Symptoms presented with increasing frequency and 2 days later were accompanied by paralysis of the left abducens nerve. He presented episodic confusion, tachycardia, sweating, fluctuations in blood pressure and temperature, and a resting tremor 32 days after being admitted for an oesophagocoloplasty. Our patient was a 2-year-old boy with VACTERL association (vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula and/or esophageal atresia, renal anomalies and limb defects). We present here the clinical case of a patient with symptoms of WE and severe lactic acidosis secondary to a thiamine deficiency due to the administration of parenteral nutrition without adequate vitamin supplementation. Although usually mild, lactic acidosis may also be severe and even fatal. 5 In practice, symptoms are varied and non-specific, including neurological (amnesia, tremor, auditory and visual disturbances, hypothermia, etc.), digestive (nausea, vomiting, abdominal pain, etc.), and cardiovascular symptoms (changes in blood pressure and heart rate, dyspnoea, etc.), 5,6 with the most serious one being lactic acidosis. The classic triad of symptoms includes ataxia, ophthalmoplegia, and confusion however, it is only present in 10% of the patients. Most typically associated with alcoholism, it may also occur in patients with hyperemesis, hyperthyroidism, or tumours and those undergoing haemodialysis or bariatric surgery, and on occasions it is iatrogenic in patients who depend on parenteral nutrition. Wernicke encephalopathy (WE) is a serious, sometimes lethal disorder caused by thiamine (vitamin B 1) deficiency, which is normally quickly reversible using vitamin supplementation.
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