Brief Communication Wernicke’s syndrome during parenteral feeding: Not an unusual complication Francesco Francini-Pesenti, M.D. a, *, Filippo Brocadello, M.D. a , Renzo Manara, M.D. b , Luca Santelli, M.D. c , Alice Laroni, M.D. c , and Lorenza Caregaro, M.D. a a Clinical Nutrition Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera, Padova, Italy b Neuroradiology Unit, Azienda Ospedaliera, Padova, Italy c Department of Neurosciences, Azienda Ospedaliera, Padova, Italy Manuscript received March 6, 2008; accepted August 6, 2008. Abstract Objective: Wernicke’s encephalopathy (WE) is an acute disorder due to thiamine deficiency, characterized by ophthalmoplegia, ataxia, and mental confusion, similar to that classically observed in alcoholism. Some cases of WE were reported to coincide with other conditions such as hyperemesis gravidarum, bariatric surgery, and total parenteral nutrition. In this study the objective was to retrospectively evaluate the prevalence of WE among intravenously fed patients in our hospital during the previous 2 y. Methods: Among all cases of WE diagnosed by cranial magnetic resonance scan during a 2-y period in the Azienda Ospedaliera of Padua, we identified patients who exhibited WE during parenteral feeding. Albumin plasma levels, measured at the onset of WE symptoms, were used to estimate nutritional status. Results: We found seven cases of WE that coincided with intravenous feeding. WE occurred, on average, 13 d after the start of glucose infusion. The five subjects with albumin plasma levels lower than 35 g/L at the onset of WE received glucose infusion for fewer days. In six cases the clinical signs disappeared the day after thiamine infusion. In one case mental function did not normalize and the patient developed Korsakoff’s syndrome despite prolonged thiamine treatment. Conclusion: During a 2-y period we observed a high prevalence of WE in intravenously fed patients due to lack of thiamine supplementation. A prophylactic treatment must be performed in at-risk patients and multivitamin infusion containing thiamine must be administered daily during the course of intravenous feeding. © 2009 Elsevier Inc. All rights reserved. Keywords: Wernicke’s encephalopathy; Thiamine; Total parenteral nutrition Introduction Thiamine, a water-soluble B-complex vitamin, is in- volved in numerous bodily functions. A major biologically active form of thiamine is thiamine pyrophosphate, some- times called thiamine diphosphate, and cocarboxylase. Thi- amine pyrophosphate is a coenzyme for pyruvate dehydro- genase, -ketoglutarate dehydrogenase, branched-chain -keto acid dehydrogenase, and transketolase. The first two enzymes are important for carbohydrate metabolism and transketolase functions in the pentose phosphate pathway. Thiamine requirement is related to caloric and carbohydrate intake [1]. The recommended dose of thiamine for an av- erage, healthy adult is 0.5 mg/1000 kcal consumed or 1.4 mg/d [2]. When metabolic rate is increased, as in critically ill patients or during pregnancy, the thiamine requirement increases [3]. Thiamine deficiency in humans causes car- diovascular disease, “wet beriberi,” and nervous system diseases such as peripheral neuropathy, “dry beriberi,” and Wernicke-Korsakoff syndrome. Wernicke’s encephalopa- thy (WE) is an acute disorder characterized by ophthalmo- plegia, ataxia, and mental confusion [4], classically ob- served in alcoholism [5]. Some cases of WE were reported in the presence of other conditions such as hyperemesis gravidarum [6], bariatric surgery [7] and total parenteral * Corresponding author. Tel.: +39-498-212-346; fax: +39-482-821-1374. E-mail address: francescofrancini@yahoo.it (F. Francini-Pesenti). Nutrition 25 (2009) 142–146 www.elsevier.com/locate/nut 0899-9007/09/$ – see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.nut.2008.08.003