Wernicke Encephalopathy: Khaello e Hlollang ea Thiamine (B1), Ho holofala ha Mahlo, Ataxia, le Sefi sa Glucose.¶

Wernicke encephalopathy ke boemo ba tšohanyetso ba methapo ea kutlo bo sokelang bophelo, bo nang le nako e boima bo bakoang ke ho fokotseha ho hoholo ha thiamine (vithamine B1) bokong, thalamus, 'mele ea mammillary le cerebellum. Hobane 'mele oa motho o ka boloka thiamine e lekaneng sebeteng hore e tšoarelle ** matsatsi a 14 ho isa ho a 18 ** mme e hloka thiamine pyrophosphate e le coenzyme e tlamang bakeng sa metabolism ea tsoekere ea boko, boemo leha e le bofe bo thibelang ho ja lijo tse nang le phepo e nepahetseng kapa ho potlakisa ho hlatsa ka nako e fetang libeke tse peli ho isa ho tse tharo li ka qeta mehloli ea matla a boko ka tšohanyetso. Le hoja historing e amahanngoa le bothata ba ho sebelisa joala bo sa foleng, hoo e batlang e le ** karolo ea 50 lekholong ea linyeoe tsa morao-rao tsa Wernicke encephalopathy li etsahala ho bakuli bao e seng joala **, ho kopanyelletsa le bakhachane ba nang le bokuli bo matla ba hoseng (**hyperemesis gravidarum ), bakuli ba hlaphoheloang ho tloha bariatric weight-loss surgery (gastric sleeve kapa Roux-en-Y bypass), batho ba tšoaroang ke mofets'e ka nako e telele, ba tšoaroang ke mofets'e ka nako e telele, kapa ba tšoaroang ke kankere ka nako e telele. bakuli, le bakuli ba sepetlele ba fumanang maro a tšeloang methapong a se nang livithamine. Ha e sa alafshoe, encephalopathy e matla ea Wernicke e baka tšollo ea mali e hlakileng le necrosis ea cellular mohopolong o tebileng le litsing tse ikemetseng tsa boko, e tsoela pele ka potlako ho ea ho koma, ho putlama ha pelo, lefu (ho fihlela ho karolo ea 20 lekholong ea linyeoe), kapa amnesia e ke keng ea fetoloa le confabulation e tsejoang e le ** Korsakoff80 syndrome. Haeba motho ea kotsing ea khaello ea phepo e nepahetseng kapa ho hlatsa nako e telele a ka hlaha ka tšohanyetso pherekano kapa ho hloka thahasello, ho tsamaea ho thekesela ho sa tsitsang (ataxia), kapa ho tsikinyeha/ho putlama mahlo le pono e habeli (nystagmus kapa sixth-nerve ophthalmoplegia), letsetsa sebaka sa heno. dinomoro tsa tshohanyetso hanghang. Ha u ntse u emetse baoki ba fanang ka thuso ea bongaka maemong a tšohanyetso, hlahloba litataiso tse amanang le tsona ho botahoa, botahoa, le lipalangoang tse sireletsehileng, maemo a tšohanyetso a lefu la tsoekere le hypoglycemia, le ho lemoha lefu la stroke le thuso ea pele.

Hobane ho fepa lik'habohaedreite, lino tse tsoekere, kapa dextrose (glucose) ka methapong ho ea bokong bo senyehileng ba thiamine ho ja limolek'hule tsa ho qetela tsa vithamine B1 'me ho baka necrosis ea tšohanyetso ea kelello le lactic acidosis, molao oa hau oa bohlokoa oa thuso ea pele ke ** Thiamine Pele ho Glucose soda, lipompong, kapa lijo tse nang le setache pele lingaka tsa sepetlele li fana ka tekanyo e phahameng ea thiamine ka methapo**.

Etsa sena hona joale¶

1. Letsa nomoro ea hau ea tšohanyetso ea sebakeng sa heno hang-hang 'me u tlalehe motho ea belaelloang hore ke Wernicke encephalopathy. Letsetsa 911 United States le Canada, 112 ho pholletsa le European Union, 999 United Kingdom, 000 Australia, kapa u hlahlobe lethathamo la rona la dinomoro tsa tshohanyetso. Bolela ka ho hlaka: *"Ho belaelloang hore Wernicke encephalopathy / khaello e matla ea thiamine: pherekano e matla, ho tsamaea ho sa tsitsang, le ho sisinyeha ho sa tloaelehang ha mahlo ka mor'a ho hlatsa nako e telele / ho buuoa ka matla / tšebeliso ea joala."
2. EMETSA lino-mapholi tsohle tse tsoekere, lero la litholoana, soda e tloaelehileng, lino-mapholi, lipompong, li-crackers, kapa lijo tse nang le lik'habohaedreite tse ngata hang-hang (The Glucose Trap). Ha setho sa lelapa se fokola, se akheha, kapa se ferekane ka mor'a matsatsi a mangata a ho hlatsa (joalo ka ha a le moimana kapa ka mor'a ho itlopa joala), ka tlhaho bahlokomeli ba mo fa khalase ea lero la lamunu "lero la lamunu" ho noa tsoekere, ginger kapa tsoekere ea mali. Ka khaello e matla ea thiamine, ho tlatsa mali ka tsoekere e se nang vithamine B1 ho sithabetsa potoloho ea Krebs ea bokong, e bakang ho phatloha intracellular lactic acidosis, cerebral edema, le ts'enyeho e ke keng ea lokisoa Korsakoff boko ka mor'a lihora tse seng kae.
3. Hlahloba boemo ba tsoekere maling ka letsoho la monwana haeba glucometer e le teng ('me u bolelle baoki hore mokuli o hloka IV Thiamine haufi le kapa pele ho IV Dextrose). Mokhelo feela moo tsoekere e sitoang ho ema ke ke hypoglycemia ea 'nete, e behang bophelo kotsing (tsoekere e maling e ka tlaase mona. 3.0 to 3.9 mmol/L [54 to 70 mg/dL]). Leha ho le joalo, baoki ba maemo a tšohanyetso le lingaka tsa sepetlele ba fana ka intravenous thiamine (200 ho 500 mg IV) ka nako e le 'ngoe kapa hang ka mor'a dextrose bolus kahoo boko bo na le coenzyme e hlokahalang ho chesa tsoekere ka mokhoa o sireletsehileng.
4. Thusa motho hore a lule kapa a paqame hang-hang ho thibela kotsi e mpe ea hlooho e bakoang ke cerebellar truncal ataxia. Ho Wernicke encephalopathy, tlala e khethehileng ea vermis e phahameng ea cerebellar e senya botsitso ba 'mele gyroscope (**vestibulocerebellar ataxia **); Bakuli ba atisa ho phethoha ka morao kapa ka mahlakoreng joaloka sefate se renngoeng ntle le ho ntša matsoho, ba tšoeroe ke lefu le bolaeang la subdural hematomas.
5. U SE KE UA itšetleha ka lipilisi tsa vithamine B1 tse rekisoang ka ntle ho counter ho phekola lefu la Wernicke encephalopathy. Mala a manyane a motho a monya thiamine ea molomo ka sepalangoang se lekanyelitsoeng sa sekhahla se koalang nakong ea khaello ea phepo e nepahetseng, ho ruruha ha joala, kapa ho hlatsa, ho monya ka klzzwxh:0053-0milligrams feela. Ho pholosa boko ho hloka **lethal dose le phahameng la parenteral (intravenous or iramuscular) thiamine (200 ho 500 mg IV hararo ka letsatsi)** e le hore khatello e phahameng ea mali e ka qobella thiamine e sa sebetse ho pholletsa le mokoallo oa mali le boko.
6. Sheba mocheso oa 'mele 'me u boloke motho a koahetsoe ka likobo tse ommeng ka mofuthu. Tšenyo ea posterior hypothalamus ho Wernicke encephalopathy hangata e senya thermostat e ka hare ea 'mele, e baka central hypothermia (mocheso oa mantlha oa 'mele o theohela ka tlase 35.0 C [95.0 F]) le khatello e tlaase ea mali (** wet beriberi / dysautonomia **) esita le ka hare ho kamoreng e futhumetseng.

Sefate sa qeto: pherekano e matla, ho tsamaea ho sa tsitsang, ho sisinyeha ha mahlo ka tsela e sa tloaelehang, le tlhahlobo ea thiamine¶

flowchart TD
    Start["Pherekano e Khethehileng, Tahlehelo ea Mehopolo, Motsamao o Hatellang (Ataxia), Pono e Habeli, kapa Mahlo a Jerking (Nystagmus)"] --> CheckRisk{"Mohato oa 1: Na Mokuli o na le Ntho E 'ngoe ea Kotsi ea Thiamine-Depletion (Matsatsi a 14 ho isa ho a 18 feela a ho Kena / Ho Hlatsa ho Hlokahala)?"}

