SHM Converge Scientific Abstract ePoster Gallery-An Unexpected Outcome: Wernicke's Encephalopathy Associated With Diabetic Gastroparesis

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This case report describes a 47-year-old woman with uncontrolled type 2 diabetes, hypertension, and stage 3 chronic kidney disease who presented with recurrent intractable nausea, vomiting, diarrhea, abdominal pain, lightheadedness, poor balance, and blurry vision. She had been hospitalized multiple times over several months for similar symptoms. During admission, neurology was consulted after an episode of unresponsiveness. Initial CT head and CT angiography were unrevealing, but her exam later showed horizontal nystagmus, gait disturbance, and confusion. These findings, along with a low thiamine level, led to concern for Wernicke’s encephalopathy (WE), and she was treated promptly with IV thiamine.<br /><br />WE is a neurologic disorder caused by thiamine deficiency and classically presents with ophthalmoplegia, confusion, and ataxia, though the full triad is seen in only a minority of patients. The condition is reversible if treated early, but delayed recognition can lead to Korsakoff syndrome, a potentially irreversible complication. Although WE is most commonly associated with alcohol use, this case was unusual because it was linked to diabetic gastroparesis rather than alcohol.<br /><br />The patient’s uncontrolled diabetes likely caused gastroparesis, leading to chronic refractory nausea and vomiting, poor intake, and subsequent thiamine deficiency. Her symptoms improved with antiemetics and thiamine replacement, including improvement in nystagmus, ataxia, and cognition. However, due to functional decline from baseline independence, she required discharge to inpatient rehabilitation. Outpatient neurology and gastroenterology follow-up were arranged.<br /><br />This case highlights the importance of a careful history and physical examination in patients with nonspecific symptoms, especially those with multiple comorbidities. It also shows how poorly controlled chronic disease can trigger acute, serious, and potentially irreversible neurologic complications.

Asset Subtitle

Kavita S. Patwardhan

Meta Tag

Author List Kavita S. Patwardhan

Category Clinical Vignettes

Concept Wernicke Encephalopathy

Concept Thiamine Deficiency

Concept Intravenous Thiamine

Concept Classic Triad

Concept Korsakoff Syndrome

Distinguished Non-Finalist

Presenter Organization Tulane University School of Medicine

Presenting Author Kavita S. Patwardhan

Track Adult

Keywords

Wernicke encephalopathy

thiamine deficiency

diabetic gastroparesis

type 2 diabetes

nystagmus

ataxia

confusion

vomiting

neurologic complication

inpatient rehabilitation

Wernicke Encephalopathy

Thiamine Deficiency

Intravenous Thiamine

Classic Triad

Korsakoff Syndrome