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If this guy has confabulation and retrograde amnesia, he has Korsakoff's syndrome, which is irreversible, so we're not exactly 'treating' it
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Bradykinin Gastro
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one pair is equal to 5ml (in BNF) so would it be correct to put 5ml in the dose

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Dorsal Jaundice
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Oh noo i just gave him some thiamine :(
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Supine Serotonin
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# Summary

Wernicke's encephalopathy is a neurological disorder resulting from thiamine (vitamin B1) deficiency, often caused by conditions such as chronic alcohol abuse, malnutrition, bariatric surgery, or hyperemesis gravidarum. It commonly presents with a triad of ataxia, confusion, and ocular abnormalities. Key investigations include neurological examination and imaging techniques, while management primarily involves high-dose intravenous thiamine, such as Pabrinex IV. If left untreated, it may progress to Korsakoff's syndrome, characterized by irreversible deficits in anterograde and retrograde memory.

# Definition

Wernicke's encephalopathy is a neurological disorder caused by thiamine (vitamin B1) deficiency, manifesting in a triad of specific clinical symptoms: ataxia, confusion, and ocular abnormalities.

# Epidemiology 

Worldwide prevalence of Wernicke's encephalopathy, based on unselected autopsy studies, ranges from 0.8% to 2.8%. 

The condition exhibits a higher prevalence in certain populations: 12.5% in individuals with a history of alcohol dependence, 10% in those with AIDS, and 6% in bone marrow transplant recipients. 

The prevalence is higher in males, with a male-to-female ratio of 1.7:1, often attributed to the higher incidence of alcoholism in men.

# Aetiology

The primary causes of Wernicke's encephalopathy include:

- Chronic alcohol abuse: Alcohol interferes with thiamine absorption and utilization.
- Malnutrition: This can occur due to inadequate dietary intake, malabsorption disorders, or increased requirements.
- Bariatric surgery: Rapid weight loss and reduced nutrient absorption can lead to thiamine deficiency.
- Hyperemesis gravidarum: Persistent severe vomiting in pregnancy may lead to nutrient deficiencies, including thiamine.

# Signs and Symptoms

Wernicke's encephalopathy typically presents with a characteristic triad of symptoms:

- Ataxia: Unsteady and uncoordinated movements
- Confusion: Disorientation and difficulty with attention
- Ocular abnormalities: This can include gaze-evoked nystagmus, spontaneous upbeat nystagmus, and horizontal or vertical ophthalmoplegia.

# Differential Diagnosis

- Meningitis: Presents with fever, headache, neck stiffness, and altered mental status.
- Stroke: Sudden onset of focal neurological deficits, which may include difficulty speaking, face drooping, arm weakness.
- Encephalitis: Characterized by fever, headache, behavioral changes, and sometimes, seizures.
- Korsakoff's syndrome: Notable for severe anterograde and retrograde memory loss, often seen as a progression from untreated Wernicke's encephalopathy.

# Investigations

To confirm a diagnosis of Wernicke's encephalopathy, the following investigations may be undertaken:

- Neurological examination: Assessment of the characteristic triad of symptoms.
- MRI Head: May show characteristic changes in specific brain regions, such as the mammillary bodies and periaqueductal area.
- Blood tests: Although not definitive, they can reveal low thiamine levels and other signs of malnutrition or alcohol abuse.

# Management

Management of Wernicke's encephalopathy primarily involves replacement of thiamine. High-dose intravenous thiamine, commonly given as Pabrinex IV, is the standard treatment. If left untreated, the condition can progress to **Korsakoff's syndrome**, which affects the mammillary bodies, leading to irreversible deficits in anterograde and retrograde memory.
2015
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Wernicke's encephalopathy and Korsakoff's syndrome
Topic
90
Psychiatry
# Drug choice feedback

This gentleman is likely suffering from Wernicke's encephalopathy. Apart from addressing problems of alcohol abuse and diet, stable patients require multivitamins including vitamins B1 and C. Pabrinex is recommended in such cases.

# Dose/Route/Frequency/Duration feedback

The intravenous route is recommended in the treatment of Wernicke's encephalopathy. The dose is expressed in pairs of ampoules, whereby each pair contains distinct vitamins that are only mixed just prior to administration. 2-3 pairs of ampoules are recommended TDS for 3 to 5 days, followed by 1 pair OD for a further 3 to 5 days guided by clinical improvement.
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2 pairs
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Vitamin B substances with ascorbic acid ampoules
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3 days
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three times daily (TDS)
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intravenous (IV)
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3 pairs
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Vitamin B substances with ascorbic acid ampoules
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5 days
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three times daily (TDS)
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intravenous (IV)
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2 pairs
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Vitamin B substances with ascorbic acid ampoules
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5 days
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three times daily (TDS)
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intravenous (IV)
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3 pairs
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Vitamin B substances with ascorbic acid ampoules
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3 days
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three times daily (TDS)
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intravenous (IV)
Case Presentation: A 58-year-old gentleman is brought to the Emergency Department by his relative. He is noted to have moderate confusion, double vision and unsteady walking.


## PH

Alcoholism, Chronic pancreatitis, Depression

## DH

Sertraline 100mg PO OD (NKDA)

## On examination

Appears alert, but confabulation and retrograde amnesia suspected.

Temperature 36.2°C, HR 67, RR 13, BP 125/78, O<sub>2</sub> 98% RA, GCS 14, Weight 81kg

## Investigations

None

# Prescribing Request

Write a prescription for one drug that is most appropriate for treating his condition.