213 - Wernicke’s Encephalopathy Associated With Ozempic Use

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

EK

Eunyeop Kim, MD

Resident Physician
University of Texas Southwestern Medical Center
Dallas, Texas, United States
GM

Grace Meehan, DO

Resident Physician
UT Southwestern Medical Center
Dallas, Texas, United States

Corresponding Author(s)

JB

Julia Bryarly, MD

Assistant Professor
University of Texas Southwestern
Dallas, Texas, United States

Submitter(s)

EK

Eunyeop Kim, MD

UT Southwestern
Dallas, Texas, United States

Case Diagnosis: Wernicke’s Encephalopathy Associated With Ozempic Use

Case Description: A 50-year-old man with type 2 diabetes (A1c 6.9%) presented with six weeks of nausea, vomiting, and progressively worsening altered mental status. Past medical history notable for two year history of Ozempic (semaglutide) use, during which time he experienced intermittent nausea and vomiting. Patient with worsening gastrointestinal symptoms in the three months preceding presentation despite discontinuation of Ozempic. He denied alcohol use, dietary restrictions, or intentional weight loss. Admission exam notable for drowsiness and disorientation. Neurological findings included dysarthria and nystagmus. Low thiamine (21.3 nmol/L) with MRI findings of Wernicke’s encephalopathy and gastric emptying study showed 64.6% retention at 4 hours. He was treated with high-dose IV thiamine. During inpatient rehabilitation, he demonstrated moderate–severe cognitive impairment with deficits in attention, memory, and executive function, progressing from hoyer lift to contact guard assist with sliding board as initiation and attention improved.

Discussions:

Wernicke’s encephalopathy (WE) is a neurologic condition caused by thiamine deficiency, typically seen in alcohol use and malnutrition. This case highlights a rare presentation of WE in a non-alcoholic patient without dietary restrictions, where prolonged Ozempic use likely led to gastroparesis, poor intake, and subsequent thiamine deficiency. GLP-1 receptor agonists are increasingly used for diabetes and weight loss, with nausea and vomiting among their known side effects. In this case, imaging findings of delayed gastric emptying confirmed Ozempic induced gastroparesis as a likely contributor.

Conclusions: This case illustrates Wernicke's encephalopathy as a rare but serious complication of prolonged Ozempic use due to thiamine deficiency from medication-induced gastroparesis. Clinicians should monitor for signs of nutritional deficiency and neurologic symptoms in patients on GLP-1 receptor agonists, even in the absence of traditional risk factors.