Case Reports
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Introduction: Acute encephalopathy is a common symptom encountered in critically ill patients, and may be associated with Wernicke’s Encephalopathy (WE) or serotonin syndrome (SS). We describe a patient who presented with clinical manifestations of both WE and SS and who responded to treatment for both pathologies.
Case: A 56-year-old male presented after being found unresponsive and in a questionable tonic-clonic state. Past medical history was significant for depression managed with fluoxetine 20 mg by mouth daily and alcohol abuse. Initial imaging did not support an acute neurologic process, though the patient was found to be shivering profusely on arrival. A physical exam revealed the following abnormalities: severe clonus in the bilateral lower extremities; diffuse hyperreflexia along with akinesia on the left upper extremity; ophthalmoplegia; and persistent tachycardia despite pharmacologic interventions. The patient’s daughter indicated that the patient had been taking his fluoxetine three times per day rather than daily as prescribed. Oral cyproheptadine at a 12 mg initial dose followed by 4 mg every 6 hours for a total of six doses was administered. Similarly, a thiamine regimen of 500 mg IV every 8 hours in addition to folic acid 1 mg IV every 24 hours was initiated to treat WE. Physical symptoms of both WE and SE resolved within 48 hours and the patient was ultimately discharged to home in stable condition.
Discussion: The clinical diagnosis of both WE and SS in this case is supported by the Caine and Hunter criteria, respectively, as well as the resolution of symptoms with accepted treatment modalities for each.
Conclusion: It is important for clinicians to be cognizant of potential overlapping pathologies when patients present with non-specific symptoms, especially acute encephalopathy, in the intensive care unit.
Presenting Author
Justin Reinert Pharm.D., MBA, BCCCPThe University of Texas at Tyler, Ben and Maytee Fisch College of Pharmacy
Authors
Paul Brady MD
The Neuroscience Institute at Mercy Health