Wernicke’s Encephalopathy in hyperemesis Gravidarum: A Clinical Challenge

Background: Wernicke's encephalopathy is a rare but potentially fatal acute neurological complication of hyperemesis gravidarum resulting from severe thiamine (Vitamin B1) deficiency. Its occurrence during pregnancy is uncommon and is associated with significant maternal and fetal morbidity and mortality. The coexistence of Wernicke’s encephalopathy with paralytic ileus in pregnancy is extremely rare and represents a major multidisciplinary obstetric emergency. Case Presentation: A 27-year-old primigravida at 19 weeks and 6 days of gestation presented with recurrent episodes of vomiting for three months and classical triad of Wernicke’s encephalopathy, i.e., altered mental status, gait instability, and oculomotor dysfunction. Clinical examination revealed dehydration, tachycardia, nystagmus, abdominal distension with absent bowel sounds, and paresis predominantly involving the lower limbs. Ultrasonography of the abdomen revealed a missed abortion. Laboratory investigations demonstrated severe hypokalemia, hypocalcemia, hypoalbuminemia, metabolic acidosis, elevated liver enzymes, and coagulation abnormalities. Contrast-enhanced computed tomography of the abdomen showed features suggestive of paralytic ileus. The patient received multidisciplinary management including high-dose intravenous thiamine, aggressive electrolyte correction, gastrointestinal decompression, antibiotics, nutritional support, and intensive monitoring. During hospitalization, medical termination of pregnancy was done. Conclusion: This case highlights the importance of early recognition of Wernicke’s encephalopathy in patients with prolonged hyperemesis gravidarum. Prompt thiamine replacement and correction of metabolic derangements through multidisciplinary management, are essential to prevent irreversible neurological injury, severe maternal complications, and adverse fetal outcomes. Wernicke’s encephalopathy with paralytic ileus in pregnancy due to severe hypokalemia and electrolyte imbalance is exceptionally rare and clinically significant.