SHM Converge Scientific Abstract ePoster Gallery-Weren't You Going to Think of That? A Case of Wernicke Encephalopathy

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A 13-year-old boy with a history of food aversion presented with one month of vomiting, dysphagia, anorexia, fatigue, and a 10-pound unintentional weight loss. He initially had normal vital signs and BMI, with exam notable only for dehydration and mild abdominal tenderness. Labs showed metabolic acidosis, and he was treated with IV fluids, pantoprazole, and ondansetron. On hospital day 3, he developed lateral nystagmus, and by day 6 he had acute encephalopathy, lower extremity weakness, and persistent nystagmus.<br /><br />Further evaluation showed gaze-evoked nystagmus, optic nerve hyperemia, dysmetria, hyperreflexia, and generalized lower extremity weakness. CSF studies were unrevealing, and infectious testing was negative. Brain MRI showed diffusion restriction in the caudates and thalami, consistent with a metabolic process due to thiamine deficiency. Micronutrient testing revealed low thiamine, vitamin C, copper, vitamin D, and folate.<br /><br />The patient was diagnosed with Wernicke encephalopathy and treated with IV thiamine, leading to resolution of encephalopathy and improvement in neurologic findings. A detailed nutrition history later revealed a highly restricted diet of only eight foods, consistent with avoidant/restrictive food intake disorder likely present since toddlerhood.<br /><br />This case emphasizes that severe micronutrient deficiency can occur even in patients with a normal BMI. It highlights the importance of obtaining a thorough dietary history in hospitalized patients, especially those with weight loss or unusual neurologic symptoms. Wernicke encephalopathy is a medical emergency, and when suspected, treatment with IV thiamine should not be delayed for imaging or lab confirmation.

Asset Subtitle

Lauren McIntosh

Meta Tag

Author List Chinma O. Ugorji, Eli Forst, Jacob D. Story, Kimberly O'Hara, Lauren McIntosh, Rachita Gupta, Tiera Nell

Category Clinical Vignettes

Concept Wernicke Encephalopathy

Concept Thiamine Deficiency

Concept Intravenous Thiamine

Concept Encephalopathy

Concept Cerebellar Dysfunction

Distinguished Non-Finalist

Presenter Organization Children's Hospital Colorado

Presenting Author Lauren McIntosh

Track Pediatric

Keywords

Wernicke encephalopathy

thiamine deficiency

avoidant restrictive food intake disorder

micronutrient deficiency

nystagmus

encephalopathy

restricted diet

weight loss

pediatric case

MRI diffusion restriction

Wernicke Encephalopathy

Thiamine Deficiency

Intravenous Thiamine

Encephalopathy

Cerebellar Dysfunction