Thiamine (Vitamin B1) Deficiency - Wernicke Encephalopathy

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  • Thiamine (Vitamin B1) Deficiency - Wernicke Encephalopathy


  • Thiamine (B1) deficiency

Risk Factors

  • Overall, rare
  • Chronic alcohol abuse
  • Others w/severe nutritional deficiency: anorexia/bulimia, hyperemesis gravidarum, s/p gastric bypass, TPN w/o supplementation, other states with chronically poor intake


  • Delirium - with range of severity in confusional state; mild forms may predominantly affect memory
  • Balance problems (ataxia), extremity numbness (peripheral neuropathy - dry Beri Beri)
  • Occulomotor dysfunction leading to double vision or other occular disturbances
  • Wernicke encephalopathy: most patients wont have all 4 (confusion, ataxia, ophthalmoplegia, nutritional depletion); To diagnose, need to have 2 of 4
  • Symptoms typically develop over days to a few weeks
  • Symptoms resolve w/thiamine, occulmotor most quickly; typically within hours to days
  • If untreated, can lead to coma and death; also to Korsakoff's dementia→ permanent inability to form new memories
  • Wet Beri Beri: High output heart failure→ SOB, PND, orthopnea

Physical Exam Findings

  • Variable levels of confusion
  • Cranial nerve palsy (in particular CN6→ lateral rectus)
  • Severe ataxia→ often unable to stand
  • Persistent vertical and/or horizontal nystagmus
  • If high output heart failure: rales on lung exam, elevated JVP, edema
  • Peripheral neuropathy