Wernicke Encephalopathy: Thiamine (B1) a Ɛho Hia Kɛse, Aniwa a Ɛyɛ Fɛ, Ataxia, ne Glucose Afiri¶

Wernicke amemene mu yare yɛ ntini mu yare a ɛde nkwa to asiane mu, a ɛho hia bere tenten a efi thiamine (vitamin B1) a ɛso tew kɛse, kɛse wɔ amemene no dua, thalamus, nufu nipadua, ne amemene mu ntini mu. Esiane sɛ onipa nipadua tumi de thiamine a ɛdɔɔso sie mmerɛbo no mu ma ɛtra hɔ nnafua 14 kosi 18 na ɛhwehwɛ thiamine pyrophosphate sɛ coenzyme a ɛyɛ ahyɛde ma amemene mu glucose a ɛsakra nti, tebea biara a esiw aduannuru a wɔde di dwuma anaasɛ ɛma ɔfe ntɛmntɛm bɛboro adapɛn abien kosi abiɛsa no betumi ama amemene no ahoɔden a wɔde asie no ayɛ mmerɛw mpofirim. Bere a abakɔsɛm mu no, ɛne nsa a wɔde di dwuma bere tenten wɔ abusuabɔ no, ɛkame ayɛ sɛ nnɛyi Wernicke amemene mu yare no ɔha biara mu nkyem 50 ba ayarefo a wɔnnom nsa mu, a mmea a wɔyem a wɔwɔ anɔpa yare a emu yɛ den (hyperemesis gravidarum), ayarefo a wɔn ho tɔ wɔn afi bariatric weight-loss surgery (gastric sleeve anaa Roux-en-Y bypass), nnipa ka ho a wɔredi mmuada bere tenten, ɔkɔm de wɔn, anaa aduan a ɛyɛ fɛ a ɛtra so, ayarefo a wɔde kokoram anaa nnuru sa yare, ne ayarefo a wɔde wɔn kɔ ayaresabea a wɔde nsu a wɔde fa ntini mu a vitamin nnim ma wɔn. Sɛ wɔansa a, Wernicke amemene mu yare a emu yɛ den no ma mogya tu ntɛmntɛm na nkwammoaa mu wuwu wɔ amemene no mmeae a emu dɔ a wɔkae ne nea ɛma ɛyɛ adwuma no, ɛkɔ so ntɛmntɛm kodu coma, koma ne ntini a ɛhwe ase, owu (wɔ nsɛm no mu bɛyɛ ɔha biara mu nkyem 20), anaasɛ nkae a ɛtra hɔ daa, a wontumi nsakra ne confabulation a wonim no sɛ Korsakoff syndrome (wɔ wɔn a wonyaa nkwa mu ɔha biara mu 80 mu). Sɛ obi a ɔwɔ asiane mu sɛ obenya aduan pa nni anaasɛ ɔbɛfe bere tenten no nya mpofirim adwene mu naayɛ anaa anibiannaso, nantew a ɛtrɛw a ɛyɛ nwonwa a entumi nnyina (ataxia), anaasɛ n’ani a ɛwosow/a ɛbɔ ne aniwa abien (nystagmus anaa ntini a ɛto so asia aniwa mu yare) a, frɛ wo mpɔtam hɔfo nɔma ahorow a egye ntɛmpɛ ntɛm ara. Bere a woretwɛn nnuruyɛfo a wɔboa nkurɔfo no, hwɛ akwankyerɛ ahorow a ɛfa ho a ɛfa nsa a wɔnom, nsa a wɔnom, ne kar a ahobammɔ wom, . asikreyare a egye ntɛmpɛ ne asikreyare a ɛkɔ fam, na stroke a wohu ne mmoa a edi kan.

Esiane sɛ carbohydrates, anonne a asikre wom, anaa dextrose (glucose) a wɔde fa ntini mu ma amemene a thiamine nnim no di vitamin B1 molecule a etwa to koraa na ɛma amemene no mu ntini a ɛyɛ mmerɛw mpofirim ne lactic acidosis ba nti, wo mmoa a edi kan mmara biako pɛ a ɛho hia sen biara ne "Thiamine Before Glucose" Mmara no: gye sɛ onipa no si so dua hypoglycemic coma wɔ mogya mu asikre mita so, MMA nsu a asikre wom, soda, ahwiesa, anaa aduan a starch wom DA ansa na ayaresabea nnuruyɛfo de thiamine a wɔde fa ntini mu a ɛboro so ama.

