'Iatrogenic' Wernicke's encephalopathy in Japan

'latrogenic' Wernicke's encephalopathy has appeared to occur more frequentl y in Japan, probably induced by the change of our Japanese national health insurance policy in 1992. We report 4 nonalcoholic patients with such Werni cke's encephalopathy, which occurred during the early postoperative oral fo od intake period following intravenous nutrition without vitamin supplement s. We analyzed the medical records of 4 patients, 3 men and 1 woman, aged b etween 55 and 71 years, who were admitted to our hospital between 1992 and 1995. Three patients underwent gastrointestinal surgery and 1 suffered chro nic pyothorax. We diagnosed our patients as having Wernicke's encephalopath y based on typical neurological abnormalities, in addition to typical crani al magnetic resonance image findings, low serum vitamin B-1 levels, or both . Although all of the patients were treated with vitamin B-1 and showed som e improvement, 1 patient developed Korsakoff syndrome, 2 made incomplete ne urological recovery, and 1 died. We speculated that the body vitamin B-1 st ores had been decreasing in our patients who did not receive any vitamin su pplements during intravenous hyperalimentation or hydration. Subsequent adm inistration of high calorie and high carbohydrate oral diets increased the demand for vitamin B-1, further depleting the vitamin stores, thereby causi ng 'iatrogenic' Wernicke's encephalopathy. The change of our national healt h insurance policy in 1992 discouraged the routine administration of vitami ns, probably causing Wernicke's encephalopathy in our patients. Copyright ( C) 2000 S. Karger AG, Basel.