Endocrine Abstracts

Introduction: Wernicke Encephalopathy (WE) is an acute neurologic disorder caused by thiamine deficiency. It is characterized by the classic triad of encephalopathy, gait ataxia and oculomotor dysfunction. It occurs in the setting of poor nutrition caused by lack of dietary intake or malabsorption. Since both of them can happen in patients that underwent bariatric surgery it is of utmost importance to prevent, recognize and treat this severe complication.

Case Report: 41-year-old female with obstructive sleep apnea, gallstone disease, gastroesophageal reflux and class III obesity (IMC 41,9 kg/m²) underwent bariatric surgery roux-en-y gastric bypass in 2018. Preoperative blood analyses showed a low vitamin D, folic acid and zinc and was supplement for these deficiencies. There were no postoperative complications. Three months after the surgery, the patient enter the emergency department with complaints of abdominal pain and vomiting with 1 month of evolution. Upper endoscopy was performed showing a patent anastomosis. She was discharged with prokinetics and liquid diet. One week later she returned to the emergency department with intractable vomiting, indifference, inactiveness, axial ataxia, multidirectional nystagmus and hyporeflexia. There were no motor deficits. No abnormalities were demonstrated in the brain CT and MRI and the lumbar puncture showed no alterations. Blood analysis were normal except for: folic acid 2.1 ng/ml [reference range (RR) 2.2-17.5], total proteins 0.27 g/l [RR > 0.45] and thiamine 37 nmol/l [RR: 66-300]. Thiamine parenteral replacement was immediately initiated. The evolution was favourable and the patient was discharged after 2 weeks. She maintain a gait deficit with myopathy in the right thigh confirmed by electromyography and biopsy.

Conclusion: We present a patient that developed severe vomits after Roux-en-Y gastric bypass leading to a state of protein malnutrition and severe hypovitaminosis B1. She developed WE with motor deficit sequelae possibly in the context of a radiculoplexus neuropathy setting. It is important to identify vomits and prevent malnourishment after bariatric surgery since WE has a rapid onset and detrimental course. Vitamin and mineral supplementation after bariatric surgery will prevent this severe complication.