Yɛ eyi mprempren¶

1. Frɛ wo mpɔtam hɔ ntɛmpɛ nɔma ntɛm ara na bɔ amanneɛ sɛ wosusuw sɛ Wernicke amemene mu yare a emu yɛ den. Frɛ 911 wɔ United States ne Canada, 112 wɔ Europa Aman Nkabom no nyinaa mu, 999 wɔ United Kingdom, 000 wɔ Australia, anaa hwɛ yɛn din a yɛakyerɛw no nɔma ahorow a egye ntɛmpɛ. Ka no pefee: "Wɔsusuw sɛ Wernicke amemene mu yare a emu yɛ den / thiamine a enni nipadua mu denneennen: adwene mu naayɛ a emu yɛ den, nantew a ɛyɛ nwonwa a entumi nnyina, ne aniwa a ɛkeka ne ho a ɛnteɛ bere a woafe bere tenten / bariatric oprehyɛn / nsa a wɔnom akyi."
2. GYAE anonne a asikre wom, nnuaba mu nsu, soda a wɔnom daa, agumadi mu anonne, ahwiesa, krak, anaasɛ carbohydrate pii a wɔsan de ma no ntɛm ara (The Glucose Trap). Sɛ abusua muni bi yɛ mmerɛw, n’adwene tu fra, anaasɛ n’adwene tu fra wɔ nna pii a wafe akyi (te sɛ wɔ nyinsɛn mu hyperemesis mu anaasɛ bere a wanom nsa pii akyi) a, wɔn a wɔhwɛ no fi awosu mu de orange nsu, ginger ale, sweet kuruwa ma wɔn tii, anaa toast de "ma wɔn mogya mu asikre kɔ soro." Wɔ thiamine a enni nipadua mu kɛse mu no, glucose a vitamin B1 nnim a ɛhyɛ mogya no mu ma no bunkam Krebs kyinhyia a abubu wɔ amemene no mu no so, na ɛde intracellular lactic acidosis a ɛpae, amemene mu edema, ne Korsakoff amemene a wɔsɛe no a wontumi nsakra no ba wɔ nnɔnhwerew kakraa bi mu.
3. Hwɛ nsateaa mu mogya mu glucose dodow sɛ glucometer wɔ hɔ a (na ka kyerɛ nnuruyɛfo a wɔboa ɔyarefo no sɛ ɔyarefo no hia IV Thiamine ka IV Dextrose biara ho anaasɛ ansa na aba). Ade biako pɛ a ɛka ho wɔ baabi a glucose ntumi ntwɛn ne nokware, asikre a ɛba fam a ɛde nkwa to asiane mu (mogya mu asikre a ɛwɔ ase 3.0 to 3.9 mmol/L [54 to 70 mg/dL]). Saa bere no mpo, nnuruyɛfo a wɔboa ntɛm ne ayaresabea nnuruyɛfo de ** thiamine a wɔde fa ntini mu (200 kosi 500 mg IV)** ma bere koro mu anaasɛ wɔde ma wɔ dextrose bolus no akyi ntɛm ara ma enti amemene no nya coenzyme a ɛho hia na ama asikre no ahyew no dwoodwoo.
4. Boa onipa no ma ɔntena ase anaa ɔnda ntɛm ara na amma ne ti apira kɛse afi amemene no mu ntini a ɛyɛ mmerɛw mu no ano. Wɔ Wernicke amemene mu yare mu no, ɔkɔm a wɔpaw wɔ amemene mu ntini a ɛwɔ soro no sɛe nipadua no kari pɛ gyroscope (vestibulocerebellar ataxia); ayarefo taa hwe ase kɔ akyi anaa nkyɛn te sɛ dua a wɔatwa a wɔmfa wɔn nsa nkɔ, na wonya subdural hematomas a edi awu.
5. MMFA wo ho nto vitamin B1 nnuru a wɔnom a wɔtɔn a wɔmfa nnuru nhyɛ mu so mfa nsa Wernicke amemene mu yare a emu yɛ den. Onipa dwensɔtwaa ketewaa no twetwe thiamine a wɔnom denam ade a wɔde fa nneɛma a ɛkɔ so ntɛmntɛm a ɛto mu bere a aduan pa nni, nsa a ɛyɛ hyew, anaasɛ ɔfe, na ɛma nea wɔtwe no to 4.5 milligrams pɛ so sɛ ɔyarefo no mene 100-milligram tablet mpo a. Amemene no a wobegye no hwehwɛ ** thiamine a wɔde ma kɛse (a wɔde fa ntini mu anaa wɔde fa ntini mu) (200 kosi 500 mg IV mprɛnsa da biara)** enti mogya mu dodow a ɛkɔ soro betumi ahyɛ thiamine a ɛnyɛ hwee atwa mogya-amemene akwanside no.
6. Hwɛ nipadua no hyew na fa ntama a ɛyɛ dry nkata onipa no so ma ɛyɛ hyew. Nneɛma a ɛsɛe akyi hypothalamus wɔ Wernicke encephalopathy mu no taa sɛe nipadua no mu thermostat, na ɛde central hypothermia (core body temperature kɔ fam ba fam 35.0 C [95.0 F]) ne mogya mmoroso a ɛba fam (wet beriberi / dysautonomia) wɔ dan a ɛhɔ yɛ hyew mu mpo.

Gyinaesi dua: adwene mu naayɛ a emu yɛ den, nantew a entumi nnyina, aniwa a ɛkeka ne ho a ɛnteɛ, ne thiamine triage¶

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    Start["Basabasayɛ a Ɛyɛ Den, Nkae a Ɛyera, Nantew a Ɛyɛ Hu (Ataxia), Anisoadehu Mmienu, anaa Aniwa a Ɛtwetwe (Nystagmus) ."] --> CheckRisk{"Anamɔn 1: So Ɔyarefo Wɔ Thiamine-Depletion Asiane Factor BIARA (Nnafua 14 kosi 18 Pɛ na Ɛho Hia sɛ Ɔnnom No Yiye / Ɔfe)?"}

    CheckRisk -->|"Nyinsɛn Hyperemesis Gravidarum, Bariatric Oprehyɛn (Gastric Bypass/Sleeve), Fefe/Mmuadadi/Ɔkɔm a Ɛkyɛ, Nsa a Wɔnom, Adidi mu Nsɛnnennen, Kokoram/Chemo, anaa Dialysis"| CheckCaine{"Anamɔn 2: Fa Caine Operational Criteria di dwuma ma Wernicke Encephalopathy (Ehia Nsɛnkyerɛnne 4 no mu 2 BIARA): 1. Aduan a wonnya nni, 2. Oculomotor Signs (Nystagmus / Eye Palsy), 3. Cerebellar Ataxia, 4. Adwene mu Tebea a Ɛsakra / Nkae a Ɛnyɛ Den"}

    CheckCaine -->|"Edu Caine Criteria 2 anaa Nea ɛboro saa (ANAA Neuro Sign 1 Biara a Ɛwɔ Ɔyarefo a Asiane Kɛse Mu) ."| Wernicke["WERNICKE ENCEPHALOPATHY A WƆSUSUW sɛ WƆYƐ AKWANKYERƐ: Frɛ Dwumadibea a Ɛhwɛ Ntɛmntɛm So (911 / 112 / 999) Ntɛm ara; Aduruyɛ mu Ntɛmntɛm a Wɔde Siw Coma ne Korsakoff Amnesia a Wontumi Nsakra no Ano"]

    CheckRisk -->|"NNIPA biara nni hɔ a ɛde asiane ba aduannuru mu; Anim a ɛhwe ase wɔ ɔfã biako, nsa a ɛyɛ mmerɛw, anaasɛ kasa a ɛyɛ mmerɛw a efi ase mpofirim simma 1"| StrokeCheck["WOSUSUW AKYI CIRCULATION STROKE A ƐYƐ MMƆDENBƆ: Frɛ Nnwuma a Ɛho Hia Ntɛmntɛm (Hwɛ Stroke Guide) ."]

