title: Wernicke's encephalopathy after sleeve gastrectomy: Literature review.
abstract: OBJECTIVE
  To describe a case of Wernicke's encephalopathy after laparoscopic sleeve gastrectomy.
  
  
  METHODS
  Emergency Department and gastrointestinal surgery department.
  
  
  METHODS
  A 20-year-old man class III obesity (BMI 50.17kg/m(2)) underwent laparoscopic sleeve gastrectomy with uneventful recovery. Five weeks after surgery he was admitted in the Emergency Department because of persistent vomiting and dysphagia to solids. Esophagogastroduodenal transit and upper gastrointestinal endoscopy were requested but no relevant findings were shown. Laboratory analyses showed vitamin B1 12.2ng/mL and 48h following admission the patient experienced generalized weakness, sialorrhea and restrictions of actions such as reading a book. Neurological evaluation found confusion, motor ataxia, diplopy and nystagmus. A brain magnetic resonance was normal. According to low level of vitamin B1 and symptoms found in the patient a presumed diagnosis of Wernicke encephalopathy was made and parenteral thiamine 100mg/day was started. The patient was discharged asymptomatic with oral intake of vitamin B1 600mg per day.
  
  
  CONCLUSIONS
  Nutritional deficiencies after restrictive procedures are uncommon but easily preventable and can result in life threatening. With the upswing of bariatric surgery, surgeons and emergency physicians should be able to diagnose and treat those complications. Prophylactic thiamine should be administered to patients with predisposing factors.
authors.affiliation: Hospital Universitario Mutua Terrassa, Barcelona, Spain. Electronic address: fparanda@gmail.com.
authors.forename: Fernando
authors.initials: F
authors.lastname: Pardo-Aranda
authors.affiliation: Hospital Universitario Mutua Terrassa, Barcelona, Spain.
authors.forename: Noelia
authors.initials: N
authors.lastname: Perez-Romero
authors.affiliation: Hospital Universitario Mutua Terrassa, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Osorio
authors.affiliation: Hospital Universitario Mutua Terrassa, Barcelona, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Rodriguez-Santiago
authors.affiliation: Hospital Universitario Mutua Terrassa, Barcelona, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Muñoz
authors.affiliation: Hospital Universitario Mutua Terrassa, Barcelona, Spain.
authors.forename: Noelia
authors.initials: N
authors.lastname: Puértolas
authors.affiliation: Hospital Universitario Mutua Terrassa, Barcelona, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Veloso
keywords: Bariatric surgery; Pathologic nystagmus; Sleeve gastrectomy; Thiamine mononitrate; Wernicke’s encephalopathy
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