Psychiatric Emergencies for Clinicians: Emergency Department Management of Wernicke-Korsakoff Syndrome

Sharp, Christopher S.; Wilson, Michael P.; Nordstrom, Kimberly

doi:10.1016/j.jemermed.2016.05.044

Cited by 13 publications

(8 citation statements)

References 26 publications

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“…[ 63 ] This particular syndrome has been seen to have occurred frequently in patients who have chronic alcoholism and includes both Wernicke encephalopathy and Korsakoff syndrome and hence the name. [ 64 ] But, this could also happen due to infections, malnutrition, certain GI tract diseases, or certain psychiatric disorders such as schizophrenia. [ 63 ] In a majority of patients, this WKS syndrome is not diagnosed properly.…”

Section: Alcoholism and Neural Disordersmentioning

confidence: 99%

Molecular mechanisms of alcohol's effects on the human body: A review and update

Renu,

Myakala,

Chakraborty

et al. 2023

J Biochem & Molecular Tox

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Alcohol consumption has been linked to numerous negative health outcomes although it has some beneficial effects on moderate dosages, the most severe of which being alcohol‐induced hepatitis. The number of people dying from this liver illness has been shown to climb steadily over time, and its prevalence has been increasing. Researchers have found that alcohol consumption primarily affects the brain, leading to a wide range of neurological and psychological diseases. High‐alcohol‐consumption addicts not only experienced seizures, but also ataxia, aggression, social anxiety, and variceal hemorrhage that ultimately resulted in death, ascites, and schizophrenia. Drugs treating this liver condition are limited and can cause serious side effects like depression. Serine‐threonine kinases, cAMP protein kinases, protein kinase C, ERK, RACK 1, Homer 2, and more have all been observed to have their signaling pathways disrupted by alcohol, and alcohol has also been linked to epigenetic changes. In addition, alcohol consumption induces dysbiosis by changing the composition of the microbiome found in the gastrointestinal tract. Although more studies are needed, those that have been done suggest that probiotics aid in keeping the various microbiota concentrations stable. It has been argued that reducing one's alcohol intake may seem less harmful because excessive drinking is a lifestyle disorder.

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Section: Alcoholism and Neural Disordersmentioning

confidence: 99%

Molecular mechanisms of alcohol's effects on the human body: A review and update

Renu,

Myakala,

Chakraborty

et al. 2023

J Biochem & Molecular Tox

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show abstract

“…Protocols to guide thiamine dosing and route of administration differ among institutions and medical society guidelines, with doses varying from 100 mg of thiamine in a typical intravenous fluid infusion up to 200-500 mg every 8 hrs for a minimum of 72 hrs if WE is suspected. [34][35][36] Patients who are actively seizing should be immediately treated with benzodiazepines until cessation of seizure activity is achieved. Typical starting doses are 5-10 mg intravenous (IV) of diazepam and of 2-4 mg of lorazepam, which can be repeated in 5-10 mins.…”

Section: Management Of Acute Alcohol Withdrawal Stabilizationmentioning

confidence: 99%

<p>Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives</p>

Wolf

Curry

Nacht

et al. 2020

OAEM

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Alcohol withdrawal syndrome (AWS) is a common, heterogenous, and lifethreatening complication of alcohol use disorder (AUD). AUD is a leading cause of worldwide mortality, and many patients with AUD will develop AWS during their ED course. This review summarizes the epidemiology, pathology, and management of AWS and AUD in the emergency setting. The time course of AWS and its impact on ED treatment is emphasized. Once AWS is diagnosed, symptom-triggered benzodiazepine administration remains the most commonly provided treatment but may not be appropriate for patients with significant medical or psychiatric comorbidity or pending discharge. In these cases, ED clinicians may consider short courses of barbiturates or alternative regimens based on novel anticonvulsants. Specific treatment protocols are enumerated for clinical practice. Finally, emergency providers must not only manage acute patients' AWS but also lay the foundation for successful treatment of AUD. An approach to the disposition of the patient with AUD is presented. The authors examine shortcomings in the extant literature and suggest opportunities for further study.