    Wernicke --> CheckSugar{"Anamɔn 3: Hwɛ Fingerstick Blood Glucose (Sɛ Glucometer Wɔ Hɔ) Ansa na Wobɛma Biribiara"}

    CheckSugar -->|"Mogya mu Glucose a Ɛteɛ anaasɛ Ɛdɔɔso (70 mg/dL / 3.9 mmol/L anaa nea ɛboro saa) ANAA Wonnim na Ɔyarefo Nyan"| NoSugar["GLUCOSE TRAP MMRA: Ma Nsã a Asikre nnim ZERO, Carbs ZERO, ne Dextrose ZERO IV Ansa na Woama Thiamine a Ɛdɔɔso IV"]

    CheckSugar -->|"Nokware Hypoglycemic Emergency (Ase 70 mg/dL / 3.9 mmol/L a ɛyɛ mmerɛw/akisikuru) ."| DualTreat["Sa Asikre a Ɛkɔ So Ntɛmntɛm Bere a Wode Thiamine a Ɛdɔɔso (200 kosi 500 mg IV/IM) Rema Bere Koro Mu no"]

    NoSugar --> HospitalBundle["Ayaresabea Ntɛm ara a Wɔsan de Ma Nkwa Ntɛmntɛm Bundle (EFNS / Royal College of Physicians Akwankyerɛ): 200 kosi 500 mg Thiamine a Wɔde Fa Ntini mu Bɛboro Simma 30 Mpɛn 3 Da biara (600 kosi 1,500 mg/da) + IV Magnesium Sulfate (Necessary Cofactor for Thiamine) + Electrolyte Refeeding Monitoring"]
    DualTreat --> HospitalBundle

Pathophysiology: nea enti a nnipa thiamine akorae no sa wɔ nnafua 14 kosi 18 pɛ mu¶

Nea ɛnte sɛ vitamin ahorow a srade ntumi nwura mu (te sɛ vitamin A ne D) anaa vitamin B12 a mmerɛbo no sie pii a ebetumi atra hɔ mfe pii no, thiamine (vitamin B1) yɛ vitamin a ɛtumi nwura nsuo mu a nipadua no nyinaa akoraeɛ ketewaa bi a ɛyɛ miligram 25 kɔsi 30 pɛ, na abɔdeɛ mu nkwa nna fã yɛ nnafua 9 kɔsi 18 pɛ. Esiane sɛ nnipa nkwammoaa ntumi nyɛ thiamine na wɔhwere vitamin B1 a ɛboro so a wɔmfa nni dwuma wɔ nsu mu da biara nti, ɔpanyin hia sɛ ɔkɔ so di miligram 1.1 kosi 1.5 da biara da biara (ɛkɔ soro wɔ nyinsɛn, nufu, atiridiinini, hyperthyroidism, ne carbohydrate pii a odi mu).

Sɛ thiamine a wɔnom no gyae anaasɛ ɔfe siw nea ɛbɛtwe no ano adapɛn 2 kosi 3 pɛ a, enzyme atitiriw abiɛsa a egyina thiamine so a ɛwɔ amemene no ntini ne glial nkwammoaa mu no twitwiw ma egyina:

1. Pyruvate Dehydrogenase Complex (PDH): Ɛde glycolysis bata Krebs (citric acid) kyinhyia no ho; ne huammɔdi no twa aerobic ATP ahoɔden a wɔyɛ no mu na ɛde lactic acid yiri hyɛ ntini ahorow mu, na ɛde cytotoxic cerebral edema na ɛma mogya-amemene akwanside no bubu.
2. Alpha-Ketoglutarate Dehydrogenase (KGDH): Enzyme a ɛto rate ano hye wɔ Krebs kyinhyia no mu a ɛsan nso hwɛ neurotransmitter glutamate dodow so; ne huammɔdi ma glutamate boaboa ano kɛse wɔ nkwammoaa no akyi, na ɛkanyan excitotoxic cell death (ntini ahorow a ɛtow wɔn ho tuo ankasa ma wowuwu denam calcium a ɛboro so so).
3. Transketolase: Enzyme titiriw a ɛwɔ pentose phosphate kwan no mu, a ɛyɛ myelin sheaths a ɛbɔ ntini nhama ho ban na ɛyɛ NADPH de bɔ amemene mu nkwammoaa ho ban fi oxidative free-radical damage ho.

Nea enti a wɔpaw sɛe amemene no mmeae pɔtee bi (Symmetric Midline Periventricular Lesions) .¶

Wernicke amemene mu yare no nsɛe amemene no nyinaa pɛpɛɛpɛ. Mmom no, ɛde mogya a ɛtɔ gu nipadua mu a ɛyɛ pɛpɛɛpɛ, a ɛyɛ pɛpɛɛpɛ ba mfinimfini nhyehyɛe anan a ɛyɛ pɛpɛɛpɛ a ɛne ventricles a ɛto so abiɛsa ne anan a nsu ahyɛ mu ma ne amemene mu nsu kwan (periventricular gray matter) hye so, a ɛwɔ glucose a ɛsakra wɔ nipadua no mu kɛse ne thiamine a wɔhwehwɛ kɛse wɔ ntini nhyehyɛe no mu:

• Mammillary Bodies ne Dorsomedial Nuclei a ɛwɔ Thalamus no mu: Master relay hubs a ɛwɔ Papez memory circuit no mu; ɔsɛe a ɛwɔ ha no de adwene mu naayɛ kɛse, adwene a ɛyɛ basaa, na sɛ wɔansakra no wɔ nnɔnhwerew kosi nna mu a, entumi nyɛ nkae foforo daa (Korsakoff amnestic syndrome).
• Oculomotor (CN III), Trochlear (CN IV), ne Abducens (CN VI) Nuclei a ɛwɔ Midbrain ne Pons mu: Amemene no ntini nuclei a ɛhwɛ aniwa a ɛkɔ baabiara a ɛyɛ biako so; ɔsɛe a ɛwɔ ha no de nystagmus a ɛkɔ soro ne nea ɛda fam, ntini a ɛto so asia a ɛwɔ afã abien (a wontumi nsan n’ani nkɔ abɔnten), ne conjugate gaze palsies ba.
• The Superior Vermis of the Cerebellum and Vestibular Nuclei: Beae a ɛma wogyina hɔ, dua a ɛkari pɛ, ne nantew yɛ nhyehyɛe; ɔsɛeɛ a ɛwɔ ha no de wide-based truncal ne gait ataxia a emu yɛ den ba.
• Akyi Hypothalamus ne Dorsal Motor Nucleus a ɛwɔ Vagus no mu: Autonomic control center; ɔsɛe a ɛwɔ ha no de central hypothermia, orthostatic hypotension, home tachycardia (high-output wet beriberi komayare), ne autonomic circulatory collapse mpofirim ba.

