11: Understanding Wernicke’s Encephalopathy in Pediatric Intestinal Failure: a case series and risk analysis
Notice bibliographique
Résumé
Introduction: Vitamin and mineral deficiencies have been reported in numerous cohort studies and case series in children with intestinal failure (IF). Despite this emerging evidence there are no specific reports on thiamine (B1) deficiency or Wernicke’s encephalopathy (WE). WE can present as oculomotor dysfunction, altered mental status and cerebellar dysfunction. The administration of dextrose in the setting of thiamine deficiency can be harmful because glucose oxidation is a thiamine-intensive process that may drive the insufficient circulating thiamine intracellularly, thereby precipitating neurologic injury. Since children with IF are highly dependent on constant glucose infusions, they may be at increased risk for developing complications of thiamine deficiency. Our objective was to review cases of WE and evaluate thiamine levels in children with significant parenteral nutrition (PN) dependence. Methods: We completed a retrospective cohort study of children with IF. We included children ages 0-17 years old, with routine follow up thiamine levels (serum or whole blood), and significant dependency on PN, defined as a parenteral nutrition dependency index (PNDI) of > 80%. All patients received customized PN, and multivitamin product (Multi-12/K1 pediatric) added to PN at home with a set amount of thiamine (1.2 mg). Demographic data, PN composition, PN days and thiamine bloodwork levels were collected from patient charts. Statistical analysis included summary statistics and a logistic regression model to evaluate anatomical and PN variables that may influence thiamine levels. A p-value of <0.05 was considered significant. Results: Thirty-five patients, median age 4.5 years old (IQR= 3 days-16 years old) were included in the analysis. Median length of PN therapy was 1450 days (IQR=78 - 6756 days). Logistic regression of whole blood thiamine levels demonstrated females (p<0.05) and older children (p<0.01) were more likely to have lower thiamine levels within the normal range. There were no asymptomatic patients identified with low thiamine levels. Four patients had thiamine deficiency and were diagnosed with WE. The four patients presented to hospital with altered levels of consciousness (LOC) and had common pre-clinical factors including recent increases in PN calories or glucose infusion rates and non-standard or missed vitamin administration. Conclusion: Children with intestinal failure and high PN dependency are at risk for thiamine deficiency. Wernicke’s encephalopathy should be considered when these children present with altered LOC. Females and older children with high PNDI’s may be at highest risk. The development of age and sex specific pediatric multi-vitamins should be considered.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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