Encephalopathy associated with vomiting during pregnancy

Abstract

Objective: To report a rare case of hyperemesis gravidarum associated with Wernicke encephalopathy, reviewing aspects related to its etiology, diagnosis, and treatment. Case details: A 17-week pregnant woman presented with dizziness, severe vomiting, weight loss, and memory impairment, with a recent history of hospitalization for a lower urinary tract infection. She subsequently developed fluctuations in the level of consciousness, nystagmus, and dysarthria. Sepsis of urinary origin was initially investigated; later, the diagnosis of hyperemesis gravidarum with Wernicke encephalopathy was established. Progressive clinical improvement was observed after thiamine supplementation. Final considerations: Nausea and vomiting during pregnancy are common in the first trimester, but approximately 3% progress to hyperemesis gravidarum, with a risk of fluid and electrolyte disturbances and neurological complications due to thiamine depletion. Delayed recognition of this association may postpone essential interventions. The limited evidence regarding therapeutic dosing and the scarcity of research in this area make clinical decision-making more challenging, highlighting the need for greater vigilance and prospective studies.