![]() ![]() ( Ir J Med Sci 1981 150:301.) A careful reading of this paper, however, reveals that the four patients described already had manifestations of Wernicke's when they presented, and were given prolonged infusions of dextrose before their condition worsened. ![]() Some authors who advocate thiamine-before-glucose refer to an article “Acute Wernickes Encephalopathy Precipitated by Glucose Loading” by Watson et al. But is there any evidence that these catastrophic neurological deficits can be caused by administering a single dose of dextrose to a thiamine-deficient patient? I have not been able to find any such case described in the medical literature. This is the stuff that nightmares are made of. ( Table 3.) TABLE 3:ĬLINICAL FEATURES OF KORSAKOFF'S PSYCHOSIS No Evidence As Sacks explains it, “Such a patient must literally make himself (and his world) up every moment” in a “narrational frenzy.” Indeed, confabulation is another key feature of Korsakoff's psychosis. Thompson, was in a constant state of “confabulatory delirium,” having continually to invent meaning for what he experienced as an eternal present without any sense of recent history. FigureĪnother Korsakoff's patient described in the book, Mr. Fortunately, several minutes later, he had no memory of this terrifying incident. When he looked into a mirror and saw a middle-aged face staring back at him, he became panic-stricken, unable to reconcile his sense of himself with the image of his actual face. ![]() Jimmie G., a 49-year-old former seaman, had no memories past age 19. In his remarkable book, The Man Who Mistook His Wife for a Hat, Oliver Sacks writes about several unforgettable patients with full-blown Korsakoff's psychosis. The hallmark of Korsakoff's is anterograde amnesia with severe impairment in the ability to retain new memories. ( Table 1.) TABLE 1:ĬLINICAL FEATURES OF WERNICKE'S ENCEPHALOPATHY It was therefore essential to give parenteral thiamine before dextrose in any patient at risk for thiamine depletion. We were taught that this could happen suddenly, after even a single ampule of D50 or one liter of 5% dextrose in someone who was previously neurologically intact. The theory, such as it was, held that a thiamine-deficient patient in the process of metabolizing a carbohydrate load such as dextrose could use up his meager stores of the vitamin and become completely thiamine-depleted. One maxim I heard repeated time and again during medical school, internship, and residency is that one must give a dose of thiamine (vitamin B 1) to any alcoholic, comatose, or potentially malnourished patient before administering intravenous dextrose for fear of precipitating the dreaded Wernicke-Korsakoff syndrome. Give thiamine before glucose series#This column is the first of an occasional series examining commonly held but scientifically unsubstantiated beliefs concerning the management of toxic patients. ![]()
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