Preventing Wernicke Encephalopathy After Bariatric Surgery

Obes Surg. 2018 Jul;28(7):2060-2068. doi: 10.1007/s11695-018-3262-4.

Abstract

Half a million bariatric procedures are performed annually worldwide. Our aim was to review the signs and symptoms of Wernicke's encephalopathy (WE) after bariatric surgery. We included 118 WE cases. Descriptions involved gastric bypass (52%), but also newer procedures like the gastric sleeve. Bariatric WE patients were younger (median = 33 years) than those in a recent meta-analysis of medical procedures (mean = 39.5 years), and often presented with vomiting (87.3%), ataxia (84.7%), altered mental status (76.3%), and eye movement disorder (73.7%). Younger age seemed to protect against mental alterations and higher BMI against eye movement disorders. The WE treatment was often insufficient, specifically ignoring low parenteral thiamine levels (77.2%). In case of suspicion, thiamine levels should be tested and treated adequately with parenteral thiamine supplementation.

Keywords: Bariatric; Clinical nutrition; Dietary; Gastric; Obesity; Thiamine; Wernicke’s encephalopathy.

Publication types

  • Review

MeSH terms

  • Adult
  • Bariatric Surgery / adverse effects*
  • Bariatric Surgery / statistics & numerical data
  • Dietary Supplements
  • Humans
  • Obesity, Morbid / epidemiology
  • Obesity, Morbid / surgery*
  • Parenteral Nutrition
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control*
  • Thiamine
  • Thiamine Deficiency
  • Vomiting / epidemiology
  • Vomiting / etiology
  • Vomiting / therapy
  • Wernicke Encephalopathy / epidemiology
  • Wernicke Encephalopathy / etiology
  • Wernicke Encephalopathy / prevention & control*

Substances

  • Thiamine