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February 26, 1982

Encephalopathy Following Jejunoileostomy

JAMA. 1982;247(8):1127. doi:10.1001/jama.1982.03320330023015

To the Editor.—  In a recent article, Ayub et al described seven patients with intermittent encephalopathy after jejunoileostomy performed for morbid obesity (1981;246:970). Their patients complained of episodes of confusion, lethargy, and ataxia lasting a few hours to several days. Electroencephalography performed in two symptomatic patients demonstrated diffuse slowing that returned to normal after clinical recovery. A hyperchloremic metabolic acidosis was present in two patients, but it was not clear whether other patients were observed during their spells.

Report of a Case.—  We recently encountered a 36-year-old man who had a jejunoileostomy five years earlier. He complained of "spells" for one year, each consisting of somnolence, ataxia, irritability, and craving for water and food lasting up to several days.1 Detailed neuroendocrine evaluation was normal. Electroencephalograms during two attacks demonstrated diffuse, high-voltage, slow-wave activity but were normal between attacks. A self-limited metabolic acidosis was observed to coincide with the onset