title: Wernicke's encephalopathy during parenteral nutrition.
abstract: BACKGROUND
  Thiamine deficiency in humans affects the cardiovascular, muscular, nervous, and gastrointestinal systems. Wernicke's encephalopathy is described in alcoholism, in hyperemesis gravidarum, and in prolonged IV feeding without vitamin supplementation.
  
  
  METHODS
  We report a case of a 66-year-old man undergoing surgery for acute necrotic-hemorrhagic pancreatitis, who presented a Wernicke's syndrome during parenteral nutrition (PN). After surgery, he was treated with infusion of industrial 3-compartment bags, without vitamin supplementation. On the seventh postoperative day, nausea and vomiting began, and 5 days later the patient showed diplopia, ataxia, general muscular stiffness, reduction of osteotendinous reflexes, confusional state, and thrombocytopenia. The magnetic resonance scan evidenced pathologic changes in the medial thalamus, in the third and fourth ventricular floor, in the cerebellar vermis, and in the periaqueductal gray substance.
  
  
  RESULTS
  All neurologic signs and platelet blood count gradually normalized after IV supplementation of thiamine, 100 mg daily. The magnetic resonance scan repeated 40 days after the first one was normal.
  
  
  CONCLUSIONS
  Our report points out the risk of incorrect procedures in management of industrial 3-compartment bags. Moreover, we suggest that thrombocytopenia may be related to thiamine deficiency.
authors.affiliation: Clinical Nutrition Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera, Padua, Italy. francescofrancini@yahoo.com
authors.forename: Francesco
authors.initials: F
authors.lastname: Francini-Pesenti
authors.forename: Filippo
authors.initials: F
authors.lastname: Brocadello
authors.forename: Stefania
authors.initials: S
authors.lastname: Famengo
authors.forename: Mariateresa
authors.initials: M
authors.lastname: Nardi
authors.forename: Lorenza
authors.initials: L
authors.lastname: Caregaro
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects*; D013831:Thiamine / Q000627:therapeutic use*; D013832:Thiamine Deficiency / Q000150:complications* / Q000188:drug therapy; D013921:Thrombocytopenia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome; D014803:Vitamin B Complex / Q000627:therapeutic use*; D014899:Wernicke Encephalopathy / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*
chemical_list: D014803:Vitamin B Complex; D013831:Thiamine