ABSTRACT
Thiamine deficiency can manifest as Wernicke encephalopathy, with the classic clinical triad of altered mental status, nystagmus, and ataxia. Although a rare diagnosis in pediatric patients within developed countries, gastrointestinal disorders that impair nutritional intake and absorption can place patients at higher risk. Rapid diagnosis and early empiric treatment of Wernicke encephalopathy is paramount due to high risk of mortality and long-term morbidity. We present a patient with intestinal failure who developed thiamine deficiency following weaning off parenteral nutrition with acute onset of vertigo-associated vomiting. In the absence of consensus guidelines for treatment dosing and duration, in both adult and pediatric populations, we review prior pediatric cases and propose a strategy for dosing with symptom-guided step-up approach to maximize treatment efficacy in a time-conscious manner.
ABSTRACT
Transplantation of the intestine in children has presented significant challenges even as it has become a standard to treat nutritional failure due to short gut syndrome. These challenges have been addressed in part by significant improvements in short and long-term care. Noteworthy enhancements include reduced need for intestine transplantation, drug-sparing immunosuppressive regimens, immune monitoring, and improved surveillance and management of PTLD and non-adherence.
