NEUROLOGICAL DISTURBANCES AND HYPERDYNAMIC SHOCK IN A PATIENT WITH ESOPHAGOCOLOPLASTY

A 39-year-old man, with no history of alcohol intake, who had had an e sophago-ileo-colo-gastroplasty with ileotransversostomy, developed dip lopia, seizures, metabolic acidosis, and cardiac failure and finally r efractory hyperdynamic shock. He died 20 h after admission to our inte nsive care unit from cardiocirculatory collapse. Postmortem results re vealed low erythrocyte transketolase activity, which was increased by 22 % by in vitro addition of thiamine diphosphate (TDP effect). Cerebr al pathology showed the alterations of Wernicke's encephalopathy. We d iscuss the possible mechanisms of fatal cardiovascular collapse and th e unusual presentation of a case without a history of alcoholic intake or clinical malnutrition.