P1456 - Semaglutide’s Hidden Perils: A Rare Case of Malnutrition and Wernicke Encephalopathy

Suhib Alhaj Ali, MD¹, Majd Khadra, MD², Mina Sitto, BS¹, Madison Graifman, BS¹, John Gietzen, MD^1
1Henry Ford Hospital, Detroit, MI; ²Detroit Medical Center/Wayne State University, Detroit, MI

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 (BMI 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 lbs weight loss) due to nausea, vomiting, abdominal pain, fatigue, lightheadedness, generalized weakness, & decreased bowel movements with the 0.5 mg dose, resulting in three 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 EEG 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 risk of lasting complications.


Disclosures:


Suhib Alhaj Ali, MD¹, Majd Khadra, MD², Mina Sitto, BS¹, Madison Graifman, BS¹, John Gietzen, MD¹. P1456 - Semaglutide’s Hidden Perils: A Rare Case of Malnutrition and Wernicke Encephalopathy, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.