THIAMINE DEFICIENCY

B1

Thiamine (B1) Deficiency can cause several different neurological problems: peripheral neuropathy, Wernicke’s encephalopathy and Korsakoff syndrome. Alcoholics are the group that is most susceptible to Thiamine deficiency (due to several complicated biochemical reasons, in addition to their overall poor diets). The malnourished and those with eating disorders are also at risk. 

Vitamins are “vital” because we can only get them through the diet. Thiamine is found in pretty much everything other than processed grains. Thiamine helps us turn glucose and fat into ATP. Without Vitamin B1, we run low on life-sustaining ATP. The brain is especially sensitive to low ATP because (a) it uses a buttload of ATP and (b) the CNS neurons are incapable of regenerating when damaged. The parts of the brain most susceptible are the Mammillary Bodies, the Dorsal Medial Thalamus, and the Midbrain. 

Wernicke vs Korsakoff?

Wernicke’s Encephalopathy and Korsakoff Syndrome are very similar. In fact they aren’t even separate disease processes. Most doctors lump them together as “Wernicke-Korsakoff syndrome.” They’re just two ends along a spectrum of suckiness: 

WERNICKE’S ENCEPHALOPATHY occurs first. The classic triad of symptoms is (1) Ophthalmoplegia (which is a fancy way of saying eye muscle weakness), (2) Ataxia and (3) Confusion. That’s a high yield triad! Wernicke’s encephalopathy is due to injury in many different parts of the brain, especially the midbrain and cerebellum. Wernicke’s is reversible if you give the patient thiamine!

KORSAKOFF SYNDROME occurs later. The classic symptom is global amnesia, which makes the patient confabulate (they make up stories to fill in the memory gaps). Korsakoff begins when there is infarction (hemorrhage and necrosis) of the Mammillary Bodies. Korsakoff is irreversible! 

Treatment?

When you give Thiamine supplements to an alcoholic with Wernicke’s make sure to give them glucose too. If you only give glucose, their starving cells all over the body immediately gobble it up and use B1 to metabolize the sugars. Their supply of B1 is pitiful, and they could exhaust all of their B1 stores. This can put them into rapid-onset Korsakoff! You should avoid this problem by administering glucose and thiamine together  using a “banana bag” which is a bag of IV yellow-colored fluids that contains both! Don’t give glucose before thiamine!!!