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Wernicke’s encephalopathy, refeeding syndrome and wet beriberi after laparoscopic sleeve gastrectomy: the importance of thiamine evaluation

European Journal of Clinical Nutrition volume 74, pages 659–662 (2020)Cite this article

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Abstract

We described the case of a young man with morbid obesity who underwent bariatric surgery who experiences different complications. After the discharge the patient starts to complain about nausea, dizziness, and visual impairment. After a first access to an emergency department, with a diagnosis of labyrinthopathy, the patient gets worse. He then has been hospitalized and a wernicke’s encephalopathy was diagnosed. During the hospitalization other comploication of low thiamine appeared such as wet beriberi. The clinical picture was also complicated with the refeeding syndrome. Wernicke’s encephalopathy, wet beriberi, and refeeding syndrome are life-threatening conditions that can be prevented and treated. Both physicians and patients must be warned about these potential risks in order to put in act a prompt treatment.

Morbid obesity has been recognized by the World Health Organization as a systemic disease that, if untreated, can lead to the development of many comorbidities [1]. Despite conservative management is essential for the treatment of this disease, patients are unlikely to achieve their goal only with lifestyle changes. Bariatric surgery is widely used to manage morbid obesity, with sleeve gastrectomy being the most frequent procedure [2,3,4]. Neurological complications of bariatric surgery are rare and reported in only 1.3% of patients [5, 6].

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Fig. 1: MRI Flair.
Fig. 2

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Authors and Affiliations

  1. Department of Neurology, ASST Nord Milano, Ospedale Bassini, Via Gorki 50, Cinisello Balsamo, MI, Italy

    Federico Pacei & Luisa De Toni Franceschini

  2. Department of Clinical Nutrition, Ospedale Niguarda, Piazza dell’Ospedale Maggiore 3, Milano, Italy

    Laura Iaccarino

  3. MRC Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, WC1N 3BG, UK

    Enrico Bugiardini

  4. Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK

    Enrico Bugiardini

  5. Deprtment of Cardiology, ASST Nord Milano, Ospedale Bassini, Via Gorki 50, Cinisello Balsamo, MI, Italy

    Viola Dadone

  6. PoliS-Lombardia, Via Taramelli 12/F, Milano, Italy

    Chiara Colombo

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  1. Federico Pacei
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Correspondence to Federico Pacei.

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Pacei, F., Iaccarino, L., Bugiardini, E. et al. Wernicke’s encephalopathy, refeeding syndrome and wet beriberi after laparoscopic sleeve gastrectomy: the importance of thiamine evaluation. Eur J Clin Nutr 74, 659–662 (2020). https://doi.org/10.1038/s41430-020-0583-x

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  • DOI: https://doi.org/10.1038/s41430-020-0583-x

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