SESSION TITLE: Student/Resident Case Report Poster - Critical Care V SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Wernicke Encephalopathy has been traditionally associated with alcohol abuse. Among non alcoholic causes are dialysis, diuretic use, malnutrition, parenteral nutrition, bariatric surgery, cancer and AIDS. Wernicke encephalopathy is a heterogeneous entity not only limited to the described triad of ophthalmoplegia, encephalopathy and ataxia. CASE PRESENTATION: 43-year-old male with history of aspergillosis was admitted with pneumonia. Due to increased work of breathing he required endotraqueal intubation. The patient looked cachectic, HR: 100 bpm, BP:130/70, and on lung auscultation bilateral rales were noted. He failed weaning trials for two weeks requiring tracheostomy placement. He also developed renal failure requiring dialysis and high doses of diuretics. His mental status after weaning sedation remained abnormal and multiple attempts to switch to trach collar were also unsuccessful. On his neurological exam completely off sedation, he could not follow commands or communicate. He also had a fixed look and unable to track with eyes, concerning for ophthalmoplegia. CT Head showed no abnormalities and an EEG resulted negative for seizures. Repeated blood cultures, TSH and cortisol levels were normal. The etiology of his abnormal mental status was unclear but given his poor nutritional status, diuretic use, critically ill state and what seemed to be an unspecific encephalopathy with ophthalmoplegia, thiamine deficiency was entertained. High doses of IV thiamine was started with dramatic improvement. He progressively started following commands and communicating and within 48 hours he was able to be completely weaned to trach collar. DISCUSSION: Wernicke encephalopathy can present with different sign and symptoms that may be overlooked by a physician. In early stages there is gait and trunk incoordination, ocular abnormalities or mental status changes, and infrequently hemodynamic instability hypothermia, behavioral changes and seizures. Late stages present with hyperthermia, spastic paralysis or increase muscle tone, choreic dyskinesia and coma.1 Wernicke can present in non-alcoholic patient in the setting of malnutrition, parenteral nutrition, cancer, AIDS, illness, Inflammatory bowel syndrome, diuretic use, peritoneal dialysis, hemodialysis and bariatric surgery.2 CONCLUSIONS: Diagnosing thiamine deficiency and Wernicke encephalopathy can be challenging in non-alcoholic. Wernicke can be treated with intravenous thiamine and its development can be prevented in at risk patients with proper supplementation. No agreement on dosage has yet been stablished but it is clear that high doses of thiamine are effective in the treatment of Wernicke encephalopathy. 2,3. Reference #1: Sechi GP, et al. Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol 2007; 6: 442-55 Reference #2: Hutcheon DA. Malnutrition-induced Wernicke’s encephalopathy following a water-only fasting diet. Nutr Clin Pract. 2015;30:92-99. DISCLOSURE: The following authors have nothing to disclose: Konstantinos Sdrimas, Supakanya Wongrakpanich, Jean Bustamante Alvarez No Product/Research Disclosure Information