A 59-year-old male presented with confusion, disorientation, and an unsteady gait. He has a history of heavy drinking. On examination, he was febrile with normal blood pressure but extremely confused and agitated, with rapid eye movements on lateral gaze bilaterally. His gait was very unsteady. Urine drug screen was negative but blood alcohol level was positive. The probable diagnosis is Wernicke's syndrome due to vitamin B1 (thiamine) deficiency.

1. THIAMINE
VITAMIN B1
-S.GOKULPRABHU

2. QUE: A 59 YR OLD MALE IS BROUGHT TO THE EMERGENCY
DEPARTMENT IN AN EXTREMELY CONFUSED AND DISORIENTED ,WITH
AN UNSTEADY GAIT.THE PATIENT HAS BEEN KNOWN IN THE PAST FOR
HEAVY DRINKER.ON EXAMINATION HE IS AFEBRILE WITH A NORMAL
BLOOD PRESSURE.HE IS EXTREMELY DISORIENTED AND
AGITATED.HORIZONTAL RAPID EYE MOVEMENT ON LATERAL GAZE IS
NOTED BILLATERALLY.HIS GAIT IS VERY UNSTEADY.
INVESTIGATIONS:URINE DRUG SCREEN WAS
NEGATIVE AND HAD A POSITIVE LOOD
ALCOHOL LEVEL.WHAT IS THE PROBABLE
DIAGNOSIS?

3. 3
MISNOMER
THYMINE IS PRESENT IN
DNA
THIAMINE IS PRESENT IN
VITAMIN B1

4. ALEURONE LAYER OF CEREALS
WHOLE WHEAT FLOUR AND UNPOLISHED HAND POUND RICE
YEAST
MEAT
NUTS
GREEN VEGETABLES
SOURCE

5. “
STRUCTURE OF THIAMINE
IT CONTAINS A SUBSTITUTED
PYRIMIDINE RING CONNECTED TO A
SUBSTITUTED THIAZOLE BY MEANS OF
METHYLENE BRIDGE.
IT IS IN INACTIVE FORM
IT IS CONVERTED TO ACTIVE FORM BY
ADDITION OF 2 PHOSPHATE BY ATP IN
PRESENCE OF ENZ.TPP TRANSFERASE TO
FORM TPP (ACTIVE FORM)
5

6. STRUCTURE
.
6

7. 7
METABOLISM
ABSORBED IN SMALL INTESTINE BY
ACTIVE
TRANSPORT IF ALLOWANCE IS 5MG/DAY
IF EXCEEDED MORE THAN 5 MG/DAY
PASSIVE DIFFUSION CONTRIBUTES

8. PHOSPHORYLATION TAKES
PLACE AT JEJENUM TO
YIELD TPP
THIAMINE IS CARRIED BY
PORTAL VEIN TO LIVER
8

9. BIOCHEMICAL FUNCTIONS
CARBOHYDRATE METABOLISM
PYRUVATE DH
COMPLEX
9

10. 10

11. 11
HMP SHUNT

12. BRANCHED CHAIN ALPHA KETO ACID DEHYDROGENASE
12
VALINE TPP SUCCINYL COA

13. 13
IN ABSENCE OF THIAMINE
PYRUVATE IS CONVERTED TO
LACTIC ACID LEADIND TO LACTIC
ACIDOSIS

14. 14
RDA
NUTRITIONAL RESEARCH COUNCIL
INSISTS TO TAKE ABOUT 1.0 - 1.5 MG FOR
ADULT
IN TERMS OF ENERGY 0.4MG/1000KCAL
FOR MALE – 1.2MG/DAY
FOR FEMALE– 1.1MG/DAY
CHILD – 0.5MG/DAY

15. 15
DEFICIENCY
MANIFESTATIONS
BERI BERI
OVERALL PICTURE OF THIAMINE DEFICIENCY
LEADS TO……

16. 16
CARDIOVASCULAR
GI DISSORDERS
NEUROLOGICAL

17. CARDIOVASCULAR DISEASES
17
PALPATION AND RISE IN
HEART BEAT
ENLARGEMENT OF LIVER
DILATION
CARDIAC FAILURE
EDEMA

18. CARDIAC FAILURE
● THIAMINE
DEFICIENCY
18
FAILURE IN CARB.METAOLISM
ATP LEVEL DECRESES
DEMAND FOR O2
INCREASES
PALPATION AND
TRACHYCARDIA
CARDIOMEGALY
EDEMA

19. CARDIAC FAILURE CAUSES CYANOSIS WHICH LEADS TO
BLUE IN COLOUR
19

20. “
● NEUROLOGIGAL
DISEASES
● ANXIETY
● MENTAL CONFUSION
● WERNICKE’S
ENCEPHALOPATHY
● PERIPHERAL NEURITIS
20

21. 21
DECREASED AVAIL OF ACETYL COA
AND NADPH
DECREASE IN ACETYL CHOLINE
MENTAL DISSORDER

22. GI MANIFESTATIONS
IMPAIRED CELL FN LEADS TO IMPAIRED
DIGESTION LEADS TO CONSTIPATION AND
ANOREXIA

23. 23
TYPES OF BERI BERI
WET BERI BERI
DRY BERI BERI
INFANTILE BERI BERI

24. 24

25. 25

26. 26
INFANTILE BERI BERI

27. 27
WERNICKE SYNDROME
CEREBRAL BERI BERI
ENCEPHALOPATHY
(OPTHALMOPLEGIA,,NYSTAGMUS,
CEREBRAL ATAXIA)

28. 28

29. 29

30. QUE: A 59 YR OLD MALE IS BROUGHT TO THE
EMERGENCY DEPARTMENT IN AN EXTREMELY CONFUSED
AND DISORIENTED ,WITH AN UNSTEADY GAIT.THE PATIENT
HAS BEEN KNOWN IN THE PAST FOR HEAVY DRINKER.ON
EXAMINATION HE IS AFEBRILE WITH A NORMAL BLOOD
PRESSURE.HE IS EXTREMELY DISORIENTED AND
AGITATED.HORIZONTAL RAPID EYE MOVEMENT ON
LATERAL GAZE IS NOTED BILLATERALLY.HIS GAIT IS VERY
UNSTEADY.
INVESTIGATIONS:URINE DRUG SCREEN
WAS NEGATIVE AND HAD A POSITIVE
BLOOD ALCOHOL LEVEL.WHAT IS THE
PROBABLE DIAGNOSIS?

31. 31
ANSWER
VITAMIN B1 DEFICIENCY
WERNICKE’S SYNDROME

32. 32