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March 20, 1978

Wernicke's Encephalopathy and Hyperalimentation

JAMA. 1978;239(12):1133. doi:10.1001/jama.1978.03280390029014

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To the Editor.—  The CLINICAL NOTE by Kramer and Goodwin (238:2176,1977) should draw attention to a phenomenon that seems to receive little attention in considering nutritional disturbances. In our own institution there were no less than six cases of Wernicke's encephalopathy in a short period of time two years ago. All patients were receiving supplementary vitamins. Of these, the most interesting was a 57-year-old woman who was considered to be in good health until May 1975 when she noted progressive fatigue, weakness, and dizziness. She was found to have esophagitis and mild gastritis. Exploratory laparotomy disclosed no abnormality. She was transferred to Cleveland Clinic Hospital, and during 81 hospital days she received 75 units of blood because of recurrent gastrointestinal bleeding. The patient exhibited a bleeding diathesis and right pleural effusion throughout the course.Between Sept 1 and Oct 2 she averaged an intake of 24 mg/day of thiamine, and