‘Iatrogenic’ Wernicke’s Encephalopathy in Japan

Abstract

‘Iatrogenic’ Wernicke’s encephalopathy has appeared to occur more frequently in Japan, probably induced by the change of our Japanese national health insurance policy in 1992. We report 4 nonalcoholic patients with such Wernicke’s encephalopathy, which occurred during the early postoperative oral food intake period following intravenous nutrition without vitamin supplements. We analyzed the medical records of 4 patients, 3 men and 1 woman, aged between 55 and 71 years, who were admitted to our hospital between 1992 and 1995. Three patients underwent gastrointestinal surgery and 1 suffered chronic pyothorax. We diagnosed our patients as having Wernicke’s encephalopathy based on typical neurological abnormalities, in addition to typical cranial magnetic resonance image findings, low serum vitamin B₁ levels, or both. Although all of the patients were treated with vitamin B₁ and showed some improvement, 1 patient developed Korsakoff syndrome, 2 made incomplete neurological recovery, and 1 died. We speculated that the body vitamin B₁ stores had been decreasing in our patients who did not receive any vitamin supplements during intravenous hyperalimentation or hydration. Subsequent administration of high calorie and high carbohydrate oral diets increased the demand for vitamin B₁, further depleting the vitamin stores, thereby causing ‘iatrogenic’ Wernicke’s encephalopathy. The change of our national health insurance policy in 1992 discouraged the routine administration of vitamins, probably causing Wernicke’s encephalopathy in our patients.

Thiamine (vitamin B1) deficiency and associated brain damage is still common throughout the world and prevention is simple and safe!

“…It is said that thiamine deficiency has virtually disappeared in countries such as Japan and the USA since the introduction of thiamine enrichment of rice and flour respectively. This may not be the case given the recent reports of new cases of WKS in the UK and Japan [7,10 ]. Thiamine enrichment of bread flour was initiated in Australia in 1991 following documentation of high prevalence rates of WKS in several autopsy studies across the country.…”

“…In fact, several recent papers suggest that there is an increase in the prevalence of WKS, perhaps related to changes in hospital and government policy. In Japan, iatrogenic WKS appears to be more frequent, probably because of the change of the Japanese national health insurance policy in 1992 which discourages the routine administration of vitamins to patients on intravenous nutrition [7]. Of equal concern is the attitude of health professionals to treat with thiamine and the apparent lack of specific policies for dealing with at risk groups of patients as shown in a recent survey.…”

Three Iatrogenic Cases of Wernicke’s Encephalopathy From Turkey: An Early Warning

“…), sonraki beş gün 200 mg/gün (alkol bağımlılarına 500 mg/gün), 100 veya 250 cc salin içinde 30 dakikada infüzyon şeklindedir (12 İlk iki vakadaki gibi hastanede yatan, parenteral yolla beslenen hastalarda iatrojenik olarak WE görülmesi dikkat çekici bir durumdur. Benzer vakalar İtalya, Japonya, Amerika Birleşik Devletleri (ABD) gibi pek çok gelişmiş ülkede de bildirilmiştir (12,13). İtalya'dan bildirilen vakalarda sebep olarak kullanılan TPN torbalarının cinsinin değişimi sonrası, hatalı olarak, multivitamin eklenmesinin unutulması saptanmıştır.…”

Wernicke’s encephalopathy in nonalcoholic patients: Clinical and pathologic features of three cases and literature reviewed

“…This theorising induced changes in the Japanese national health insurance policy. The routine administration of vitamins is now required in such patients 9 …”

“…The routine administration of vitamins is now required in such patients. 9 Thiamine is a water-soluble vitamin. The daily requirement in humans is estimated to be 1.0-1.5 mg per day and body stores can be depleted within about 3 weeks.…”