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“…It is often difficult to differentiate Wernicke's encephalopathy from Korsakoff syndrome because both belong to the same spectrum of disease, with their etiology consisting of thiamine deficiency. Doctors must screen for both pathologies when certain clinical features are present ( 8 ).…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Few patients present all of these criteria. Signs and symptoms that may be associated with Wernicke-Korsakoff syndrome are ataxia, oculomotor disorders, and impaired mental status ( 8 ). Thiamine is a cofactor for several enzymes and can be involved in the propagation of action potential along the axon and in the synaptic transmission ( 9 ).…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Caine criteria have been developed to diagnose Wernicke's encephalopathy, but due to the frequent overlap with Korsakoff syndrome, they can also be used to diagnose Korsakoff syndrome ( 11 ). In order to diagnose Wernicke's encephalopathy at least two of the following signs must be present: Oculomotor disorders, cerebellar dysfunction, nutritional deficiency, altered mental status or mild memory disorder ( 8 ).…”

Section: Clinical Featuresmentioning

confidence: 99%

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Korsakoff syndrome: An overlook (Review)

Rădulescu

Drăgoi

et al. 2021

Exp Ther Med

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This review aimed to analyze the latest neurobiological findings regarding Korsakoff syndrome, since alcoholism is the most prevalent addiction worldwide. In addition, we analyzed the optimal treatment that can be administered in order to minimize the symptoms and improve the outcome of these patients. The disruption of memory circuits within the brain of alcoholic patients results in the amnestic syndrome known as Korsakoff syndrome. It is generally characterized by a chronic neuropsychiatric syndrome caused by vitamin B1 (thiamine) deficiency. Other categories of patients can develop Korsakoff syndrome without consuming alcohol such as AIDS patients, terminally ill cancer patients, or patients with chronic infections and malnutrition. Vitamin B1 is required in the Krebs cycle for production of adenosine triphosphate (ATP). It is also a cofactor in the production of acetylcholine and certain neurotransmitters. Alcohol consumption can decrease the intake, gastrointestinal absorption and cellular utilization of vitamin B1. Treatment of alcohol withdrawal along with high doses of vitamin B1 can improve the general outcome of patients. A small percentage of patients can recover from Wernicke's encephalopathy with no permanent brain damage. The onset of Korsakoff syndrome darkens the prognosis. Alcohol abstinence is an absolute recommendation and prevents the extension of neural damage. Contents 1. Research methods 2. Introduction 3. Clinical features 4. Neurobiology 5. Treatment strategies 6. Conclusions Research methodsThe review started from an extensive search of Korsakoff syndrome for the last 10 years over the database PubMed ® /MEDLINE (http://www.ncbi.nlm.nih.gov/pubmed). Even if the trigger for this disease can be found in more than 2,700 scientific articles and 9 clinical trials, the Korsakoff keyword returned only 160 published scientific papers, 91 in the last 5 years and only one clinical trial. As research keywords we used 'Korsakoff' OR 'Korsakoff syndrome' OR 'Wernicke' AND 'Wernicke encephalopathy' AND 'alcohol' AND 'Thiamine' AND 'brain structures' AND 'treatment'. In the same time 'Korsakoff' search over Web of Knowledge returned 342 scientific articles but only one published in Romania. We constructed an Excel table highlighting these findings, we eliminated the duplicates, we kept the review articles because some of them bring upfront old results or ideas that are still valid and useful.

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Psychiatric Emergencies for Clinicians: Emergency Department Management of Wernicke-Korsakoff Syndrome

Cited by 13 publications

References 26 publications

Molecular mechanisms of alcohol's effects on the human body: A review and update

Molecular mechanisms of alcohol's effects on the human body: A review and update

<p>Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives</p>

Korsakoff syndrome: An overlook (Review)

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