    CheckRisk -->|"Pregnancy Hyperemesis Gravidarum, Bariatric Surgery (Gastric Bypass/Sleeve), Ho hlatsa nako e telele/Ho itima lijo/Tlapa, Bothata ba ho Sebelisa Joala, Bothata ba ho ja, Kankere/Chemo, kapa Dialysis"| CheckCaine{"Mohato oa 2: Sebelisa Mekhoa ea Ts'ebetso ea Caine bakeng sa Wernicke Encephalopathy (Ho Hloka 2 ea Matšoao a 4): 1. Khaello ea Lijo, 2. Matšoao a Oculomotor (Nystagmus / Eye Palsy), 3. Cerebellar Ataxia, 4. Boemo bo Fetohileng ba Kelello / Boloetse bo Bonolo ba Khopolo"}

    CheckCaine -->|"E kopana le litekanyetso tse 2 kapa ho feta tsa Caine (KAPA Letšoao lefe kapa lefe la 1 la Neuro ho Mokuli ea Kotsing e Phahameng)"| Wernicke["TSOANG ACUTE WERNICKE ENCEPHALOPATHY: Letsetsa Litšebeletso tsa Tšohanyetso (911 / 112 / 999) Hang-hang; Boemo ba Tšohanyetso ba Bongaka ho Thibela Coma le Korsakoff Amnesia e sa fetoheng"]

    CheckRisk -->|"HA HO mabaka a kotsi a phepo e nepahetseng; Ho qala ka tšohanyetso motsotso o le 1 ha sefahleho se kobehile ka lehlakoreng le le leng, ho fokola ha letsoho, kapa puo e sa hlakang."| StrokeCheck["TŠEBELETSO EA TŠEBELETSO EA TŠEBELETSO EA POSTERIOR POSTERIOR CIRCULATION STROKE: Letsetsa Litšebeletso tsa Tšohanyetso Hang-hang (Sheba Tataiso ea Stroke)"]

    Wernicke --> CheckSugar{"Mohato oa 3: Lekola Glucose ea Mali ea Monoana (Haeba Glucometer e le Teng) Pele o fana ka eng kapa eng."}

    CheckSugar -->|"Glucose ea Mali e Tloaelehile kapa e Phahameng (70 mg/dL / 3.9 mmol/L kapa ho feta) KAPA Tsoha e sa Tsejoeng le Mokuli"| NoSugar["MOLAO OA LERAO LA GLUCOSE: Fana ka Lino Tse Tsoekere tsa ZERO, ZERO Carbs, le ZERO IV Dextrose Pele Ho Tekanyetso e Phahameng ea IV Thiamine."]

    CheckSugar -->|"Boemo ba Tšohanyetso ba 'Nete ba Hypoglycemic (ka tlase ho 70 mg/dL / 3.9 mmol/L ka ho tsieleha)"| DualTreat["Phekola Hypoglycemia Hang Ha U Fana ka Tekanyo e Phahameng ea Motsoali oa Thiamine (200 ho isa ho 500 mg IV/IM) ka nako e le 'ngoe."]

    NoSugar --> HospitalBundle["Sepetlele se Phethahalang Hang-hang (EFNS / Royal College of Physicians Guidelines): 200 ho 500 mg Thiamine e Intravenous e Kentsoeng ka Metsotso e fetang 30 makhetlo a 3 ka letsatsi (600 ho 1,500 mg / letsatsi) + IV Magnesium Sulfate (Ho Hlokahala Cofactor bakeng sa Thiamine Molytoring Elefection) +"]
    DualTreat --> HospitalBundle

Pathophysiology: hobaneng mabenkele a batho a thiamine a fela ka matsatsi a 14 ho isa ho a 18 feela¶

Ho fapana le livithamini tse qhibilihang ka mafura (joalo ka livithamini A le D) kapa vithamine B12, eo sebete se e bolokang ka bongata bo ka tšoarellang lilemo tse ngata, **thiamine (vithamine B1) ke vithamine e qhibilihang ka metsing e nang le letamo le lenyenyane la polokelo ea 'mele la limiligrama tse 25 ho isa ho tse 30 **, le halofo ea bophelo ba bophelo ba matsatsi a 18 ho isa ho a 9 ho isa ho a 9. Hobane lisele tsa motho ha li khone ho kopanya thiamine le ho lahleheloa ke vithamine B1 e sa sebelisoeng ka har'a moroto letsatsi le leng le le leng, motho e moholo o hloka ho noa ho sa khaotseng letsatsi le leng le le leng ho **1.1 ho 1.5 milligrams ka letsatsi ** (ho eketseha nakong ea bokhachane, ho anyesa, feberu, hyperthyroidism, le ho ja lik'habohaedreite tse ngata).

