Hyperemesis gravidarum presenting to the emergency department with Wernicke encephalopathy: a case report

Background: Wernicke encephalopathy (WE) is an under-diagnosed condition of thiamine deficiency commonly attributed to chronic alcohol abuse but associated with other medical conditions such as bariatric surgery, pancreatitis, anorexia nervosa and hyperemesis gravidarum (HG). Symptoms of WE include ocular dysfunction, ataxia, mental status change, peripheral neuropathies, hypothermia and cardiovascular instability. Laboratory results are generally unhelpful in the diagnosis of WE and a high index of suspicion should be maintained for all potential presentations. Documented extensively in obstetrics/gynecology and neurology literature, the condition of WE from HG is not well represented in emergency medicine literature despite the propensity of pregnant patients to present to the emergency department (ED) with nausea and vomiting.