Semaglutide's Hidden Perils: A Rare Case of Malnutrition and Wernicke Encephalopathy
Recommended Citation
Ali SA, Khadra M, Sitto M, Graifman M, and Gietzen J. Semaglutide's Hidden Perils: A Rare Case of Malnutrition and Wernicke Encephalopathy. Am J Gastroenterol 2024; 119(10):S2964.
Document Type
Conference Proceeding
Publication Date
10-1-2024
Publication Title
Am J Gastroenterol
Abstract
Introduction: With increasing use, concerns about semaglutide's long-term effects have been raised due to its potential to cause extended malnutrition, which can lead to vitamin deficiencies such as thiamine even without a history of alcohol use. We report a rare case of semaglutide-associated Wernicke Encephalopathy (WE) in an older adult with numerous comorbidities.
Case Description/Methods: A 74-year-old woman with history of ischemic stroke, coronary artery disease, hypertension, hypothyroidism, depression, & class 2 obesity (body mass index 35 kg/m2) presented to the emergency department with generalized weakness after 3 days of low oral intake & decreased appetite. She was adherent to her medications, including semaglutide initiated 6 months & subsequently stopped 2 months prior (following 47 pounds weight loss) due to nausea, vomiting, abdominal pain, fatigue, lightheadedness, generalized weakness, & decreased bowel movements with the 0.5 mg dose, resulting in 3 hospitalizations. She exhibited changes in mental status, oriented to person & place but not to time or situation. Notable findings included incidental COVID-19 infection, vertical & horizontal nystagmus, & diffuse areflexia. Diagnostic imaging revealed right frontal lobe encephalomalacia & chronic micro-idiopathic alterations, while electroencephalogram indicated mild cerebral dysfunction. Thyroid stimulating hormone, vitamin B12, ammonia, & infectious/paraneoplastic/autoimmune workup were negative. She was treated with IV immunoglobulin for possible COVID-19-induced encephalopathy without improvement. Ultimately, her symptoms were attributed to WE & axonal neuropathy due to protein-calorie malnutrition & multiple vitamin/mineral deficiencies (zinc & vitamins B6, C, D, A). Treatment with IV thiamine was empirically initiated & continued despite a normal serum thiamine level, but her cognitive condition remained poor, leading to a diagnosis of WE possibly complicated by Korsakoff syndrome. She was ultimately discharged to hospice care.
Discussion: This case underscores the need for awareness of the risks associated with semaglutide, along with the diagnostic challenges in recognizing WE as a complication of semaglutide-induced nutritional deficiency. While traditionally linked to alcohol use, WE should be considered when patients present with prolonged dietary deficiencies, altered mental status, & oculomotor abnormalities even in the setting of normal serum thiamine. Diagnosis should be made promptly & treatment given empirically to reduce the risk of lasting complications.
Volume
119
Issue
10
First Page
S2964