Nnipa 6 a Wɔnnom Asadweam a Wɔn Ho Yɛ Asiane Kɛse ("Hidden Wernicke Encephalopathy") .¶

Esiane sɛ na aduruyɛ ho adesua nhoma ahorow a wɔde mfe du du pii akyerɛw no twee adwene sii nsa a wɔnom a enni sabea so titiriw nti, nnuruyɛfo a wɔhwɛ wɔn a wɔwɔ ayaresa a egye ntɛmpɛ mu ne mmusua taa hwere Wernicke amemene mu yare a ɛnyɛ nsa kosi sɛ wɔbɛyɛ amu anaasɛ amemene no asɛe daa. Ma w’ani da hɔ kɛse wɔ akuw asia yi mu biara mu wɔ adapɛn 2 pɛ a woafe anaasɛ woanya aduan pa akyi:

1. Nyinsɛn a Anɔpa Yare a emu yɛ den (Hyperemesis Gravidarum) .¶

Mmea a wɔyem wɔ thiamine** a wɔhwehwɛ da biara da ɔha biara mu nkyem 40 na ama awotwaa ne awotwaa a ɛrenyin no anya ahoɔden. Sɛ ɔbea a onyinsɛn nya hyperemesis gravidarum (akisikuru ne ɔfe a ennyae wɔ ɔsram abiɛsa a edi kan anaa nea ɛto so abien mu, ne mu duru a ɛso tew boro ɔha biara mu nkyem 5 ansa na nyinsɛn no, ne ketonuria) a, thiamine a ɛwɔ ne mmerɛbo mu no betumi akɔ fam akodu zero wɔ nnafua 10 kosi 14 mu. - Ayaresabea afiri a ɛyɛ awerɛhow: Ɔbea a onyinsɛn a ɔwɔ hyperemesis kɔ ayaresabea a wɔhwɛ ntɛm anaa awo ne awo triage a nsu nnim na ɔyɛ ketotic. Sɛ wɔma no Dextrose 5% a wɔde fa ntini mu wɔ Lactated Ringer’s anaa Saline (D5LR / D5NS) nkotoku a nnuru a ekum akisikuru (ondansetron) ka ho a wɔadi kan de thiamine ahyɛ no mu a, ade kyee anɔpa no obetumi asɔre a ohu ade abien, ontumi nnantew, n’adwene tu fra, na awotwaa no hwere.

2. Oprehyɛn a Wɔyɛ wɔ Bariatric Akyi a Wɔtew So ("Bariatric Beriberi") .¶

Ayarefo a wɔayɛ wɔn Roux-en-Y gastric bypass, sleeve gastrectomy, anaa biliopancreatic diversion no wɔ asiane kɛse mu wɔ adapɛn 2 ne 16 wɔ oprehyɛn akyi (ne mfe bi akyi sɛ wogyae bariatric vitamins a wɔnom anaasɛ wonya yafunu mu akisikuru a wɔtaa fe a). Sɛ wotwa duodenum ne proximal jejunum ho a, eyi nipadua mu beae titiriw a vitamin B1 twetwe no fi hɔ, bere a mu duru a ɛso tew ntɛmntɛm ne kotoku nketewa a wɔfe no ma nipadua no mu nneɛma akorae ntɛmntɛm no.

3. Mmuadadi a Ɛkyɛ, Aduane a Ɛyɛ Fad a Ɛtra So, Ɔkɔm, ne Anorexia Nervosa¶

Ankorankoro a wɔde wɔn ho hyɛ nsu nkutoo mu mmuadadi a ɛkyɛ, ketogenic/ɔkɔm a ɛtra so crash aduan a wɔmfa aduannuru nketenkete nka ho, nyamesom anaa amammui mu ɔkɔm, anaasɛ adidi mu haw ahorow a anohyeto wom mu no sa wɔn nnafua 18 thiamine tank no. Asiane kɛse no ba Da 1 a ɛne sɛ "wobebu mmuada" bere a onipa no di aduan kɛse a carbohydrate wom (Refeeding Syndrome + Wernicke Precipitation).

4. Ayarefo a Wɔde Oncology, Chemotherapy, ne Nnompe mu Ntini Ma Wɔn¶

Kokoram nkwammoaa a ɛpaapae ntɛmntɛm (titiriw wɔ mogya mu nyarewa bɔne te sɛ mogya mu kokoram ne lymphoma mu) di thiamine a ɛkyinkyini pii, bere a akisikuru, akisikuru, ne anorexia a nnuru a wɔde sa yare de ba no siw aduan a wodi ano.

5. Ayarefo a Wɔde Wɔn Kɔ Ayaresabea a Wɔma Wɔn Aduandi a Wɔde Fa Anom (TPN), Nnuru a Wɔde Ma Wɔn a Wɔde Nsu Gu Mu a Enni Sabea, anaa Nnuru a Wɔde Di Dwuma a Wɔde Di Dwuma a Wɔde Di Dwuma a Wɔyɛ no Kɛse¶

• Total Parenteral Nutrition (TPN) anaasɛ IV nsu a wɔde hwɛ so bere tenten bere a vitamin ho ayɛ na anaasɛ wɔayi nnuru a wɔakyerɛw ama obi no.
• Continuous Renal Replacement Therapy (CRRT) / Hemodialysis: Wɔyi thiamine a ɛtumi nwura nsuo mu ntɛmntɛm fi mogya no mu fa dialysis membrane no so.
• Nnuru a wɔde fa ntini mu a wɔde fa ntini mu (furosemide): Ɛma thiamine ne magnesium nyinaa sɛe kɛse wɔ nsu mu.

