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Alcoholism ,wernicke's encephalopathy and the social factors

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Linking the social factors with thiamine deficiency in chronic alcohol users

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Alcoholism ,wernicke's encephalopathy and the social factors

  1. 1. Alcohol and Wernicke’s encephalopathy A public health perspective Dr Gargi Sinha MBBS(LHMC,New Delhi),Grad Dip Public Health(Edith Cowan University Australia) Dr Nilotpal Das FRANZCP,MD(AIIMS,New Delhi),DNB
  2. 2. Content Introduction Clinical features Differential Diagnosis Treatment Summary
  3. 3. What is Wernicke’s encephalopathy Wernicke’s encephalopathy is an acute neuropsychiatric syndrome resulting from thiamine deficiency. The condition can arise in many clinical settings including chronic alcohol abuse, malnutrition, gastrointestinal surgical procedures, recurrent vomiting, chronic diarrhoea, chemotherapy, malnutrition and starvation.
  4. 4. What are the social factors associated with Wernicke’s encephalopathy
  5. 5. Complex interplay of factors
  6. 6. Clinical Traid of Wernicke’s encephalopathy
  7. 7. HowtodiagnoseWernicke'sencephalopathy? Diagnostic workup is as for any case of delirium
  8. 8. Differential diagnoses alcohol withdrawal delirium temporal lobe epilepsy.
  9. 9. Treatment Wernicke’s encephalopathy is a medical emergency Oral thiamine is generally of no benefit Thiamine should be given early, as soon as the condition is suspected.
  10. 10. How much thiamine? Although there are no consensus guidelines, most common practice is to provide 500 mg of thiamine hydrochloride in 100 ml of normal saline, given by infusion, over a period of 30 minutes, three times per day, for 2-3 days. After this, thiamine hydrochloride is continued at a dose of 250 mg IV, once a day for 3-5 days.
  11. 11. Why thiamine before carbohydrate? It is mandatory that thiamine is given before any carbohydrate load a carbohydrate challenge in the presence of severe thiamine deficiency can precipitate tissue damage.
  12. 12. Prevention strategies
  13. 13. Summary ocular abnormalities (nystagmus, ophthalmoplegia), Clinical features
  14. 14. Treatment summary Do not give carbohydrate before thiamine
  15. 15. references • David, Antony; Fleminger, Simon; Kopelman, Michael; Lovestone, Simon; and Mellers, John(2009) Lishman's Organic Psychiatry: A Textbook of Neuropsychiatry,4rth edition ,wiley publication . • WorldHealth Organisation Thiamine deficiency and its prevention andcontrolinmajoremergenciewww.who.int/nutrition/publications/en/th iamine_in_emergencies_eng.pdf
  16. 16. Thank you

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