{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T16:54:03Z","timestamp":1777654443571,"version":"3.51.4"},"reference-count":18,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1998,1,1]]},"abstract":"<jats:p>Objective.\u2003Wernicke encephalopathy (WE) is an acute neurologic disorder characterized by a triad of ophthalmoplegia, ataxia, and mental confusion. WE is attributable to thiamine (vitamin B1) deficiency. Beriberi is the systemic counterpart of thiamine deficiency and often manifests in cardiovascular collapse. WE is usually associated with alcoholism and malnutrition. It has also been seen in people with gastrointestinal diseases with malabsorption. Patients who have received total parenteral nutrition (TPN) without proper replacement of thiamine have also developed WE. Since November 1996, there has been a shortage of multivitamin infusion (MVI). Many patients who were on chronic TPN with MVI ceased to receive the MVI and were converted to an oral form of the multivitamin. As a result, there have been several reports of children and adults on TPN who have developed WE as a result of thiamine deficiency. With this case report, we bring to attention the association of the MVI shortage and WE. Early diagnosis of WE is important, because if it is treated with thiamine in the acute stages, the neurologic and cardiovascular abnormalities can be reversed.<\/jats:p>\n               <jats:p>Case Report.\u2003We report a 20-year-old female patient with Crohn's disease who developed WE as a result of thiamine deficiency. She had Crohn's disease since age 9 years and was on chronic TPN. Two months before admission, MVI was discontinued in the TPN because of the shortage of its supply. An oral multivitamin tablet was substituted instead. She was admitted to the hospital for persistent vomiting. In the hospital, she continued to receive TPN without MVI, but continued taking an oral multivitamin preparation. Two weeks after admission, she developed signs of WE including diplopia, ophthalmoplegia, nystagmus, and memory disturbance. She also developed hypotension that was thought to be caused by beriberi. She was treated with 50 mg of intravenous thiamine. Within hours of the intravenous thiamine, her hypotension resolved. The day after the infusion, she no longer complained of diplopia, and her ophthalmoplegia had improved dramatically. Magnetic resonance imaging showed several areas of abnormally high signal on T2-weighted images in the brainstem, thalamus, and mamillary bodies. The topographic distribution of these changes was typical of WE. After 2 months, her mental status and neurologic status had recovered completely.<\/jats:p>\n               <jats:p>Conclusion.\u2003WE and thiamine deficiency should be considered in all patients with malabsorption, malnutrition, and malignancies. WE from thiamine deficiency can occur as a result of cessation of MVI in the TPN infusion. Even if an oral multivitamin preparation is given instead of MVI, patients with malabsorption may not absorb thiamine adequately. Prompt diagnosis of WE is important because it is potentially fatal and readily treatable with thiamine supplementation. Early recognition of WE may be more difficult in children, because the classic triad of symptoms may not develop fully. Magnetic resonance imaging may be useful in these cases to confirm the diagnosis of WE. Because the shortage of MVI is expected to be a long-term, there are likely to be more cases of WE in the pediatric population of TPN-dependent children. Because there is no shortage of intravenous thiamine, it should be administered with TPN even if MVI is not available.<\/jats:p>","DOI":"10.1542\/peds.101.1.e10","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:44:32Z","timestamp":1092440672000},"page":"e10-e10","source":"Crossref","is-referenced-by-count":80,"title":["Wernicke Encephalopathy and Beriberi During Total Parenteral Nutrition Attributable to Multivitamin Infusion Shortage"],"prefix":"10.1542","volume":"101","author":[{"given":"Jin S.","family":"Hahn","sequence":"first","affiliation":[{"name":"Departments of Neurology and Neurological Sciences,"},{"name":"Pediatrics, and Packard Children's Hospital at Stanford"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Berquist","sequence":"additional","affiliation":[{"name":"Pediatrics, and Packard Children's Hospital at Stanford"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah M.","family":"Alcorn","sequence":"additional","affiliation":[{"name":"Pediatrics, and Packard Children's Hospital at Stanford"},{"name":"Ophthalmology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Chamberlain","sequence":"additional","affiliation":[{"name":"Pediatrics, and Packard Children's Hospital at Stanford"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorsey","family":"Bass","sequence":"additional","affiliation":[{"name":"Pediatrics, and Packard Children's Hospital at Stanford"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[1998,1,1]]},"reference":[{"key":"2021120904451642000_B1","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1136\/pgmj.73.855.27","article-title":"Wernicke-Korsakoff syndrome.","volume":"73","author":"Zubaran","year":"1997","journal-title":"Postgrad Med J."