Postmortem results revealed low erythrocyte transketolase activity, which was increased by 22% by in vitro addition of thiamine diphosphate (TDP effect). Cerebral pathology showed the alterations of Wernicke's encephalopathy. We discuss the possible mechanisms of fatal cardiovascular collapse and the unusual presentation of a case without a history of alcoholic intake or clinical malnutrition.
Campos
L
L
Servei de Medicina Intensiva, Hospital General, Barcelona, Spain.
Masclans
J R
JR
Ortega
A
A
Martin
C
C
de Latorre
F J
FJ
Planas
M
M
D000138:Acidosis / Q000209:etiology*; D000328:Adult; D004944:Esophagoplasty / Q000009:adverse effects*; D017809:Fatal Outcome; D015391:Gastroplasty / Q000009:adverse effects*; D006261:Headache / Q000209:etiology; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D008297:Male; D012640:Seizures / Q000209:etiology; D012678:Sensation Disorders / Q000209:etiology*; D012769:Shock / Q000209:etiology*; D013695:Temperance; D013832:Thiamine Deficiency / Q000150:complications* / Q000175:diagnosis / Q000209:etiology