Brain injury can occur due to Wernicke’s encephalopathy, a condition caused by brain inflammation resulting from a thiamine deficiency. Recently, I became aware of a spate of such cases affecting patients who have undergone gastric bypass surgery (weight loss surgery such as roux en y surgery, etc.). Gastric bypass surgery creates a malabsorption syndrome that results in controlled malnutrition. Particular vitamins and elements, such as B vitamins (thiamine is a B vitamin), are particularly affected by the procedure because they are absorbed in the small intestine which is partially bypassed. Additional factors play a role in the development of vitamin deficiencies in these patients.
The risk of vitamin and protein deficiencies in gastric bypass patients is well-known. Any credible weight loss surgeon should counsel these patients about their postoperative diet and prescribe supplements. However, many patients develop a condition called dumping syndrome that prevents them from complying with dietary recommendations. These patients are at risk of developing vitamin deficiencies.
Thiamine deficiency was relatively rare until weight loss surgery came into vogue. Medical literature reflects that thiamine deficiency resulting in disease (sometimes called beriberi disease) occurred in prisoners of war who were malnourished. Additional reports reflect that the condition can occur in alcoholics. Thiamine deficiencies can manifest as Wernicke’s encephalopathy, a condition marked by changes in mental state (e.g., confusion), loss of eye movement and loss of muscle coordination (ataxia). Not all of these symptoms must be present. Careful dissection of the brain following death due to Wernicke’s will reveal biochemical lesions and hemorrhage in the brain. Left untreated, Wernicke’s can result in stroke.
However, Wernicke’s is only one potential manifestation of thiamine deficiency. Other manifestations include interruption of the Kreb’s cycle which controls the body’s synthesis of carbohydrates and protein to make energy. When the Kreb’s cycle is interrupted, the body may resort to anaerobic metabolism and begin consuming its own muscle for energy. This process is known as rhabdomyolosis.
Medical malpractice claims may arises out of brain injury or death resulting from beriberi, rhabdomyolosis and/or Wernicke’s encephalopathy. These cases may arise due to improper care by a bypass surgeon in selecting patients who are proper candidates for the procedure or failure to prescribe vitamin supplements. Medical negligence claims may also arise when subsequent caregivers fail to recognize the dietary deficiency in postop patients who develop rhabdomyolosis or signs of encephalopathy.