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O&G CasesEarly pregnancy care

O&G Cases · Early pregnancy care

Wernicke encephalopathy in hyperemesis — emergency management station

Emergency station: clinical Wernicke encephalopathy in hyperemesis gravidarum, with an ED doctor about to give dextrose. Tests recognition of the eye-and-confusion presentation, the thiamine-before-glucose rule, high-dose parenteral thiamine dosing, the multi-system complications, and structured communication with the team. Includes assessor key and marking domains.

resus4 min readVerification in progress

Target exams

FRANZCOGMRCOGABOG
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Target exams

FRANZCOGMRCOGABOG
Prompt
A 30-year-old woman at 13 weeks gestation is admitted from the emergency department with confusion and double vision. She has had hyperemesis gravidarum since 6 weeks, has lost 11 kg, and has eaten almost nothing for three weeks. The ED doctor has just prescribed a bag of 5% dextrose with the next bag of fluids. You are the obstetric registrar arriving on the ward.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the obstetric registrar called to the ward. The ward nurse and an ED doctor who clerked her are present; your consultant is in theatre and contactable. The assessor will run the clock and feed you new findings. [2]

Candidate instruction. Recognise and manage suspected Wernicke encephalopathy in a hyperemetic woman. Verbalise the time-critical intervention, the drug and dose, the escalation, and your communication with the ED doctor who has prescribed dextrose. [1][2]

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References6ShowHide
  1. [1]Nelson-Piercy C, Dean C, Shehmar M, et al. The Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No. 69). BJOG, 2024.PMID 38311315
  2. [2]Oudman E, Wijnia JW, Oey M, et al. Wernicke's encephalopathy in hyperemesis gravidarum: A systematic review. Eur J Obstet Gynecol Reprod Biol, 2019.PMID 30889425
  3. [3]da Silva JSV, Seres DS, Sabino K, et al. ASPEN Consensus Recommendations for Refeeding Syndrome. Nutr Clin Pract, 2020.PMID 32115791
  4. [4]Jansen LAW, Koot MH, Van't Hooft J, et al. The windsor definition for hyperemesis gravidarum: A multistakeholder international consensus definition. Eur J Obstet Gynecol Reprod Biol, 2021.PMID 34555550
  5. [5]Ebrahimi N, Maltepe C, Bournissen FG, et al. Nausea and vomiting of pregnancy: using the 24-hour Pregnancy-Unique Quantification of Emesis (PUQE-24) scale. J Obstet Gynaecol Can, 2009.PMID 19941704
  6. [6]Jansen LAW, Shaw V, Grooten IJ, et al. Diagnosis and treatment of hyperemesis gravidarum. CMAJ, 2024.PMID 38621783
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