Ha ho noa thiamine ho emisa kapa ho hlatsa ho thibela ho monya bakeng sa libeke tse ** tse peli ho isa ho tse 3**, li-enzyme tse tharo tsa bohlokoa tse itšetlehileng ka thiamine ka har'a methapo ea boko le lisele tsa glial lia sila ho fihlela li ema:

1. Pyruvate Dehydrogenase Complex (PDH): E kopanya glycolysis ho potoloho ea Krebs (citric acid); ho hlōleha ha eona ho fokotsa tlhahiso ea matla ea ATP ea aerobic le likhohola tsa methapo ea kutlo ka **lactic acid **, e bakang cytotoxic cerebral edema le ho senyeha ha mokoallo oa mali le boko.
2. Alpha-Ketoglutarate Dehydrogenase (KGDH): Enzyme e fokotsang sekhahla ka har'a potoloho ea Krebs e boetse e laola maemo a neurotransmitter **glutamate **; ho hloleha ha eona ho baka ho bokellana ho hoholo ha glutamate, ho baka excitotoxic cell death (li-neuron li ithunyetsa lefung ka lebaka la khalsiamo e ngata).
3. Transketolase: Enzyme ea bohlokoa ea tsela ea pentose phosphate, e kopanyang mashethe a myelin a kenyang likhoele tsa methapo le ho hlahisa NADPH ho sireletsa lisele tsa boko khahlanong le tšenyo ea oxidative free-radical.

Hobaneng ha libaka tse itseng tsa boko li senngoa ka mokhoa o ikhethileng (Symmetric Midline Perventricular Lesions)¶

Encephalopathy ea Wernicke ha e senye boko bohle ka ho lekana. Sebakeng seo, e baka symmetric, pinpoint hemorrhagic necrosis ka har'a mehala e mene e bohareng e moeling oa ventricle ea boraro le ea bone e tletseng mokelikeli le cerebral aqueduct (**periventricular gray matter **), e nang le phetoho e phahameng ka ho fetesisa ea tsoekere le tlhokahalo e phahameng ka ho fetisisa ea thiamine tsamaisong ea methapo:

• The Mammillary Bodies le Dorsomedial Nuclei ea Thalamus: The master relay hubs tsa Papez memory circuit; Tšenyo mona e baka pherekano e matla, ho ferekana kelellong, 'me, haeba e sa khutlisetsoe ka mor'a lihora tse seng kae ho isa ho matsatsi, ho sitoa ho etsa mehopolo e ncha (Korsakoff amnestic syndrome).
• **The Oculomotor (CN III), Trochlear (CN IV), le Abducens (CN VI) Nuclei ho Midbrain le Pons: ** Li-nuclei tsa boko tse laolang motsamao oa mahlo o hokahaneng; tshenyo mona e baka tsekaletseng le tse otlolohileng nystagmus, bilateral sixth-nerve palsy (ho se khone ho lebisa mahlo ka ntle), le conjugate haze palsies.
• The Superior Vermis of the Cerebellum and Vestibular Nuclei: Setsi sa khokahanyo bakeng sa boemo, ho leka-lekana ha kutu, le ho tsamaea; tshenyo mona e baka matla wide-based truncal and gait ataxia.
• The Posterior Hypothalamus le Dorsal Motor Nucleus ea Vagus: Setsi sa taolo ea boits'oaro; tšenyo mona e baka ** hypothermia bohareng **, hypotension orthostatic, ho phomola tachycardia (**high-output wet beriberi heart failure **), le ho putlama ka tšohanyetso ha autonomic circulatory.

