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1. Cause is thiamine (B 1 ) deficiency. TIP: patient is confused, walks drunk & has trouble moving eyes.

2. Most often associated with alcoholism, but can be seen in cases of protein-energy malnutrition, malabsorption, and specific loss of thiamine during dialysis.

3. Characterized by global confusion with inattention, apathy, disorientation, and memory loss that progressively worsens.

4. Attention and mentation are affected (difference between Korsakoff vs Wernickie's).

5. Horizontal nystagmus and a disordered conjugate gaze that progresses to ophthalmoplegia (bilateral lateral rectus palsty). The pupils may become sluggish. Trunkal ataxia may be present.

6. If untreated, progressive depression of consciousness, coma and death within 1-2 weeks.

7. IV glucose can precipitate Wernicke encephalopathy in alcoholics. Give IV thiamine before IV glucose in any patient with a possible metabolic cause of coma.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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