Wernicke's encephalopathy, considered a unique complication of alcoholism, is also seen in malnourished patients, bariatric surgery patients, and patients who have undergone bone marrow transplantation.
Some pearls about Wernicke's encephalopathy:
The classic triad of confusion, ataxia, and opthalmoplegia is seen in only about 10-15% of cases
The diagnosis is made before death in only about 10_15% of cases
Most authorities on the disease have suggested that opthalmoplegia be replaced by ocular, since many ocular findings may be seen in these patients (nystagmus, retinal hemorhages, cranial nerve palsies)
Essentially any alcoholic who presents with confusion (ever see these patients in your ED?) could have the disease, so give Thiamine liberally when the patient arrives.
It is a myth that administration of thiamine before glucose will precipitate Wernicke's. This dogma is based on a case series of 4 patients from the Irish Journal of Medical Sciences.