Baahi ba 6 bao e seng Batahi ba Kotsing e Phahameng ("E patiloeng Wernicke Encephalopathy").¶

Hobane libuka tsa bongaka ka mashome a lilemo li ne li shebane haholo le bothata ba ho sebelisa joala bo sa foleng, lingaka le malapa a tšohanyetso a lula a hloloheloa Wernicke encephalopathy eo e seng tahi ho fihlela lefu la setopo kapa tšenyo e sa feleng ea boko e etsahala. E-ba seli ho se seng sa lihlopha tsena tse tšeletseng ka mor'a **libeke tse 2 feela tsa ho hlatsa kapa phepo e fosahetseng **:

1. Bokhachane bo nang le Boloetse bo Matla ba Hoseng (Hyperemesis Gravidarum)¶

Basali ba bakhachane ba na le liphesente tse 40 tse hlokahalang letsatsi le leng le le leng bakeng sa thiamine ho matlafatsa lesea le ka pōpelong le placenta. Ha mokhachane a e-na le hyperemesis gravidarum (ho nyekeloa ke pelo le ho hlatsa ho sa khaotseng ha pele kapa ka lekhetlo la bobeli, ho theola boima ba 'mele ho feta karolo ea 5 lekholong ea boima ba 'mele pele ho bokhachane, le ketonuria), mehloli ea hae ea sebete ea thiamine e ka theohela ho zero ka nako ea **10 ho ea ho matsatsi a 14 **. - Leraba le bohloko la sepetlele: Mokhachane ea nang le hyperemesis o ea tleliniking ea tlhokomelo e potlakileng kapa triage ea labour-and-pely dehydrated le ketotic. Haeba a fuoa mekotla ea intravenous Dextrose 5% in Lactated Ringer's or Saline (D5LR / D5NS) hammoho le meriana e thibelang ho nyekeloa ke pelo (ondansetron) ntle le pele ho thiamine ka methapo, a ka tsoha hoseng ho hlahlamang a bona habeli, a sitoa ho tsamaea, a ferekane, le ho lahleheloa ke lesea.

2. Opereishene ea ho Fokotsa Boima ba Kamor'a Bariatric ("Bariatric Beriberi")¶

Bakuli ba kileng ba etsoa Roux-en-Y gastric bypass, leeve gastrectomy, kapa biliopancreatic diversion ba kotsing e kholo pakeng tsa beke ea 2 le 16 ka mor'a ho buuoa (le lilemo hamorao haeba ba khaotsa ho noa livithamini tsa bariatric kapa ho ba le lets'ollo la mala ka ho hlatsa khafetsa). Ho feta duodenum le proximal jejunum ho tlosa sebaka sa mantlha sa anatomical moo vithamine B1 e kenngoa teng, ha ho lahleheloa ke boima ba 'mele ka potlako le ho hlatsa ha mokotla o monyenyane ka potlako ho felisa mabenkele a' mele.

3. Ho Itima Lijo Nako e Telele, Lijo tse Feteletseng tsa Fad, Tlala, le Anorexia Nervosa¶

Batho ba itimang lijo ka nako e telele feela, lijo tse feteletseng tsa ketogenic/tlala ntle le tlatsetso ea limatlafatsi tse nyane, tlala ea bolumeli kapa ea lipolotiki, kapa mathata a ho ja a senya tanka ea bona ea thiamine ea matsatsi a 18. Kotsi e kholo ka ho fetisisa e hlaha ka Letsatsi la 1 la "ho itima lijo" ha motho a ja lijo tse ngata tsa lik'habohaedreite (Refeeding Syndrome + Wernicke Precipitation).

4. Bakuli ba Oncology, Chemotherapy, le Bone Marrow Transplant¶

Lisele tsa mofetše tse arohaneng ka potlako (haholo-holo mafung a maling a mali a kang leukemia le lymphoma) li ja thiamine e ngata e potolohang, athe ho nyekeloa ke pelo ho bakoang ke chemotherapy, mucositis le anorexia li thibela ho ja lijo.

5. Bakuli ba Lipetlele ka Phepo ea Batsoali (TPN), Chronic Dialysis, kapa High-Dose Loop Diuretics¶

• **Total Parenteral Nutrition (TPN) kapa tlhokomelo ea nako e telele ea IV ea mokelikeli ** nakong ea khaello ea livithamine kapa ho siuoa ha lengolo la ngaka.
• Kalafo e Tsoelang Pele ea Replacement (CRRT) / Hemodialysis: Thiamine e qhibilihang ka metsing e tlhotloa ka potlako ho tsoa maling ho pholletsa le lera la dialysis.
• Litlhare tse phahameng tsa intravenous loop diuretics (furosemide): E baka tšenyo e matla ea moroto oa thiamine le magnesium.

