This week we sit down with toxicologist Meghan Spyres to talk about Wernicke's Encephalopathy.
Core EM - Emergency Medicine Podcast Episode 115.0 – Wernicke’s Encephalopathy
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Oct 2, 2017 Toxicologist Meghan Spyres joins to illuminate the critical topic of Wernicke's encephalopathy. She emphasizes that anyone with nutritional deficiencies should be evaluated, not just alcoholics. The classic triad of symptoms—ophthalmoplegia, ataxia, and confusion—doesn't need to be complete for diagnosis. Meghan reveals at-risk groups beyond the expected, shares crucial diagnostic criteria, and clarifies thiamine administration myths. She gives practical treatment tips to avoid missed opportunities in emergency settings.
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Thiamine's Central Metabolic Role
- Thiamine (vitamin B1) is essential for pyruvate dehydrogenase to link glycolysis to the Krebs cycle.
- Without thiamine the brain and heart lose ATP production and become vulnerable to damage.
Recognize The Clinical Features
- Look for ophthalmoplegia, ataxia, and altered mental status as key features of Wernicke's encephalopathy.
- Remember patients often lack the full classic triad so keep a high index of suspicion.
Who To Screen For Deficiency
- Consider Wernicke's in anyone with poor intake, malabsorption, or increased elimination of thiamine.
- High-risk groups include alcoholics, bariatric surgery patients, hyperemesis gravidarum, AIDS, malignancy, elderly institutionalized, and those on furosemide.