10 Questions
What is the primary reason behind the nerve injuries caused by thiamine deficiency?
Decreased release of glutamate
What is a common symptom associated with alcohol withdrawal delirium?
Autonomic hyperactivity
Which population group exhibits a higher prevalence of alcohol withdrawal delirium (DT)?
Younger Caucasian population
What is the anticipated mortality rate of delirium tremens (DT) without appropriate treatment?
37%
Which of the following systems is affected by thiamine deficiency?
Hematopoietic system
What is the primary cause of Delirium Tremens (DT)?
Abrupt cessation of alcohol intake
How soon can alcohol withdrawal delirium (DT) occur after abruptly stopping alcohol intake in chronic abusers?
48 hours
Which neurotransmitter is affected by thiamine deficiency leading to a decrease in its formation?
Acetylcholine (Ach)
'Excitotoxicity' that leads to nerve injuries in thiamine deficiency is primarily due to the increased release of which neurotransmitter?
Glutamate
What percentage of those with a history of alcohol abuse can exhibit alcohol withdrawal symptoms upon discontinuing or decreasing their alcohol use?
More than 50%
Study Notes
Wernicke-Korsakoff Syndrome (WKS)
- Can occur in individuals with poor diet, gastric cancer, hyperemesis gravidarum, and other conditions of malnutrition
- Rarely found in chronic renal failure, glucose overload after starvation, transketolase disorders, and hypomagnesemia
- Magnesium is necessary for thiamine-dependent metabolism, and its deficiency can lead to WKS
Thiamine Deficiency and Korsakoff Syndrome
- Chronic thiamine deficiency can lead to Wernicke's encephalopathy and Korsakoff syndrome if left untreated
- The most common cause of Korsakoff syndrome is chronic alcohol abuse, which interferes with thiamine absorption and storage
- Other causes of Korsakoff syndrome include eating disorders, chronic vomiting, psychiatric disorders, chemotherapy, and cancer
Thiamine's Role in Brain Metabolism
- Thiamine is an essential cofactor for enzymes involved in brain cell metabolism
- Thiamine deficiency can lead to reduced metabolism, elevated lactate, edema, loss of neurons, and reactive gliosis in the brain
Effects of Chronic Alcohol Consumption
- Direct effects: toxic effects on bone marrow, red blood cells, white blood cells, and platelets
- Indirect effects: nutritional deficiencies, including vitamins B1, B3, B6, B7, C, D, and folate deficiency
- Vitamin deficiency exacerbates bone marrow depression
Red Blood Cell Abnormalities
- Grossly enlarged red blood cells (macrocytosis) and oddly shaped red blood cells can occur in circulation
- Defective red blood cells are subject to premature or accelerated destruction (hemolysis) due to structural abnormalities
- Megaloblastic anemia is frequently diagnosed in alcoholics
Immune System Abnormalities
- Impaired neutrophil function, leading to neutropenia (decreased neutrophil count)
- Impaired monocyte and macrophage function, including reduced adhesion abilities
Coagulation Process
- Alcohol interferes with the coagulation process at several levels
Thiamine Deficiency Consequences
- General decrease in glucose utilization
- Nerve injuries caused by increased release of glutamate (excitotoxicity)
- Reduced formation of acetylcholine (Ach)
Delirium Tremens (DT)
- Caused by the abrupt cessation of alcohol intake
- Mortality rate is about 35% if left untreated
- Can exhibit symptoms of severe alcohol withdrawal, including confusion, autonomic hyperactivity, and cardiovascular collapse
Explore the causes and associations of Wernicke-Korsakoff Syndrome, a neurological disorder often linked to thiamine deficiency. Learn about the role of magnesium as a cofactor in thiamine-dependent metabolism and its implications on conditions like chronic alcoholism and malnutrition.
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