6. Bothata bo sa Feleng ba Tšebeliso ea Joala¶

Joala bo senya metabolism ea thiamine ka mekhoa e mene ka nako e le 'ngoe: (1) lik'hilojule tsa joala li nka sebaka sa lijo tse nang le vithamine, (2) ethanol e holofatsa ka ho toba liprotheine tse sebetsang tsa mala (ThTr-1 le ThTr-2) ka duodenum kahoo thiamine ea molomo e fetela ka ho toba ka har'a stearhosis-sisirrhosis, le ho fokotsa sebete sa civer civer, (3) matla ka karolo ea 70 lekholong, le (4) joala bo sa foleng bo bakang ho matla ** magnesium ho fokotseha **, e thibelang lisele ho fetola thiamine e tala hore e be e sebetsang ** thiamine pyrophosphate (TPP) **.

Ho lemoha Triad ea Classic vs. The Criteria ea Ts'ebetso ea Caine (Hobaneng ho emela matšoao a 3 ho bolaea)¶

Seithuti se seng le se seng sa bongaka se ithuta Classic Triad of Wernicke Encephalopathy: (1) Encephalopathy (pherekano), (2) Ho se sebetse ha Oculomotor (ho se tloaelehe ha ho sisinyeha ha leihlo), le (3) Gait ataxia (ho tsamaea ho sa tsitsang ho sa tsitsang). Leha ho le joalo, liphuputso tse kholo tsa bohlokoa tsa autopsy (Harper et al.) li ipakile e le 'nete e nyarosang ea bongaka: **likarolo tsohle tse tharo tsa triad ea khale li teng hammoho ka liperesente tse 16 ho isa ho 33 feela tsa bakuli ** nakong ea tlhahlobo, mme **19 lekholong ea bakuli ha e na LE LE LENG la matšoao a triad a khale ** pele a oela kapa a koma.

Ho thibela lingaka le malapa ho emela lipontšo tsohle tse tharo, litataiso tsa machaba (European Federation of Neurological Societies [EFNS] le Royal College of Physicians) li laela ho sebelisa Caine Operational Criteria, e finyellang **85 ho karolo ea 97 lekholong ea kutloisiso ** ka ho hlahloba Wernicke encephalopathy4 neng kapa neng ha mokuli a e-na le 2

Mokhoa oa ho etsa leihlo la bethe la metsotsoana e 30 le ho hlahloba ho leka-lekana¶

Haeba u belaella khaello ea thiamine ho motho ea neng a hlatsa, a itima lijo, a etsoa opereishene ea bariatric, kapa a noa joala: 1. Teko ea Leihlo la ho Lata Menoana (Ho hlahloba Nystagmus le CN VI Palsy): Etsa hore motho eo a lule fatše 'me a khutsise hlooho ka ho feletseng. Tšoara monoana oa hau oa index hoo e ka bang 30 centimeters (12 inches) ka pel'a nko ea bona, 'me butle-butle u suthise monoana oa hau hole ho le letona, u tšoare metsotsoana e 3, ebe hole ho le letšehali, ebe u ea holimo le tlase. - Shebella linkho tsa mahlo haufi-ufi: na li tsubella kapa li tsokotsa ka morethetho ho ea pele le morao lintšing tsa mahlo (ho tsosoa nystagmus e rapameng)? - Na leihlo le le leng le ema moeling oa bohareng ebe le hlōleha ho retelehela ka ntle ho ea tempeleng ha mokuli a tletleba ka ho bona menoana e ’meli (xth cranial nerve [abducens] palsy)? - Karabelo ea tlhahlobo ea mohlolo: Ha thiamine e kenang ka methapo e phahameng e fanoa sepetlele, lefu la sethoathoa sa methapo ea botšelela le nystagmus hangata li qala ho ntlafala ka mokhoa o hlakileng nakong ea **2 ho isa ho lihora tse 6 **, ho netefatsa hore na o fumane eng hang-hang. 2. Tlhahlobo le Tlhahlobo ea Mehopolo ea Mantsoe a 3: Botsa motho hore na ke khoeli le selemo sefe, moo a leng teng, 'me u mo kope ho hopola lintho tse tharo tse bonolo ("Apple, Tafole, Penny"). Ba kope ho pheta mantsoe a mararo metsotso e 3 hamorao. 3. The Supported Sit-and-Stand Balance Check: Ha batho ba babeli ba eme ka mahlakoreng a mabeli ho ba tšoara, hlokomela hore na motho o thekesela ho tloha thekeng ha a lutse moeling oa bethe kapa o hloka ho ba le boemo bo pharaletseng ba maoto a arohaneng hole ho qoba ho oela morao.