6. Nsa a Wɔde Di Dwuma a Enni Sabea¶

Nsã sɛe thiamine nipadua mu nneɛma a ɛsakra no denam akwan anan a ɛkɔ so bere koro mu so: (1) nsa mu ahoɔdennuru si aduan a vitamin pii wom ananmu, (2) ethanol ma protein ahorow a ɛde dwensɔtwaa kɔ nipadua no mu a ɛyɛ adwuma (ThTr-1 ne ThTr-2) a ɛwɔ duodenum no mu no yɛ mmerɛw tẽẽ ma enti thiamine a wɔnom no kɔ tẽẽ wɔ nsu mu, (3) mmerɛbo mu yare a nsa de ba no so tew mmerɛbo mu nneɛma a wɔkora so ɔha biara mu nkyem 70, ne (4) nsa a enni sabea ma magnesium so tew kɛse, na ɛmma nkwammoaa ntumi nsakra thiamine a wɔannoa no nkɔ thiamine pyrophosphate (TPP) a ɛyɛ adwuma.

Recognizing the Classic Triad vs. the Caine Operational Criteria (Dɛn nti na sɛ wobɛtwɛn nsɛnkyerɛnne 3 no nyinaa a, edi awu) .¶

Aduruyɛ ho osuani biara sua Classic Triad of Wernicke Encephalopathy: (1) Encephalopathy (adwene mu naayɛ), (2) Oculomotor dysfunction (ani a ɛkeka ne ho a ɛnteɛ), ne (3) Gait ataxia (nantew a ɛyɛ nwonwa a entumi nnyina). Nanso, afunu mu nhwehwɛmu akɛse a ɛyɛ nwonwa (Harper ne afoforo) daa no adi sɛ ɛyɛ ayaresabea nokwasɛm a ɛyɛ ahodwiriw: nneɛma abiɛsa a ɛwɔ classic triad no nyinaa bom wɔ ayarefo ɔha biara mu 16 kosi 33 pɛ mu bere a wɔahu yare no, na ayarefo ɔha biara mu 19 nni classic triad sɛnkyerɛnne no BIARA SO ansa na wɔahwe ase akɔ stupor anaasɛ coma mu.

Sɛnea ɛbɛyɛ a nnuruyɛfo ne mmusua rentwɛn sɛnkyerɛnne abiɛsa no nyinaa no, amanaman ntam akwankyerɛ ahorow (European Federation of Neurological Societies [EFNS] ne Royal College of Physicians) hyɛ sɛ wɔmfa Caine Operational Criteria a ɛma wonya ɔha biara mu 85 kosi 97 nkate denam Wernicke encephalopathy a wohu bere biara a ɔyarefo bi anya ANY 2 of the following 4 domɛn ahorow:

Sɛnea wɔde sikɔne 30 yɛ mpa ho aniwa ne kari pɛ nhwehwɛmu¶

Sɛ wususuw sɛ thiamine nni obi a wafe, wadi mmuada, wɔayɛ no bariatric oprehyɛn, anaasɛ ɔnom nsa mu a: 1. Nsateaa-Tracking Eye Test (Checking for Nystagmus and CN VI Palsy): Ma onipa no ntena ase na ɔmma ne ti nyɛ dinn koraa. Fa wo nsateaa a wode kyerɛ ade no kura bɛyɛ sentimita 30 (nsateakwaa 12) wɔ wɔn hwene anim, na fa wo nsateaa no kɔ nifa so nkakrankakra, kura mu sikani 3, afei kɔ akyirikyiri kɔ benkum, afei kɔ soro ne fam. - Hwɛ aniwa no yiye: so ɛhuruhuruw anaasɛ ɛwosow wɔ ɔkwan a ɛyɛ dɛ so kɔ anim ne akyi wɔ aniwa no anoano (gaze-evoked horizontal nystagmus)? - So aniwa biako gyina mfinimfini na entumi nsan nkɔ abɔnten nyinaa nkɔ asɔredan no mu bere a ɔyarefo no nwiinwii sɛ ohu nsateaa abien (sixth cranial nerve [abducens] palsy)? - Anwonwade mu mmuae a wɔde hwehwɛ yare mu: Sɛ wɔde thiamine a wɔde fa ntini mu dodow a ɛkɔ soro ma wɔ ayaresabea a, aniwa a ɛto so asia a ɛyɛ mmerɛw ne nystagmus taa fi ase nya nkɔso a wotumi hu wɔ ** nnɔnhwerew 2 kosi 6** mu, na ɛkyerɛ sɛ wɔahu yare no wɔ hɔ ara. 2. Orientation ne 3-Word Memory Check: Bisa onipa no bosome ne afe a ɛyɛ, baabi a ɔwɔ, na bisa no sɛ ɔnkae nneɛma mmiɛnsa a ɛnyɛ den ("Apple, Table, Penny"). Bisa wɔn sɛ wɔnsan ntĩ nsɛmfua abiɛsa no mu simma 3 akyi. 3. The Supported Sit-and-Stand Balance Check: Bere a nnipa baanu gyina afã abien no nyinaa sɛ wɔrekyere wɔn no, hwɛ sɛ onipa no wosow fi n’asen bere a ɔte mpa no ano anaasɛ ohia gyinabea a ɛtrɛw a ne nan atrɛw akyirikyiri na amma wanhwe akyi.

Nsonsonoe a ɛda Wernicke Amemene Yare, Korsakoff Syndrome, Wet/Dry Beriberi, ne Nsa a Wɔnom¶

Esiane sɛ thiamine a enni nipadua no mu denneennen betumi abɔ amemene no, ntini a ɛwɔ akyi no, ne koma ne ntini ahorow no bere koro mu, na esiane sɛ wɔtaa bu Wernicke amemene mu yare sɛ “ɔnom nsa kɛkɛ” anaasɛ “ɔnom nsa kɛkɛ nti,” fa ayaresabea ntotoho pon yi di dwuma:

Ayaresabea ayaresa a edi mũ: thiamine a wɔde di dwuma kɛse wɔ IV mu, nea wɔahu wɔ MRI mu, ne Refeeding Syndrome a wɔde siw ano¶

Sɛ ɔyarefo bi a wosusuw sɛ ɔwɔ Wernicke amemene mu yare ba dwumadibea a wɔhwɛ ntɛmpɛ so a, wofi ase sa yare ntɛm ara wɔ ayaresabea adwenem naayɛ nkutoo so (ayaresafo ntwɛn da sɛ wobenya vitamin B1 dodow a ɛwɔ mogya mu anaasɛ MRI scan ansa na wɔde thiamine kotoku a edi kan a wɔde fa ntini mu no asɛn hɔ):

