Wernicke's encephalopathy in hyperemesis gravidarum.

A 20-year-old woman developed severe persistent vomiting early in pregnancy. In three months she lost 18 kg of body weight: and showed the biochemical features of mild hepatic failure. Four days after starting intravenous dextrose and insulin, she developed short-term miemory loss, confusion, ataxia, dysarthria, mild left upper motor neurone facial weakness and upbeat nystagmus. Thiamine was given and no further deterioration occurred. The vomiting persisted until intra-uterine fetal death. Thereafter, her medical, neurological and psychological problems gradually improved. The association of hyperemesis gravidarum, intravenous calorie load and Wernicke's encephalopathy is discussed.