Phapang ea Wernicke Encephalopathy, Korsakoff Syndrome, Beriberi e metsi / e omileng, le tahi ea joala.¶

Hobane khaello e matla ea thiamine e ka hlasela boko, methapo ea kutlo le tsamaiso ea pelo ka nako e le 'ngoe, le hobane Wernicke encephalopathy e atisa ho nkoa e le "ho tahoa" kapa "ho tlohela joala feela," sebelisa tafole ena ea papiso ea bongaka:

Kalafo e hlakileng ea sepetlele: litekanyetso tse phahameng tsa IV thiamine regimens, liphuputso tsa MRI, le Thibelo ea Refeeding Syndrome.¶

Ha mokuli ea belaelloang hore Wernicke encephalopathy a fihla lefapheng la tšohanyetso, **phekolo e qala hang-hang ka lipelaelo tsa bongaka feela ** (baoki ha ho mohla ba emelang litekanyetso tsa vithamine B1 ea mali kapa tlhahlobo ea MRI pele ba fanyeha mokotla oa pele oa thiamine e kenang methapong):

1. Hobaneng ha Thiamine ea Intravenous e phahameng (200 ho isa ho 500 mg IV TID) e tlameha ho feta litekanyetso tse tloaelehileng tsa 100 mg.¶

Ka lilemo tse mashome, li-sets'oants'o tsa sepetlele tsa khale li laetsoe "100 mg ea thiamine letsatsi le letsatsi." Lithuto tsa sejoale-joale tsa pharmacokinetic le litataiso tsa machabeng (EFNS, Royal College of Physicians, ASAM, le NICE) li pakile hore 100 mg letsatsi le letsatsi hangata ha e lekane ho thibela psychosis ea Korsakoff hobane: - Thiamine e na le halofo ea bophelo ba plasma ea ** metsotso e 96 ** feela; lethal dose e le 'ngoe ea letsatsi le letsatsi e tlosoa ka har'a moroto nakong ea lihora tse 3. - Lipalangoang tse tloaelehileng ho pholletsa le mokoallo oa mali le boko li sebelisa protheine e tsamaisang thepa e senyehang ke khaello ea phepo e nepahetseng le bokhoba ba tahi. Feela ho tšeloa ka methapo ea tekanyo e phahameng ka makhetlo a mararo ka letsatsi ho hlahisa moepa o lekaneng oa khatello maling ho qobella thiamine ho tšela mokoallo oa mali le boko ka phallo e sa sebetseng. - Melao ea Litaelo ea Semmuso ea ho Doa: - Litaelo tsa European Federation of Neurological Societies (EFNS): 200 mg ea thiamine e kenang methapong e hlapolotsoeng ka 100 mL ea saline e tloaelehileng (NEVER dextrose), e kenngoa ka metsotso e fetang 30, ka makhetlo a mararo ka letsatsi (kakaretso ea 600 mg / letsatsi) ho fihlela matšoao a khaotsa ho ntlafala. - ** UK Royal College of Physicians (RCP) / NICE / BNF Protocol (Pabrinex IV): ** **2 lipara tse peli tsa li-vithamine tsa B le C tse nang le matla a mangata (tse nang le 500 mg ea thiamine ka tekanyo) li hlapollotsoe ka 100 mL ea saline e tloaelehileng e kenngoa ho feta metsotso ea 30, ka makhetlo a mararo ka letsatsi le leng le le leng 5 mg, ho latela letsatsi le leng le le leng 5 mg, ho latela letsatsi le leng le le leng ka 5 mg 250 ho 500 mg IV/IM letsatsi le letsatsi bakeng sa matsatsi a mang a 3 ho isa ho a 5. - ** American Society of Addiction Medicine (ASAM) & Emergency Medicine Consensus: ** ** 500 mg IV e kentse metsotso e fetang 30 ka makhetlo a mararo ka letsatsi (1,500 mg / letsatsi) bakeng sa 3 ho matsatsi a 5 **, e lateloa ke **250 mg IV / IM letsatsi le letsatsi bakeng sa 3 ho matsatsi a 5 **, ebe nako e telele ea molomo oa letsatsi le letsatsi ea thiamine le thiamine ea 10 ka nako e telele.

