Why is it developing?
The body does not create large reserves of thiamine: they last for about two to three weeks. As soon as the supply of the vitamin stops or its absorption is sharply disrupted, brain cells lose the ability to use glucose, toxic metabolic products accumulate, edema and death of neurons develop in certain areas. Alcohol speeds up this process because it simultaneously impairs nutrition, absorption and activation of the vitamin. The second most common group of causes is not related to alcohol: prolonged vomiting, fasting, weight loss surgery, severe intestinal diseases.
- Thiamine reserves in the body are low
- Alcohol interferes with the absorption and activation of the vitamin
- Prolonged vomiting and toxicosis in pregnant women
- Stomach and intestinal surgeries
- Fasting, strict diets, malabsorption
- Dialysis, oncology, chemotherapy
Symptoms
The classic triad includes impaired consciousness, oculomotor disorders, and ataxia, but all three symptoms occur simultaneously in only a subset of people. Most often, lethargy, inattention, and disorientation are noticeable, and others mistake this for intoxication. Eye symptoms are manifested by double vision, involuntary twitching of the eyes, and, less commonly, limitation of their mobility. Gait disturbances appear as widely spaced legs and unsteadiness. Low blood pressure, decreased body temperature, and rapid heartbeat may occur due to damage to the autonomic centers.
- Confusion, lethargy, inattentiveness
- Double vision and twitching of the eyeballs
- Shaky, unsteady gait
- Reduced body temperature and blood pressure
- Rapid heartbeat
- Apathy and drowsiness
Why is delay dangerous?
Every hour without thiamine increases the amount of irreversible changes. Untreated Wernicke's encephalopathy in a significant proportion of cases develops into Korsakoff's syndrome - a persistent loss of the ability to remember new things, due to which a person loses independence. A severe outcome is also possible with cerebral edema and disruption of the autonomic centers. A separate trap: if you start administering glucose solutions without thiamine to an exhausted person, the need for the vitamin will sharply increase and the condition will worsen. Therefore, thiamine is administered before or simultaneously with glucose.
- Transition to persistent Korsakoff syndrome
- Irreversible loss of memory and independence
- Cerebral edema, respiratory and circulatory disorders
- Worse after glucose without thiamine
- Falls, injuries, aspiration
Diagnostics
The diagnosis is made clinically and treatment begins immediately without waiting for confirmation. An MRI of the brain may show characteristic changes around the ventricles and in the thalamus, but a normal finding does not exclude the diagnosis. Tests are needed to assess the general condition: electrolytes, magnesium, glucose, liver enzymes, blood counts. At the same time, other causes of confusion are excluded - stroke, traumatic brain injury, infection, poisoning, liver failure, low glucose and sodium levels.
- Urgent neurological examination
- Brain MRI if possible
- Glucose, electrolytes, magnesium
- Liver enzymes and complete blood count
- Rule out stroke and trauma
- Start treatment before results are available
Treatment and prevention
The basis is intravenous administration of thiamine in high doses several times a day for several days, followed by transition to oral administration. Be sure to correct magnesium deficiency, without which the vitamin works worse, and restore electrolytes and nutrition. At the same time, withdrawal symptoms and diseases that caused the deficiency are treated. For prevention, thiamine is prescribed to people with alcohol dependence, with prolonged vomiting, after gastric surgery and with severe exhaustion. Self-administration of pharmaceutical vitamins in acute conditions is ineffective.
- High dose intravenous thiamine
- Correction of magnesium and electrolytes
- Power restoration
- Treatment of alcohol withdrawal
- Prevention with thiamine in risk groups
- Observation by a neurologist after discharge