Give thiamine before glucose12/29/2022 ![]() ![]() FigureĪnother Korsakoff's patient described in the book, Mr. Fortunately, several minutes later, he had no memory of this terrifying incident. When he looked into a mirror and saw a middle-aged face staring back at him, he became panic-stricken, unable to reconcile his sense of himself with the image of his actual face. ![]() Jimmie G., a 49-year-old former seaman, had no memories past age 19. In his remarkable book, The Man Who Mistook His Wife for a Hat, Oliver Sacks writes about several unforgettable patients with full-blown Korsakoff's psychosis. The hallmark of Korsakoff's is anterograde amnesia with severe impairment in the ability to retain new memories. ( Table 1.) TABLE 1:ĬLINICAL FEATURES OF WERNICKE'S ENCEPHALOPATHY It was therefore essential to give parenteral thiamine before dextrose in any patient at risk for thiamine depletion. We were taught that this could happen suddenly, after even a single ampule of D50 or one liter of 5% dextrose in someone who was previously neurologically intact. The theory, such as it was, held that a thiamine-deficient patient in the process of metabolizing a carbohydrate load such as dextrose could use up his meager stores of the vitamin and become completely thiamine-depleted. One maxim I heard repeated time and again during medical school, internship, and residency is that one must give a dose of thiamine (vitamin B 1) to any alcoholic, comatose, or potentially malnourished patient before administering intravenous dextrose for fear of precipitating the dreaded Wernicke-Korsakoff syndrome. This column is the first of an occasional series examining commonly held but scientifically unsubstantiated beliefs concerning the management of toxic patients. ![]()
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