11: Understanding Wernicke’s Encephalopathy in Pediatric Intestinal Failure: a case series and risk analysis
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".