Refeeding Syndrome Complicated by Wernicke's Encephalopathy Following Severe Hyperemesis Gravidarum and Medical Management of Miscarriage: A Case Report.

Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy that may result in dehydration, malnutrition, and electrolyte imbalance. Wernicke's encephalopathy (WE), caused by thiamine deficiency, and refeeding syndrome (RFS), a metabolic complication of nutritional rehabilitation, are rare but serious sequelae of prolonged starvation in HG. We present the case of a multiparous woman in her 30s with severe HG and missed miscarriage at approximately 16 weeks, who developed refractory hypokalaemia, hypomagnesaemia, and evolving neurological symptoms following medical management of miscarriage. Magnetic resonance imaging demonstrated symmetrical medial thalamic and mammillary body changes suspicious for WE. She improved following intravenous thiamine and vitamin B complex replacement, potassium and magnesium correction, and multidisciplinary care. This case underscores the importance of early thiamine prophylaxis in severe HG and highlights persistent refractory electrolyte abnormalities as a potential early indicator of RFS and evolving WE.