Pediatric Neurology, University of Illinois college of medicine in peoria, Peoria, Illinois, USA
University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA.
BMJ Case Rep. 2024 Jan 31;17(1):e255507. doi: 10.1136/bcr-2023-255507.
Morbid obesity is a systemic disease which can result in chronic complications, including hypertension, diabetes mellitus, depression, osteoarthritis and low self-esteem in the adolescent population.Bariatric surgery can be indicated to treat more severe forms of obesity, but these procedures are not without long-term risks. Therefore, adequate preoperative and postoperative care, which includes preoperative psychosocial evaluation for compliance, ongoing nutrition counselling and vitamin and micronutrient supplementation, is required for all patients, especially adolescent patients, who generally may not comply with medical therapies and/or be able to developmentally fully appreciate or comprehend the health consequences of their behaviours, prior to as well as after bariatric surgery to prevent complications.Thiamine pyrophosphate, an active form of thiamine (also known as vitamin B1, a water-soluble vitamin), which functions as a coenzyme in glucose and energy metabolism, is one such vitamin that requires supplementation postoperatively. It is mandatory for glucose to be administered concomitantly with thiamine, as glucose alone can precipitate Wernicke's encephalopathy (WE) in thiamine-deficient individuals. WE is a medical emergency, with a mortality rate of up to 20%. WE is best understood as a classic triad of mental confusion, gait ataxia and eye movement abnormalities, and atypical WE or Wernicke's syndrome (WS) is seen when the classic triad is not present. Cases that meet some, but do not necessarily meet all three criteria, are referred to as atypical WE or WS which can lead to delayed diagnosis. Atypical WE has an incidence of 19% which can lead to misdiagnosis of a preventable medical emergency with fatal complications.The following case reviews the consequences of post-bariatric thiamine supplementation therapy non-adherence and resulting in a deficiency in an adolescent patient.
病态肥胖是一种全身性疾病，可导致慢性并发症，包括青少年人群中的高血压、糖尿病、抑郁、骨关节炎和自尊心低下。减重手术可用于治疗更严重的肥胖症，但这些手术并非没有长期风险。因此，所有患者（尤其是青少年患者）都需要进行充分的术前和术后护理，包括术前对依从性进行社会心理评估、持续的营养咨询以及维生素和微量营养素补充，因为他们可能无法遵守医疗治疗，并且/或者在接受减重手术之前和之后，可能无法在发育上充分认识或理解其行为对健康的后果，以预防并发症。焦磷酸硫胺素（thiamine pyrophosphate），硫胺素（也称为维生素 B1，一种水溶性维生素）的活性形式，作为葡萄糖和能量代谢中的辅酶，是一种需要术后补充的维生素。必须同时给予葡萄糖和硫胺素，因为单独给予葡萄糖会在硫胺素缺乏的个体中引发韦尼克脑病（Wernicke's encephalopathy，WE）。WE 是一种医学急症，死亡率高达 20%。WE 最好被理解为精神错乱、步态共济失调和眼球运动异常的经典三联征，而在没有经典三联征的情况下，会出现非典型 WE 或韦尼克综合征（Wernicke's syndrome，WS）。符合某些但不一定全部三个标准的病例被称为非典型 WE 或 WS，可导致诊断延迟。非典型 WE 的发病率为 19%，可能导致对可预防的医学急症的误诊，从而导致致命的并发症。以下病例回顾了青少年患者术后不遵守硫胺素补充治疗和导致缺乏的后果。
