[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
