Different sources recommend somewhat different doses of thiamine for WE, however the most widely accepted dose is 500 mg IV TID x 2-3 days, ...Youarehere:Home/TheToxandTheHound/ToxandHound–Don’tWernicke’s,B(1)HappybyMeghanSpyresYoutaketheperiloussignoutofa55-year-oldpatientwithalcoholusedisorder(AUD)whocametotheEDintoxicated.“He’sjustmetabolizing”yourcolleaguetellsyou.Afewhoursgobyandheisnowawakeandaskingtoleave.Thenurseroadtestshimandhecanwalk,butisalittle“shaky.”Whenyouexaminehim,hisgaitappearsataxic.Isthisnormal?A30-somethingguyhadarecentstayforEtOHwithdrawal,andwasdischargedhome.Duringyourshift,hisiswifebringshimbacktotheEDandsayshejust“isn’tright.”Hedoesn’trememberthingsthewayheshouldandoftenseemsconfused.Isthisjusthisnewbaseline?A40-year-oldmanwassenttotheEDfromjailwithaconcernforalcoholwithdrawal.Hehasnormalvitalsigns,notremor,butheappearsconfusedandhasadysconjugategazeonexam.Arewemissingsomething?Allthreeofthesepatientsshouldmakeyouthinkofoneofmyfavoritediagnoses–Wernicke’sencephalopathy.PathophysiologyWernicke’sencephalopathy(WE),alsocalled“dry”beriberi,isaneurologicdisordercausedbythiamine(vitaminB1)deficiency,firstdiagnosedbyCarlWernickein3paitentsin1881.​1​Thiamine,foundinorganmeats,eggs,andgreenleafyvegetables,isvitaltotheutilizationofcellularenergy.Initsactiveform,thiaminediphosphateactsasacoenzymeinthepyruvatedehydrogenasecomplex.Thisenzymaticreactionconvertspyruvateintoacetyl-coA,linkingglycolysistothecitricacidcycle(AKAtheKreb’sCycle).Thisstepisparamountbecauseitactsasthegate-keeper,linkingtheinefficientprocessofanaerobicmetabolism(glycolysis)tothepowerhouseofaerobicmetabolism(citricacidcycle).Together,thisallowsfortheproductionofawhopping36molesofATPforeverymoleofglucose.Inthesettingofthiaminedeficiency,aerobicmetabolismisinhibited,andATPproductionplummets.WimpyglycolysisbecomestheonlyATPproducer,givingupameager2molesofATPpermoleglucose.Ifthelastfewsentencesmadeyoureyesglazeover,justrefertothisgraphic:ThiaminerolesGIFbyMeghanSpyres.Thisworkislicens