},{"key":"2021120904451642000_B2"},{"key":"2021120904451642000_B3","first-page":"169","article-title":"Development of Wernicke's encephalopathy during the period of oral food intake after subtotal colectomy for ulcerative colitis [translation].","volume":"35","author":"Shiozawa","year":"1995","journal-title":"Rinsho Shinkeigaku."},{"key":"2021120904451642000_B4","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1177\/0148607188012006626","article-title":"Wernicke's encephalopathy during total parenteral nutrition: observation in one case.","volume":"12","author":"Mattioli","year":"1988","journal-title":"J Parenter Enteral Nutr."},{"key":"2021120904451642000_B5","first-page":"104","article-title":"Encephalopat\u0131\u0301a de Wernicke en pacientes sometidos a nutricio\u0301n parenteral.","volume":"10","author":"Tapiador Sanjuan MJ, Lopez Gaston JH, Garcia Naya M, Ayuso Blanco T","year":"1995","journal-title":"Neurologia."},{"key":"2021120904451642000_B6","first-page":"428","article-title":"Bedrohlicher thiaminmangel bei schwerer hyperemesis gravidarum.","volume":"123","author":"Fischer","year":"1993","journal-title":"Schweiz Med Wochenschr."},{"key":"2021120904451642000_B7","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/0887-8994(89)90082-9","article-title":"Wernicke encephalopathy\u2014a preventable cause of death: report of 2 children with malignant disease.","volume":"5","author":"Pihko","year":"1989","journal-title":"Pediatr Neurol."},{"key":"2021120904451642000_B8","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1007\/BF01708966","article-title":"Wernicke's encephalopathy\u2014causes to consider.","volume":"20","author":"Heye","year":"1994","journal-title":"Intensive Care Med."},{"key":"2021120904451642000_B9","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1056\/NEJM199707033370115","article-title":"Shortage of intravenous multivitamin solution in the United States.","volume":"337","author":"Kudsk","year":"1997","journal-title":"N Engl J Med."},{"key":"2021120904451642000_B10","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1056\/NEJM199707033370115","article-title":"Shortage of intravenous multivitamin solution in the United States.","volume":"337","author":"Rulewski","year":"1997","journal-title":"N Engl J Med."},{"key":"2021120904451642000_B11","first-page":"523","article-title":"Lactic acidosis traced to thiamine deficiency related to nationwide shortage of multivitamins for total parenteral nutrition\u2014United States, 1997.","volume":"46","author":"Centers for Disease Control and Prevention","year":"1997","journal-title":"MMWR."},{"key":"2021120904451642000_B12","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1007\/s002340050333","article-title":"MRI in children receiving total parenteral nutrition.","volume":"38","author":"Quaghebeur","year":"1996","journal-title":"Neuroradiology."},{"key":"2021120904451642000_B13","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/BF02080928","article-title":"Neuropathology of thiamine deficiency disorders.","volume":"11","author":"Kril","year":"1996","journal-title":"Metab Brain Dis."},{"key":"2021120904451642000_B14","first-page":"591","article-title":"Enhanced MR in the acute phase of Wernicke encephalopathy.","volume":"15","author":"D'Aprile","year":"1994","journal-title":"AJNR Am J Neuroradiol."},{"key":"2021120904451642000_B15","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1055\/s-2008-1046823","article-title":"MR-Tomographie und Computertomographie von alkoholtoxischen Hirngewebsvera\u0308nderungen.","volume":"152","author":"Ostertun","year":"1990","journal-title":"Fortschr Ro\u0308ntgenstr."},{"key":"2021120904451642000_B16","first-page":"172","article-title":"Mamillary body enhancement on MR as the only sign of acute Wernicke encephalopathy.","volume":"15","author":"Shogry","year":"1994","journal-title":"AJNR Am J Neuroradiol."},{"key":"2021120904451642000_B17","first-page":"311","article-title":"Fluid attenuated inversion recovery (FLAIR) imaging in acute Wernicke encephalopathy.","volume":"13","author":"Maeda","year":"1995","journal-title":"Radiat Med."},{"key":"2021120904451642000_B18","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1056\/NEJM199707033370115","article-title":"Shortage of intravenous multivitamin solution in the United States.","volume":"337","author":"Alloju","year":"1997","journal-title":"N Engl J Med."}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/101\/1\/e10\/823709\/e10.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/101\/1\/e10\/823709\/e10.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T21:37:11Z","timestamp":1639085831000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/101\/1\/e10\/52267\/Wernicke-Encephalopathy-and-Beriberi-During-Total"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1998,1,1]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[1998,1,1]]},"published-print":{"date-parts":[[1998,1,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.101.1.e10","relation":{},"ISSN":["1098-4275","0031-4005"],"issn-type":[{"value":"1098-4275","type":"electronic"},{"value":"0031-4005","type":"print"}],"subject":[],"published":{"date-parts":[[1998,1,1]]}}}