1. Nea enti a Thiamine a Wɔde Fa Ntini Mu (200 kosi 500 mg IV TID) yɛ ahyɛde sen dodow a wɔtaa de ma 100 mg¶

Mfe du du pii no, ayaresabea ahyɛde ahorow a ne bere atwam no kyerɛw " thiamine mg 100 da biara." Nnɛyi nnuruyɛ ho nhwehwɛmu ne amanaman ntam akwankyerɛ ahorow (EFNS, Royal College of Physicians, ASAM, ne NICE) daa no adi sɛ 100 mg da biara da ntaa nnɔɔso sɛ wobesiw Korsakoff adwene mu yare ano efisɛ: - Thiamine wɔ plasma fã nkwa nna yɛ simma 96 pɛ; wɔde nnuru biako pɛ a wɔde ma da biara no fi nsu no mu wɔ nnɔnhwerew 3 ntam. - Nneɛma a wɔde fa mogya ne amemene akwanside no so sɛnea ɛsɛ no de protein a ɛma nneɛma yɛ ma a ɛsɛe wɔ aduan pa a wonnya nni ne nsanom mu na edi dwuma. aduru a wɔde fa ntini mu a ɛboro so a wɔde ma mprɛnsa da biara nkutoo na ɛma mogya no mu dodow kɔ soro a ɛyɛ den sɛnea ɛbɛyɛ a ɛbɛhyɛ thiamine ma atwa mogya-amemene akwanside no denam passive diffusion so. - Official Akwankyerɛ Dosing Nhyehyɛe: - European Federation of Neurological Societies (EFNS) Akwankyerɛ: Thiamine a wɔde fa ntini mu a wɔde nkyene a ɛfata (NEVER dextrose) 100 mL afra mu mg 200, a wɔde ahyɛ mu bɛboro simma 30, mprɛnsa da biara (600 mg/da nyinaa) kosi sɛ sɛnkyerɛnne ahorow no begyae nkɔso. - UK Royal College of Physicians (RCP) / NICE / BNF Protocol (Pabrinex IV): Vitamin B ne C a ahoɔden wom kɛse a wɔde fa ntini mu (a thiamine mg 500 wom wɔ dodow biara mu) abien abien a wɔde nkyene a ɛfata 100 mL a wɔde ahyɛ mu wɔ simma 30 mu, mprɛnsa da biara (1,500 mg/da nyinaa) 3 kosi 5 nna, na wɔde 250 kosi 500 mg IV/IM di akyi da biara nnafua 3 kosi 5 bio. - American Society of Addiction Medicine (ASAM) & Emergency Medicine Consensus: 500 mg IV a wɔde gu mu mprɛnsa da biara (1,500 mg/da) nnafua 3 kosi 5, akyi no 250 mg IV/IM da biara nnafua 3 kosi 5, afei thiamine a wɔnom bere tenten (100 mg mprɛnsa da biara) ne magnesium ne multivitamin a wɔde ma da biara da.

2. Amemene mu MRI a Wosi so dua ne Refeeding Syndrome a Wosiw Ano¶

Bere a CT scan a ɛfata ntumi nhu Wernicke amemene mu yare no, Amemene MRI (FLAIR ne DWI ntoatoaso) wɔ ɔha biara mu nkyem 93 pɔtee (ɛwom sɛ ɔha biara mu nkyem 53 pɛ na ɛyɛ nkate, enti MRI a ɛteɛ no nnye yare no ntom da), na ɛda symmetric bright hyperintense sɛnkyerɛnne adi wɔ nufu nipadua, medial thalami, tectal plate, ne periqueductal mu ade a ɛyɛ fitaa. Bere koro no ara mu no, sɛ ɔyarefo bi a wafe anaasɛ wadi mmuada bɛboro nnafua 7 kosi 14 nya nsu ne aduannuru bere a wɔafi thiamine ase akyi a, insulin a ɛkɔ soro no ma phosphorus, potassium, ne magnesium kɔ nkwammoaa mu (Refeeding Syndrome) ayaresabea ahorow hwɛ saa electrolytes yi so na wɔsan hyɛ mu ma nnɔnhwerew 6 kosi 12 biara na wɔasiw koma a ɛnyɛ den ne ɔhome a entumi nyɛ adwuma yiye ano.

Mpɔtam hɔ ntɛmpɛ nɔma ne adwumakuw no nhyehyɛe ahorow¶

Wosusuw sɛ Wernicke amemene mu yare no hwehwɛ sɛ wɔde ambulance kɔ ayaresabea ntɛm ara Dwumadibea a Ɛhwɛ Ntɛmntɛm a ebetumi de ** thiamine a wɔde fa ntini mu dodow a ɛkɔ soro, magnesium a wɔde fa ntini mu, ne electrolyte a wɔde hwɛ so**:

• United States ne Canada: Frɛ 911. Bisa sɛ wode wo bɛkɔ ayaresabea dwumadibea a wɔhwɛ ntɛmpɛ so (ayaresabea ahorow a wɔhwɛ wɔn a egye ntɛmpɛ a wɔde wɔn ho no ntaa mfa thiamine ampules a wɔde fa ntini mu dodow a ɛdɔɔso nsie). Wɔhwɛ so wɔ Amerika Fekuw a Ɛhwɛ Aduruyɛ a Ɛhwɛ Nneɛma a Wɔde Yɛ Adwuma So (ASAM), Amerika Awo ne Mmea Ho Nnuruyɛfo Kuw (ACOG Practice Bulletin No. 189 on Hyperemesis Gravidarum), ne Amerika Fekuw a Ɛhwɛ Nkwammoaa ne Bariatric Oprehyɛn So (ASMBS) akwankyerɛ ase.
• United Kingdom: Frɛ 999 anaa kɔ ayaresabea a ɛbɛn wo ntɛm ara Emergency Department (A&E). Wɔhwɛ so wɔ Ɔman Asoɛe a Ɛhwɛ Akwahosan ne Ɔhwɛ a Ɛyɛ Paara So (NICE CG100 / NG241) ne Royal College of Physicians (RCP) Pabrinex IV a wɔde di dwuma kɛse ho nhyehyɛe ahorow ase.
• Europa Aman Nkabom: Dial 112. Wɔhwɛ so wɔ Europa Fekuw a Ɛhwɛ Ntini Ho Nsɛm So (EFNS) Akwankyerɛ a Ɛfa Wernicke Amemene mu Yare a Wɔhwehwɛ, Wɔsa na Wɔsiw Ano ase.
• Australia ne New Zealand: Frɛ 000 wɔ Australia anaa 111 wɔ New Zealand. Wɔhwɛ so wɔ Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG) ne ɔman nsa/aduan pa ho ayaresabea akwankyerɛ ase.
• India ne Asia-Pacific: Trɛ 112 (anaasɛ 108 wɔ India), 995 wɔ Singapore, 119 wɔ Japan ne South Korea, anaa 999 wɔ Malaysia ne Hong Kong.

