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Fatal encephalopathy complicating persistent vomiting in pregnancy: Importance of clinical awareness on the part of healthcare professionals


NC Ngene
J Moodley

Abstract

Women with persistent vomiting during pregnancy need early referral to appropriate  health facilities. Delayed referral and inappropriate management may lead to metabolic encephalopathy from a variety of causes, including electrolyte derangements or  thiamine deficiency (Wernicke’s encephalopathy) (WE). We present a case of persistent vomiting in pregnancy in which there was delayed referral, inappropriate treatment and failure to associate neurological signs such as terminal neck stiffness with WE,  resulting in poor fetomaternal outcomes. In this report, we discuss the following  lessons: (i) the need for early transfer of a patient with persistent vomiting and  enigmatic clinical features to a higher healthcare facility; (ii) failure to associate  neurological signs with complications of hyperemesis gravidarum/WE; (iii) lack of thiamine supplementation; and (iv) the advantages of magnetic resonance imaging over a computed tomography scan in the diagnosis of WE.

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eISSN: 2078-5135
print ISSN: 0256-9574