title: Refractory hypotension in a patient with Wernicke's encephalopathy.
abstract: A 57-year-old male patient with gastric carcinoma underwent radical distal gastrectomy type II + Braun anastomosis, and received total parenteral nutrition for 10 days after surgery, followed by small amounts of semi-liquid nutrition for 3 days and liquid nutrition for 2 days. The patient developed refractory hypotension for more than 1 week in the early course of disease, and on Day 15 after surgery presented with characteristic signs of Wernicke's encephalopathy, including diplopia and mental confusion. The hypotension did not improve despite appropriate fluid replacement soon after admission. Treatment with moderate dose of thiamine for 3 months partly relieved ophthalmoplegia and confusion, but not Korsakoff syndrome. This extraordinary presentation with refractory hypotension and the unusual course of the disease encouraged us to present this case.
authors.affiliation: Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai, People’s Republic of China.
authors.forename: Shi
authors.initials: S
authors.lastname: Wang
authors.forename: Xiaojun
authors.initials: X
authors.lastname: Hou
authors.forename: Suju
authors.initials: S
authors.lastname: Ding
authors.forename: Yangtai
authors.initials: Y
authors.lastname: Guan
authors.forename: Huimin
authors.initials: H
authors.lastname: Zhen
authors.forename: Laihui
authors.initials: L
authors.lastname: Tu
authors.forename: Yiqing
authors.initials: Y
authors.lastname: Qiu
mesh_terms: D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007022:Hypotension / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery; D014899:Wernicke Encephalopathy / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy