Risk Factors for WE:
- Alcohol Abuse (inadequate dietary intake, reduced GI absorption, and decreased hepatic storage)
- Hyperemesis Gravidarum
- Post Surgical Patients
- Post Gastric Bypass
Thiamine Deficiency Syndromes
Why thiamine is so important?
Korsakoff syndrome refers to a persistent state of mental dysfunction characterized by memory impairment associated with confabulation.
- Intracranial Hemmorhage
- Cerebral Venous Thrombosis
- Delirium Tremens
- Hepatic Encephalopathy
- Intracranial Space Occupying Lesions
- Cerebellar Disease
- Marchiafava-Bignami disease (demyelination of the corpus callous due to nutritional deficiencies)
Highly suspected disease - 500 mg IV
Administration of thiamine improves disease to some degree in almost all cases; however, persistent neurologic dysfunction is common.
Glucose before thiamine Myth!
IV Fluids to sober them up?
There is no evidence that intravenous fluids expedite sobriety in patients with acute alcohol intoxication. Read more on REBELEM and St.Emlyn's.
- Reuler JB, Girard DE, Cooney TG. Current concepts. Wernicke’s encephalopathy. N Engl J Med. 1985;312:1035-1039.
- Watson AJ, Walker JF, Tomkin GH, et al. Acute Wernicke’s encephalopathy precipitated by glucose loading. Ir J Med Sci. 1981;150:301-303.
- Zimitat C, Nixon PF. Glucose loading precipitates acute encephalopathy in thiamin-deficient rats. Metab Brain Dis. 1999; 14:1-20.
- Zimitat C, Nixon PF. Glucose induced IEG expression in the thiamin-deficient rat brain. Brain Res. 2001;892:218-227. 59. Hack JB, Hoffman RS. Thiamine before glucose to prevent Wernicke encephalopathy: examining the conventional wisdom. JAMA. 1998;279:583-584.
- Donnino MW, Vega J, Miller J, Walsh M. Myths and misconceptions of Wernicke’s encephalopathy: what every emergency physician should know. Annals of emergency medicine. 2007 Dec 31;50(6):715-21.