Nsɛm a wɔtaa bisa¶

Dɛn nti na glucose, anonne a asikre wom, anaa IV dextrose a wɔde ma ansa na thiamine ayɛ no ma Wernicke amemene mu yare no yɛ kɛse?¶

Amemene mu nkwammoaa hia vitamin B1 (wɔ nea ɛyɛ adwuma, thiamine pyrophosphate) sɛ ogyaframa a ɛho hia ma enzyme pyruvate dehydrogenase a ɛbɛhyew glucose wɔ mitochondria no mu. Sɛ obi thiamine akorae no sa koraa na wɔma no glucose adesoa mpofirim (sɛ́ ɛyɛ nsu a ɛyɛ dɛ, soda, anaa agumadi mu anonne a wɔnom wɔ fie, anaasɛ dextrose kotoku a wɔde fa ntini mu wɔ ayaresabea) so no, amemene no mu ntini ahorow no fa asikre no na ɛdan no pyruvate, na ɛbɔ birikisi fasu a ɛma nipadua no yɛ adwuma no. Pyruvate a wɔakyere no no dan lactic acid a awuduru wom wɔ thalamus, nufusu nipadua, ne amemene no ntini a ɛyɛ mmerɛw no mu, na edi vitamin B1 kakraa bi a etwa to na ɛkanyan amemene no hohoro denneennen, mogya a ɛtɔ pintinn, ne Korsakoff nkae a ɛyera daa.

Na sɛ obi a wosusuw sɛ thiamine nni no SAN nso wɔ asikre a ɛba fam wɔ mogya mu (hypoglycemia) nso ɛ?¶

Nokwarem no, asikre a ɛba fam kɛse (nsateaa mu mogya mu glucose a ɛba fam sen 54 kosi 70 mg/dL [3.0 kosi 3.9 mmol/L] a ɛma obi ho popo, kɔ koma, anaasɛ akisikuru) de nkwa to asiane mu ntɛm ara wɔ simma kakraa bi mu, bere a thiamine a ɛso tew no sɛe amemene no nnɔnhwerew pii. Enti, nnɛyi nnuruyɛ a egye ntɛmpɛ ho akwankyerɛ ahorow ka sɛ ɛnsɛ sɛ wode glucose a egye nkwa sie anaasɛ wotwentwɛn so DA wɔ ɔyarefo a wɔada no adi sɛ asikreyare a ɛkɔ fam kɛse no mu; mmom no, nnuruyɛfo a wɔboa nkurɔfo ne nnuruyɛfo a wɔhwɛ ntɛmpɛ de dextrose fa ntini mu ntɛm ara de gye amemene no fi owu a ɛma asikre a ɛba nipadua mu no mu bere a wɔde thiamine a wɔde fa ntini mu dodow a ɛkɔ soro (200 kosi 500 mg IV) gu nipadua no mu bere koro no ara pɛpɛɛpɛ (anaasɛ ɛno akyi pɛɛ) ma enti amemene no nya vitamin B1 a ehia na ama saa glucose no ayɛ adwuma dwoodwoo no.

Ɔbea a onyinsɛn a ɔwɔ anɔpa yare (hyperemesis gravidarum) anaa ɔyarefo a wɔayɛ no oprehyɛn a ɛma ne ho yɛ den no betumi anya Wernicke amemene mu yare ntɛmntɛm dɛn?¶

Esiane sɛ onipa mmerɛbo no sie vitamin B1 a ɛtumi nwura nsuo mu miligram 25 kɔsi 30 pɛ nti, ɔpanyin a ɔwɔ apɔmuden a ɔde asie no nyinaa di nnafua 14 kɔsi 18 pɛ a ɔnni. Wɔ ɔbea a onyinsɛn a ɔwɔ hyperemesis gravidarum a emu yɛ den (baabi a akokoaa a ɔrenyin no ma thiamine a wɔhwehwɛ no yɛ kɛse ɔha biara mu nkyem 40 bere a ɔfe a onnyae no mma ontumi nni aduan) anaa ɔyarefo a ne ho retɔ no wɔ yafunu mu nsateaa anaa Roux-en-Y bypass oprehyɛn mu no, Wernicke amemene mu yare a emu yɛ den betumi aba bere a ɔde nnafua 10 kosi 21 pɛ akɔ so afe akyi. Ɛsɛ sɛ ɔyarefo biara a onyinsɛn anaasɛ wayɛ bariatric akyi a wafe bɛboro dapɛn biako no nya thiamine a wɔde ma wɔ anom ansa na wama no nsu biara a dextrose wom a wɔde fa ntini mu.

Dɛn nti na wuntumi mfa vitamin B1 nnuru a wɔtɔn a wɔmfa nnuru nni dwuma wom nsa Wernicke amemene mu yare a emu yɛ den wɔ fie?¶

Onipa aduan mu ntini no twetwe thiamine a wɔnom denam protein titiriw a ɛde nneɛma kɔ mogya mu a ɛwɔ ahoɔhare anohyeto a ɛyɛ katee so: wɔ obi a ɔwɔ apɔwmuden koraa mpo mu no, sɛ obi mene vitamin B1 aduru kɛse a emu duru yɛ miligram 100 anaa miligram 500 a, ɛma bɛyɛ miligram 4.5 pɛ na ɛkɔ mogya no mu ankasa. Wɔ obi a ɔrefe, onni aduan pa nni, wɔayɛ no oprehyɛn a ɛma obi ho yɛ hyew akyi, anaasɛ ɔnom nsa fam no, nea ɛtwetwe ne dwensɔtwaa no so tew mpo (ennu miligram 1). Sɛ wobegye amemene mu nkwammoaa a ɔkɔm de wɔn wɔ Wernicke amemene mu yare a emu yɛ den mu a, ɛhwehwɛ sɛ wɔde thiamine dodow a ɛkɔ soro fa ntini mu (anaasɛ wɔde fa ntini mu) (200 kosi 500 mg a wɔde ma mpɛn 3 da biara) na ama mogya mu dodow akɔ soro araa ma ɛbɛhyɛ vitamin B1 tẽẽ atwa mogya ne amemene no akwanside no so denam trɛw a ɛnyɛ adwuma so.

