Wernicke Encephalopathy in Adolescents After Bariatric Surgery: Case Report and Review

Armstrong‐Javors, Amy; Pratt, Janey; Kharasch, Sigmund

doi:10.1542/peds.2016-1039

Cited by 22 publications

(32 citation statements)

References 37 publications

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“…Thiamine (vitamin B1) deficiency presenting with Wernicke’s encephalitis has been described previously with RYGB procedures in adolescents, especially those with poor intake and protracted emesis, but recently it has been observed after VSG as well [197]. Adolescence is a critical period for bone mass accumulation, with >50% of adult total bone mass achieved during this period; calcium and vitamin D are vital for the accrual of optimal bone mineral in the developing skeleton [198,199].…”

Section: Benefits and Risksmentioning

confidence: 99%

ASMBS pediatric metabolic and bariatric surgery guidelines, 2018

Pratt

Browne

Browne³

et al. 2018

Surgery for Obesity and Related Diseases

415

285

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The American Society for Metabolic and Bariatric Surgery Pediatric Committee updated their evidence-based guidelines published in 2012, performing a comprehensive literature search (2009-2017) with 1387 articles and other supporting evidence through February 2018. The significant increase in data supporting the use of metabolic and bariatric surgery (MBS) in adolescents since 2012 strengthens these guidelines from prior reports. Obesity is recognized as a disease; treatment of severe obesity requires a life-long multidisciplinary approach with combinations of lifestyle changes, nutrition, medications, and MBS. We recommend using modern definitions of severe obesity in children with the Centers for Disease Control and Prevention age- and sex-matched growth charts defining class II obesity as 120% of the 95th percentile and class III obesity as 140% of the 95th percentile. Adolescents with class II obesity and a co-morbidity (listed in the guidelines), or with class III obesity should be considered for MBS. Adolescents with cognitive disabilities, a history of mental illness or eating disorders that are treated, immature bone growth, or low Tanner stage should not be denied treatment. MBS is safe and effective in adolescents; given the higher risk of adult obesity that develops in childhood, MBS should not be withheld from adolescents when severe co-morbidities, such as depressed health-related quality of life score, type 2 diabetes, obstructive sleep apnea, and nonalcoholic steatohepatitis exist. Early intervention can reduce the risk of persistent obesity as well as end organ damage from long standing co-morbidities.

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Section: Benefits and Risksmentioning

confidence: 99%

ASMBS pediatric metabolic and bariatric surgery guidelines, 2018

Pratt

Browne

Browne³

et al. 2018

Surgery for Obesity and Related Diseases

415

285

View full text Add to dashboard Cite

show abstract

“…Patients often experience postoperative vomiting which reduces thiamine intake, and certain procedures, like Roux-en-Y gastric bypass, reduce thiamine absorption by reducing the length of the gut available for nutrient absorption. 48…”

Section: Medical Conditions Associated With Wementioning

confidence: 99%

Don’t seek, don’t find: The diagnostic challenge of Wernicke’s encephalopathy

Kohnke

Meek

2020

Ann Clin Biochem

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Wernicke’s encephalopathy is caused by thiamine deficiency and has a range of presenting features, including gait disturbance, altered cognitive state, nystagmus and other eye movement disorders. In the past, Wernicke’s encephalopathy was described almost exclusively in the alcohol-dependent population. However, in current times, Wernicke’s encephalopathy is also well recognized in many other patient groups, including patients following bariatric surgery, gastrointestinal surgery, cancer and pancreatitis. Early recognition of Wernicke’s encephalopathy is vital, as prompt treatment can restore cognitive or ocular function and can prevent permanent disability. Unfortunately, Wernicke’s encephalopathy is often undiagnosed – presumably because it is relatively uncommon and has a variable clinical presentation. Clinical biochemists have a unique role in advising clinicians about potential nutritional or metabolic causes of unexplained neurological symptoms and to prompt consideration of thiamine deficiency as a potential cause in high-risk patient groups. The aim of this review is to summarize the clinical features, diagnosis and treatment of Wernicke’s encephalopathy and to highlight some non-traditional causes, such as after bariatric surgery.

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“…188,189 Its onset can have a rapid progression, with or without ataxia, and can be associated with other minor clinical manifestations, including muscular fasciculation or weakness, atypical ocular symptoms, nystagmus, ophthalmoplegia, seizures, and altered mental status until coma. 59,61,65,122,173 The main causative pathological conditions in our review were from anorexia, morbid obesity, and bariatric surgery; all of them are caused by an insufficient supply of thiamine tied to the lack of risk awareness. 62,90,105 In pediatric medical imaging platforms, as found in tertiary hospitals in HICs, the imaging modalities are useful tools for assessment and making a rapid as well as decisive diagnosis of PTD.…”

Section: To What Extent Can Higher Diagnostic Capacities In Hics Influence the Detection Of Clinical Expressions Of Ptd Compared With Resmentioning

confidence: 99%

“…The reduction of both thiamine absorption following surgery and thiamine intake in the first months can lead to severe TD, including WE. [57][58][59][60][61] Categories C8 and C9 include diverse critical conditions that increase the risk of developing TD. Many highly specialized pediatric services were involved in these categories: oncology units, pediatric emergency rooms, PICUs or neonatal intensive care units, specialized surgical services (abdominal, cardiac, and transplantation), gastroenterology, and imaging and dialysis units.…”

Section: To What Extent Can Higher Diagnostic Capacities In Hics Influence the Detection Of Clinical Expressions Of Ptd Compared With Resmentioning

confidence: 99%

Pediatric thiamine deficiency disorders in high‐income countries between 2000 and 2020: a clinical reappraisal

Rakotoambinina

Hiffler²,

Gomes

2021

Annals of the New York Academy of Sciences

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Often thought to be a nutritional issue limited to low-and middle-income countries (LMICs), pediatric thiamine deficiency (PTD) is perceived as being eradicated or anecdotal in high-income countries (HICs). In HICs, classic beriberi cases in breastfed infants by thiamine-deficient mothers living in disadvantaged socioeconomic conditions are thought to be rare. This study aims to assess PTD in HICs in the 21st century. Literature searches were conducted to identify case reports of PTD observed in HICs and published between 2000 and 2020. The analyzed variables were age, country, underlying conditions, clinical manifestations of PTD, and response to thiamine supplementation. One hundred and ten articles were identified, totaling 389 PTD cases that were classified into four age groups: neonates, infants, children, and adolescents. Eleven categories of PTD-predisposing factors were identified, including genetic causes, lifestyle (diabetes, obesity, and excessive consumption of sweetened beverages), eating disorders, cancer, gastrointestinal disorders/surgeries, critical illness, and artificial nutrition. TD-associated hyperlactatemia and Wernicke encephalopathy were the most frequent clinical manifestations. The circumstances surrounding PTD in HICs differ from classic PTD observed in LMICs and this study delineates its mutiple predisposing factors. Further studies are required to estimate its magnitude. Awareness is of utmost importance in clinical practice.

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Wernicke Encephalopathy in Adolescents After Bariatric Surgery: Case Report and Review

Cited by 22 publications

References 37 publications

ASMBS pediatric metabolic and bariatric surgery guidelines, 2018

ASMBS pediatric metabolic and bariatric surgery guidelines, 2018

Don’t seek, don’t find: The diagnostic challenge of Wernicke’s encephalopathy

Pediatric thiamine deficiency disorders in high‐income countries between 2000 and 2020: a clinical reappraisal

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