PDF(Pubmed)
Abstract：
Morbid obesity is a systemic disease which can result in chronic complications, including hypertension, diabetes mellitus, depression, osteoarthritis and low self-esteem in the adolescent population.Bariatric surgery can be indicated to treat more severe forms of obesity, but these procedures are not without long-term risks. Therefore, adequate preoperative and postoperative care, which includes preoperative psychosocial evaluation for compliance, ongoing nutrition counselling and vitamin and micronutrient supplementation, is required for all patients, especially adolescent patients, who generally may not comply with medical therapies and/or be able to developmentally fully appreciate or comprehend the health consequences of their behaviours, prior to as well as after bariatric surgery to prevent complications.Thiamine pyrophosphate, an active form of thiamine (also known as vitamin B1, a water-soluble vitamin), which functions as a coenzyme in glucose and energy metabolism, is one such vitamin that requires supplementation postoperatively. It is mandatory for glucose to be administered concomitantly with thiamine, as glucose alone can precipitate Wernicke\'s encephalopathy (WE) in thiamine-deficient individuals. WE is a medical emergency, with a mortality rate of up to 20%. WE is best understood as a classic triad of mental confusion, gait ataxia and eye movement abnormalities, and atypical WE or Wernicke\'s syndrome (WS) is seen when the classic triad is not present. Cases that meet some, but do not necessarily meet all three criteria, are referred to as atypical WE or WS which can lead to delayed diagnosis. Atypical WE has an incidence of 19% which can lead to misdiagnosis of a preventable medical emergency with fatal complications.The following case reviews the consequences of post-bariatric thiamine supplementation therapy non-adherence and resulting in a deficiency in an adolescent patient.
摘要：
病态肥胖是一种可导致慢性并发症的全身性疾病,包括高血压,糖尿病,抑郁症,青少年人群的骨关节炎和低自尊。减肥手术可用于治疗更严重的肥胖症，但是这些程序并非没有长期风险。因此,充分的术前和术后护理，其中包括术前心理社会评估的依从性，正在进行的营养咨询以及维生素和微量营养素补充，是所有病人都需要的，尤其是青少年患者，通常可能不遵守医学治疗和/或能够在发育上充分理解或理解其行为对健康的影响，在减肥手术之前和之后，以防止并发症。焦磷酸硫胺,硫胺素的活性形式（也称为维生素B1，一种水溶性维生素），它在葡萄糖和能量代谢中起辅酶的作用，是一种需要在术后补充的维生素。必须将葡萄糖与硫胺素同时施用，因为单独的葡萄糖可以在硫胺素缺乏的个体中诱发Wernicke脑病（WE）。我们是医疗紧急情况，死亡率高达20%。我们最好被理解为精神错乱的经典三合会，步态共济失调和眼球运动异常，和非典型的WE或Wernicke综合征（WS），当经典三联征不存在时。遇到一些案件，但不一定满足所有三个标准，称为非典型WE或WS，可导致诊断延迟。非典型WE的发生率为19％，可能导致可预防的医疗紧急情况的误诊，并伴有致命的并发症。以下病例回顾了减肥后补充硫胺素治疗不依从性并导致青少年患者缺乏的后果。