Nsonsonoe bɛn na ɛda Wernicke amemene mu yare ne Korsakoff yare no ntam?¶

Wernicke amemene mu yare yɛ adeyɛ a emu yɛ den, a ɛyɛ aduruyɛ-ntɛmpɛ a ɛma thiamine a enni amemene no mu kɛse, a nea ɛda nsow ne adwene a ɛyɛ basaa, aniwa a ɛwosow anaasɛ ɛyɛ obubuafo (nystagmus ne aniwa abien), ne nantew a ɛyɛ nwonwa a entumi nnyina (ataxia). Sɛ wɔde thiamine ne magnesium a wɔde fa ntini mu dodow a ɛdɔɔso sa ntɛm ara a, Wernicke amemene mu yare no tumi dan koraa. Korsakoff syndrome (Korsakoff adwene mu yare) yɛ amemene no mu akuru ntini a ɛyɛ den a ɛtra hɔ daa a ɛba ayarefo bɛyɛ ɔha biara mu nkyem 80 mu bere a Wernicke amemene mu yare no ayera anaasɛ wɔasa no akyiri dodo no; ayarefo a wɔwɔ Korsakoff yare no hwere tumi a wɔde bɛyɛ bere tiaa mu nkae foforo biara fi bere biara mu na wɔyɛ nsɛm (confabulation) a wonnim de hyɛ mmeae a ɛda hɔ no ma.

Dɛn nti na nnuruyɛfo de magnesium a wɔde fa ntini mu ka thiamine a wɔde fa ntini mu ho?¶

Vitamin B1 a wɔannoa a wɔde gu ntini no mu no nyɛ adwuma wɔ abɔde mu kosi sɛ enzyme bi a ɛwɔ nkwammoaa no mu bɛbata phosphate molecule abien ho ma adan thiamine pyrophosphate (TPP), na enzyme biara a egyina thiamine so a ɛwɔ amemene no mu no hia magnesium ions na ama ayɛ adwuma. Efisɛ ɛkame ayɛ sɛ tebea biara a ɛma thiamine nnim (ɔfe a ɛkyɛ, hyperemesis gravidarum, bariatric oprehyɛn, ɔkɔm, nnuru a ɛma obi ho yɛ hyew, ne nsa a wɔnom) nso ma magnesium fi nipadua no mu, na ɛma obi a magnesium sua no thiamine dodow a ɛkɔ soro wɔ IV mu no te sɛ nea wɔde pɛtro bɛhyɛ kar a spark plug mu: ɔyarefo no ho rennya ahoɔden kosi sɛ wɔde magnesium bɛhyɛ ne ntini mu wɔde sulfate (gram 1 kosi 2 IV) ma ka thiamine no ho.

Fibea ne aban akwankyerɛ¶

• European Federation of Neurological Societies (EFNS, Europe): EFNS Akwankyerɛ a ɛfa Wernicke Encephalopathy a Wɔbɛhwehwɛ, Ayaresa ne Ne Siw Ho (Galvin ne ne mfɛfo, European Journal of Neurology, Caine oprehyɛn mu nhwehwɛmu gyinapɛn, nea ɛde ba a ɛnyɛ nsa, glucose precipitation physiology, ne 200 mg IV TID thiamine nhyehyɛe a wɔde di dwuma).
• Royal College of Physicians (RCP) & National Institute for Health and Care Excellence (NICE, United Kingdom): Nsa a Wɔde Di Dwuma Ho Nsɛnnennen: Nipadua mu Nsɛnnennen a Wɔhwehwɛ ne Nea Wɔhwɛ So (NICE Ayaresabea Akwankyerɛ CG100) ne RCP Amanneɛbɔ a ɛfa Wernicke-Korsakoff Syndrome ho wɔ Acute Medical Setting (high-dose parenteral thiamine 500 mg IV TID nnafua 3 kosi 5 ne magnesium a ɛyɛ ahyɛde a wɔde ka bom).
• American College of Obstetricians and Gynecologists (ACOG, United States): ACOG Practice Bulletin No. 189: Nausea and Vomiting of Pregnancy (ahyɛde sɛ wɔde thiamine 100 kosi 500 mg fa ntini mu ansa na wɔde dextrose biara ahyɛ mmea a wɔyem a wɔfe kyɛ anaasɛ hyperemesis gravidarum mu de asiw Wernicke ano amemene mu yare).
• American Society for Metabolic and Bariatric Surgery (ASMBS, United States): ASMBS Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient (asiw ano, wohu no ntɛm, ne IV thiamine dodow a ɛkɔ soro a wɔde gye nkwa ho nhyehyɛe ma Wernicke amemene mu yare a ɛba fam akyi ne bariatric beriberi).
• Amerika Fekuw a Ɛhwɛ Nnuruyɛ a Ɛhwɛ Aduru a Ɛma Nnipa Yɛ Adwuma So (ASAM, United States): ASAM Ayaresabea Nneyɛe Akwankyerɛ a Ɛfa Nsa a Wɔtwe Fi Ase Ho (anom thiamine dodow ne magnesium a wɔde ma ho nhyehyɛe).

Akwankyerɛ ahorow a ɛfa ho¶

• Nsã a wɔnom, nsa a wɔnom, ne kar a ahobammɔ wom
• Asikreyare a egye ntɛmpɛ ne asikre a ɛba mogya mu (hypoglycemia) .
• Stroke recognition (FAST) ne mmoa a edi kan a wɔde ma ntɛm ara
• Aduan mu awuduru, yafunu mu yare a emu yɛ den, ne nsu a ɛho ntew
• Akisikuru ne akisikuru mmoa a edi kan