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| ==Background==
| | #REDIRECT[[Wernicke-Korsakoff Syndrome]] |
| *Wernicke’s Encephalopathy (WE): ACUTE neuro/cardiovascular sx caused by thiamine deficiency
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| *Korsakoff’s Psychosis (KP): CHRONIC neuro sx caused by thiamine deficiency
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| *Wernicke-Korsakoff Syndrome (WKS): presence of WE + KP simultaneously
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| ==Epidemiology==
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| *Only 20% identified before death, failure of dx leads to 20% mortality and 75% permanent damage
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| ==Causes==
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| *Anything that causes thiamine (vitamin B1) deficiency: poor dietary intake, malabsorption, increased metabolic requirement
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| **Chronic alcoholism, dieting/fasting/starvation, anorexia, vomiting/diarrhea, unbalanced TPN, GI surgery, malignancy, dialysis, AIDS, IBD, pancreatitis, liver disease, thyrotoxicosis
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| ==Pathophysiology==
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| *Brain lesions/atrophy occurs: mamillary bodies (nearly all cases), thalamus, periaqueductal gray matter, 3rd/4th ventricle, cerebellum, frontal lobe
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| ==Diagnosis==
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| WE/KP/WKS = clinical diagnoses
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| Wernicke’s Encephalopathy
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| *Classic triad: encephalopathy, oculomotor dysfunction, gait ataxia
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| *werNICke mnemonic:
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| **N: Nystagmus/ophthalmoplegia
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| **I: Incoordination/ataxia
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| **C: Confusion/memory impairment
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| *Other sx: hypotension, tachycardia, EKG abnormalities, DOE, CHF sx, hypothermia, coma, dry/wet Beriberi
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| Korsakoff’s Psychosis
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| *Sx: anterograde/retrograde amnesia, confabulation, confusion, apathy
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| Wernicke-Korsakoff Syndrome
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| *Sx: combination of WE and KP
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| ==Treatment==
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| If suspect WE/KP/WKS: thiamine 500 mg IV over 30 min TID x 2 days, then 500 mg IV/IM q day for 5 days, then 100 mg PO q day until pt no longer at risk
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| If suspect at risk for thiamine deficiency but no sx: thiamine 100 mg PO q day
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| *If you suspect WE/KP/WKS then treat it! Diagnosis is clinical and difficult to confirm, treatment is simple/inexpensive/effective, there is little risk to treatment, and the risk of morbidity/mortality from not treating is high
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| *Give magnesium; hypomagnesemic state may be resistant to thiamine administration
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| *Give multivitamin; pt at risk for other vitamin deficiencies
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| *For chronic alcoholics always consider banana bag: thiamine 100 mg + magnesium 2-4 g + folate 1 mg + multivitamin; all in 1L NS or D5W
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| *Remember to give thiamine BEFORE glucose in pts requiring glucose who are at risk for thiamine deficiency; glucose without thiamine can precipitate/worsen WE by driving thiamine intracellularly
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| ==See Also==
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| *[[Korsakoff's Psychosis]]
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| *[[Wernicke-Korsakoff Syndrome]]
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| *[[Beriberi]]
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| *[[Thiamine deficiency]]
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