Obesity Unit, Endocrinology and Diabetes Department, Hospital Clínic Universitari, Villarroel 170, 08036 Barcelona, Spain.
Nutr Clin Pract. 2012 Dec;27(6):788-92. doi: 10.1177/0884533612453746. Epub 2012 Oct 5.
Wernicke encephalopathy--a debilitating acute or subacute neurological disorder-is caused by a deficiency in thiamine (vitamin B(1)). It is characterized by a classical clinical triad of symptoms: ocular impairment, cerebellar dysfunction, and confusion. Although bariatric surgery can certainly improve the overall health of an obese individual, it can also make him or her more susceptible to serious nutrition deficiencies. Following surgery, inadequate caloric intake, rapid and excessive weight loss, food intolerance, lack of adherence to nutrition supplementation, and/or the onset of prolonged vomiting can lead to severe nutrition deficiencies. It is generally believed that the more malabsorptive the surgery proves, the more likely is it that such a deficiency will occur. The case presented here shows that after sleeve gastrectomy (SG), a patient may also develop dangerous nutrition deficits that can negatively affect his or her life. In this particular case, a patient presented with a severe vitamin B(1) deficiency following SG for morbid obesity. Although patients may exhibit pathophysiologies similar to Wernicke encephalopathy after this surgery, only 2 cases of severe vitamin B(1) deficiency following sleeve gastrectomy have been reported. The grave consequences of thiamine deficiency observed in this patient underscore the importance of supplementation after SG.
威尼克脑病——一种使人虚弱的急性或亚急性神经系统紊乱——是由硫胺素（维生素 B(1)）缺乏引起的。它的特征是具有典型的三联临床症状：眼部损伤、小脑功能障碍和意识混乱。虽然减重手术肯定能改善肥胖个体的整体健康状况，但也会使他/她更容易出现严重的营养缺乏。手术后，热量摄入不足、体重快速过度下降、食物不耐受、不遵守营养补充、以及/或者长时间呕吐，都可能导致严重的营养缺乏。一般认为，手术的吸收不良越严重，发生这种缺乏的可能性就越大。这里呈现的病例表明，袖状胃切除术（SG）后，患者也可能会出现危及生命的营养不足，从而对其生活产生负面影响。在这个特殊病例中，一位病态肥胖的患者在接受 SG 后出现了严重的维生素 B(1)缺乏。尽管患者在手术后可能会出现类似于威尼克脑病的病理生理学变化，但仅有 2 例 SG 后出现严重维生素 B(1)缺乏的报告。该患者观察到的硫胺素缺乏的严重后果突显了 SG 后补充的重要性。
