COMPLICATED HYPEREMESIS GRAVIDARUM WITH KORSAKOFF SYNDROME: CASE REPORT

Abstract

Hyperemesis gravidarum is a rare condition characterised by intense and persistent nausea and vomiting, with a significant risk of hydroelectrolytic disorders, metabolic acidosis and malnutrition. Most cases have a benign evolution if managed properly from the outset, but severe and refractory forms can predispose to thiamine (vitamin B1) deficiency and, consequently, to Wernicke's encephalopathy (WEE), which, if not identified and treated early, can progress to Korsakoff's syndrome, with irreversible neurological damage or death. A 25-year-old previously healthy pregnant woman presented with progressive intense vomiting since the beginning of pregnancy, with a lowered level of consciousness, progressing to septic shock due to bronchoaspiration pneumonia, cardiorespiratory arrest and foetal death. The diagnostic hypothesis of Wernicke-Korsakoff syndrome was raised late on, and a dose of thiamine was started to stabilise and reverse the condition. Despite slight clinical improvement, the patient progressed to multiple infectious complications, new septic shock and death three months after hospital admission. The aim of this study was to emphasise the importance of early diagnosis of EW in pregnant women with refractory vomiting, even in the absence of alcohol consumption. Thiamine supplementation should be considered early, especially before the administration of glucose solutions, in order to prevent irreversible neurological outcomes and reduce maternal-fetal mortality. The lack of specific protocols on the dose and duration of thiamine treatment during pregnancy reinforces the need for greater standardisation of conduct.