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Lorenza Caregaro - One of the best experts on this subject based on the ideXlab platform.

  • wernicke s syndrome during parenteral Feeding not an unusual complication
    Nutrition, 2009
    Co-Authors: Francesco Francinipesenti, Filippo Brocadello, Luca Santelli, Alice Laroni, Renzo Manara, Lorenza Caregaro
    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.

Vicente Francisco Gilguillen - One of the best experts on this subject based on the ideXlab platform.

Francesco Francinipesenti - One of the best experts on this subject based on the ideXlab platform.

  • wernicke s syndrome during parenteral Feeding not an unusual complication
    Nutrition, 2009
    Co-Authors: Francesco Francinipesenti, Filippo Brocadello, Luca Santelli, Alice Laroni, Renzo Manara, Lorenza Caregaro
    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.

Kent Lundholm - One of the best experts on this subject based on the ideXlab platform.

  • The effect of postoperative Intravenous Feeding (TPN) on outcome following major surgery evaluated in a randomized study.
    Annals of surgery, 1993
    Co-Authors: Rolf Sandström, Anders Hyltander, Christer Drott, Berndt Arfvidsson, Tore Scherstén, Ingemar Wickström, Kent Lundholm
    Abstract:

    Three hundred patients undergoing major general surgical procedures were randomized by means of a computer-assisted algorithm to receive either total parenteral nutrition (TPN) from the first postoperative day or only prolonged glucose administration (250-300 g/day) up to 15 days after operation. All patients receiving TPN were treated individually based on daily measurements of energy and nitrogen balances. The treatment goal was to keep the patients in positive energy balance (+20%) and close to nitrogen balance. The effects of the two "nutrition regimens" on outcome such as mortality rate, complications, the need of additional medical support and patient-related functional disabilities were investigated. No selection of patients was made, that is, malnourished patients were also randomized. There were no differences among TPN versus glucose treatment when results were analyzed according to intent to treat. Approximately 60% of all patients were able to start eating within 8 to 9 days after operation. No differences were observed between such patients regardless of being treated with TPN or glucose only. Patients on glucose treatment during 14 days had a significantly higher mortality rate (p < 0.05) than patients on either continuous and uncomplicated TPN treatment or short-term glucose treatment. Similar results for mortality rates also were seen with regard to severe complications (cardiopulmonary problems, sepsis, and wound-healing insufficiencies), functional disturbances, the need of additional medical support, and abnormalities in nutritional state. Twenty per cent of the patients randomized to TPN treatment showed a statistical trend (p < 0.10) toward a higher mortality rate (36%) compared with patients randomized to prolonged glucose treatment (21% mortality rate). These patients could not be identified by evaluation of preoperative factors. Thus, the overall evaluation of the results makes it likely that a fraction of high-risk patients (approximately 20%) were not doing well on immediate postoperative Intravenous Feeding, and it is possible that TPN to such patients accentuated their morbidity rate. Although patients (20%) on prolonged semi-starvation (14 days glucose treatment) had increased mortality rate and severe complications, it was possible that undernutrition induced a slightly different complication scenario than induced by TPN in the high-risk patients. The results demonstrate that in most surgical patients (60%), postoperative semi-starvation is not a limiting factor for outcome. In remaining 40%, inadequate nutrition was associated with both increased morbidity and mortality rates. In this sense, inadequate nutrition represents both too much and too little, whereas overFeeding seemed to be a larger problem than underFeeding.(ABSTRACT TRUNCATED AT 400 WORDS)

Nicola M Hunkin - One of the best experts on this subject based on the ideXlab platform.

  • Wernicke-Korsakoff syndrome of nonalcoholic origin
    Brain and Cognition, 1991
    Co-Authors: Alan J. Parkin, Jessica Blunden, J E Rees, Nicola M Hunkin
    Abstract:

    Abstract We describe a patient who developed a severe loss of memory following Intravenous Feeding and intestinal surgery. The pattern of both anterograde and retrograde memory impairment and frontal pathology is shown to be comparable with that observed in patients with Wernicke-Korsakoff Syndrome of an alcoholic etiology. The data strengthen the view that the essential characteristics of the Wernicke-Korsakoff Syndrome are not dependent on a prior history of chronic alcoholism. Implications of these data for the interpretation of alcoholic Wernicke-Korsakoff Syndrome are considered.