WERNICKES ENCEPHALOPATHY IN HYPEREMESIS GRAVIDARUM - ASSOCIATION WITHABNORMAL LIVER-FUNCTION

A 27-year-old woman developed Wernicke's encephalopathy in the 18th we ek of her pregnancy after 11 weeks of vomiting accompanied by weight l oss of 21 kg and moderately abnormal liver function tests. The patient recovered after thiamine therapy but the fetus was lost. Review of th e literature published during the last 25 years revealed an additional 14 cases of Wernicke's encephalopathy complicating hyperemesis gravid arum. All patients vomited for at least 4 weeks. Six of the 15 patient s (40%) had aspartate aminotransferase values >100 U/l, much higher th an the rate reported in previous series of patients with hyperemesis g ravidarum (7%). This suggests the need for parenteral thiamine supplem entation in patients with severe hyperemesis gravidarum lasting more t han 3 weeks, especially those with abnormal liver function, and suppor ts the hypothesis that the hepatic abnormality plays a pathogenetic ro le in the development of Wernicke's encephalopathy in hyperemesis grav idarum.