Volkan İnce, Yüksel Kablan, Turgut Pişkin, Cüneyt Kayaalp, Veysel Ersan, Cemalettin Koç

Parenteral Beslenme Komplikasyonu Olarak Wernicke Ensefalopatisi

Here we described a case of Wernicke's encephalopathy with thiamin (vitamin B1) deficiency after a prolonged postoperative parenteral nutritional. A 55-year-old male patient with total gastrectomy for gastric cancer had a postoperative intestinal fistula and required a long-term parenteral nutrition. During the treatment, he developed sudden confusional state, ophtalmoplegy, truncal ataxia, hypothermia and hypotension. Wernicke's encephalopathy was diagnosed after neurological evaluation and magnetic resonance imaging. We observed a dramatic response to thiamine replacement, his symptoms recovered quickly and the patient was discharged without any sequelae. Wernicke's encephalopathy should be considered in the differential diagnosis of the surgical patients with neurological complications, and when suspected early support of thiamine should be provided. In addition, vitamin preparations should be routinely added to solutions of parenteral nutrition. Key Words: Wernicke's Encephalopathy; Parenteral Nutrition; Postoperative Complication.

Anahtar Kelimeler:

Wernicke Ensefalopatisi, Parenteral Beslenme, Postoperatif Komplikasyon

Wernicke Encephalopathy as a Complication of Parenteral Nutrition

Postoperatif uzun süre beslenme desteği alan bir hastada aniden ortaya çıkan tiamin (vitamin B1) eksikliğine bağlı Wernicke ensefalopatisi olgusu tariflenmiştir. Mide kanseri nedeniyle total gastrektomi yapılan 55 yaşındaki erkek hastada postoperatif gelişen intestinal fistül nedeniyle uzun süreli parenteral beslenme desteği verilirken ani başlayan konfüzyonel durum, oftalmoparezi, trunkal ataksi, hipotermi ve hipotansiyon semptomları ortaya çıkmıştır. Yapılan nörolojik değerlendirme ve manyetik rezonans incelemesi sonucu Wernicke ensefalopatisi tanısı konulmuştur. Hızla yapılan tiamin replasmanına dramatik cevap alınmış ve herhangi bir sekel kalmadan hasta taburcu edilmiştir. Cerrahi hastalarda gelişen nörolojik komplikasyonlarda, Wernicke ensefalopatisi ayırıcı tanıda düşünülmeli ve şüphelenildiğinde erken dönemde tiamin desteği sağlanmalıdır. Ayrıca parenteral beslenme solüsyonlarına rutin olarak vitamin preperatları eklenmelidir. Anahtar Kelimeler: Wernicke Ensefalopatisi; Parenteral Beslenme; Postoperatif Komplikasyon.

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