title: Iatrogenic Wernicke encephalopathy in a patient with severe hyperemesis gravidarum.
abstract: BACKGROUND
  Hyperemesis gravidarum complicates 0.5-2.0% of pregnancies and may lead to substantial nutritional deficiencies. Total parenteral nutrition can be used in severe cases in an attempt to avoid such deficiencies. Rarely, thiamine deficiency resulting in Wernicke encephalopathy occurs, with significant maternal morbidity.
  
  
  METHODS
  We present the case of a 30-year-old woman with hyperemesis gravidarum at 13 4/7 weeks of gestation treated with prolonged total parenteral nutrition that lacked thiamine supplementation, resulting in iatrogenic Wernicke encephalopathy. After high-dose intravenous thiamine repletion, she experienced slow resolution of her symptoms.
  
  
  CONCLUSIONS
  Pregnancies complicated by hyperemesis gravidarum treated with total parenteral nutrition represent potential high-risk clinical scenarios for thiamine deficiency. Compositions of total parenteral nutrition are not standardized. Thus, physicians must confirm repletion of all essential components to avoid significant morbidity.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences and the Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Giugale
authors.forename: Omar M
authors.initials: OM
authors.lastname: Young
authors.forename: David C
authors.initials: DC
authors.lastname: Streitman
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000628:therapy*; D007049:Iatrogenic Disease; D010289:Parenteral Nutrition, Total / Q000009:adverse effects* / Q000592:standards; D011247:Pregnancy; D013832:Thiamine Deficiency / Q000150:complications / Q000209:etiology*; D014899:Wernicke Encephalopathy / Q000209:etiology*