[Neuro] Wernicke's Encephalopathy Flashcards
what is Wernicke’s encephalopathy (WE)?
an [acute neurological complication] 2˚ to thiamine deficiency
what is Korsakoff syndrome?
a chronic neuropsychiatric complication of thiamine deficiency, which can follow on from WE
what are the features of Korsakoff syndrome?
[chronic memory problem]
- retrograde and anterograde amnesia
- confabulation
but preserved long-term memory
what is the triad for WE?
- nystagmus
- ataxia
- confusion
what is the mx of WE dependent on?
if pt is hypoglycaemic or normoglycaemic
pt with WE + hypoglycaemia <4 mmol/L. what do you do?
- treat the hypoglycaemic event → glucose
- then 2 pairs of IV pabrinex immediately after glucose
- continue for 5 days, 2 pairs TDS
pt with WE + normoglycaemia. what do you do?
- 2 pairs of IV pabrinex immediately
- continue for 5 days, 2 pairs TDS
what is given to pts with WE after acute mx (regardless of glycaemic status)?
prophylactic thiamine 50mg QDS indefinitely
if WE pt has a normal glucose at presentation, why is thiamine given before glucose?
- thiamine is an essential cofactor in energy metabolism
- glucose before thiamine precipitates the problem (due to toxic build up of intermediates of energy metabolism)
what are the presentations of thiamine deficiency?
- dry beri-beri
- wet beri-beri
- WE
- Korsakoff syndrome
what are the features of dry beri-beri?
bilateral motor and sensory peripheral neuropathy
what are the features of wet beri-beri?
- dilated cardiomyopathy
- pulmonary oedema
- high cardiac output state
what is the rx of hypoglycaemia if pt is awake+alert?
glucogel, check BM
what is the rx of hypoglycaemia if pt has a reduced conscious level?
IV access → 80mls 20% dextrose
no IV access → glucagon 1mg IM
check BM
once the hypoglycaemic pt has a BM ≥4 mmol/L, what do you do?
monitor closely
give long acting carb e.g. toast
coarse tremor, confusion, hallucinations with hx of alcohol excess. dx?
delirium tremens, consider use of chlordiazepoxide
alcohol excess, metabolic acidosis, ketosis. dx?
alcoholic ketoacidosis
disulfuram (promotes alcohol abstinence) MOA?
inhibitor acetaldehyde dehydrogenase
