A Psychiatric Presentation of Wernicke's Encephalopathy Following Intravenous Fluid Administration

Psychiatrists arefrequenlly challenged to differentiateprimarypsychiatricsymptomsfrom those that arise secondary to medical illness. Errors in clinical assessment can lead to significant morbidity and even mortality. Wernicke's encephalopathy is a medical condition that presents, in part, as psychiatric symptomatology. Despite an estimated incidence of2%, 80% qf the cases are undiagnosed. Of its classic triad, ophthalmoplegia and ataxia call be quite subtle, oreven absent, whereas mental status changes are present in all but 10%ofcases. This disorder, although widely recognized as a complication ofalcoholism, has many lessftequently considered etiologies, including iatrogenic causes, which may constitute a largefraction ofthe unrecognized cases. The authorlooks at a caseofWemicke's encephalopathy that was iatrogenically induced andpresentedaspsychiatric symptomatology. Wernicke's ence phalopa thy is a medi ca l condition which results from impaired intestinal absorpt ion of thiamine. It s pr imary manifest ations a re neurological and psych iatric, however its neurologica l seque lae (ophtha lmo pleg ia a nd a taxia) are ofte n subt le and a high ind ex of suspicion is essen tia l to conside r th e diagnosis (I). Dist urbances of consciousness an d mentation are typica l and pr esen t in all but 10 pe rce nt of pat ients (2) . The following ca se illust rates a primarily psych iatric presentat ion of the illn ess, followin g int ravenou s fluid administ ration, in a 3 1-yea r-old man with hypere mesis and protract ed hiccups.