2. Bopaki ba MRI ea Boko bo Tiisitsoeng le ho Thibela Pheliso ea Matšoao¶

Le hoja tlhahlobo e tloaelehileng ea CT e ke ke ea bona Wernicke encephalopathy, Brain MRI (FLAIR le DWI sequences) e na le 93% e ikhethang (le hoja e le karolo ea 53 lekholong feela ea kutloisiso, kahoo MRI e tloaelehileng ha ho mohla e thibelang lefu lena), e senola symmetric ** lets'oao le khanyang la hyperintense meleng ea mammillary, medial plate, gray matter * tecduct. Ka nako e le 'ngoe, ha mokuli ea' nileng a hlatsa kapa a itima lijo ka nako e fetang 7 ho matsatsi a 14 a fumana metsi le phepo e nepahetseng ka mor'a hore thiamine e qale, ho phahama ha insulin ho khanna ** phosphorus, potasiamo le magnesium ** liseleng (** Refeeding Syndrome **); lipetlele li beha leihlo le ho tlatsa li-electrolyte tsena lihora tse ling le tse ling tse 6 ho isa ho tse 12 ho thibela ho hloleha ha pelo le ho hloleha ho phefumoloha.

Linomoro tsa libaka tsa tšohanyetso le liprothokholo tsa mekhatlo¶

Ho belaelloang hore Wernicke encephalopathy e hloka sepalangoang sa hang-hang sa ambulense ho ea sepetlele Lefapheng la Tšohanyetso le khonang ho fana ka thamo e phahameng ea thiamine ea methapo, magnesium e kenang ka har'a methapo, le tlhahlobo ea electrolyte:

• United States le Canada: Letsetsa 911. Kopa lipalangoang ho ea sepetlele lefapheng la tšohanyetso (litleliniki tse ikemetseng tsa tlhokomelo e potlakileng ha se hangata li nang le li-ampules tsa thiamine tse nang le tekanyo e phahameng ea methapo). E laoloa tlas'a ** American Society of Addiction Medicine (ASAM) **, ** American College of Obstetricians and Gynecologists (ACOG Practice Bulletin No. 189 on Hyperemesis Gravidarum) **, le ** American Society for Metabolic and Bariatric Surgery (ASMBS) ** tataiso.
• United Kingdom: Letsetsa 999 kapa u ee hang-hang sepetlele se haufi Lefapha la Tšohanyetso (A&E). E laoloa tlas'a Setsi sa Sechaba sa Bophelo bo Botle le Tlhokomelo e Ntle (NICE CG100 / NG241) le Royal College of Physicians (RCP) liprothokholo tse phahameng tsa Pabrinex IV.
• European Union: Letsetsa 112. E laoloa tlas'a European Federation of Neurological Societies (EFNS) Guidelines for Diagnosis, Therapy and Prevention of Wernicke Encephalopathy.
• Australia le New Zealand: Letsetsa 000 Australia kapa 111 New Zealand. E laoloa tlas'a Royal Australian le New Zealand College of Obstetricians and Gynecologists (RANZCOG) le litataiso tsa naha tsa tahi/ phepo e nepahetseng.
• India le Asia-Pacific: Letsetsa 112 (kapa 108 India), 995 Singapore, 119 Japane le Korea Boroa, kapa 999 Malaysia le Hong Kong.

Lipotso tse botsoang khafetsa¶

Hobaneng ho fana ka tsoekere, lino tse tsoekere, kapa IV dextrose pele thiamine e mpefatsa lefu la Wernicke?¶

Lisele tsa boko li hloka vithamine B1 (ka sebopeho sa eona se sebetsang, thiamine pyrophosphate) e le spark plug e hlokahalang bakeng sa enzyme ea pyruvate dehydrogenase ho chesa tsoekere ka har'a mitochondria. Ha mabenkele a motho a thiamine a khathetse ka ho feletseng 'me a fuoa moroalo oa tšohanyetso oa tsoekere (ebang ke ka ho noa lero le monate, soda, kapa lino tsa lipapali lapeng, kapa ka ho amohela mokotlana oa dextrose o kenang methapong sepetlele), methapo ea boko e nka tsoekere ebe e e fetola pyruvate, e otlang lebota la litene tsa metabolic. Pyruvate e qabeletsoe e fetoha lactic acid e chefo ka har'a methapo ea kutlo ea thalamus, 'mele ea mammillary, le boko ba boko, e ja vithamine B1 ea ho qetela le ho baka ho ruruha ho hoholo ha boko, ho tsoa mali haholo le ho lahleheloa ke mohopolo oa Korsakoff.

Ho thoe'ng haeba motho eo ho belaelloang hore o haelloa ke thiamine LE HONA a e-na le tsoekere e tlaase e kotsi (hypoglycemia)?¶

Ke ’nete, hypoglycemia e matla (tsoekere e maling e ka tlas’a 54 ho ea ho 70 mg/dL [3.0 ho ea ho 3.9 mmol/L] e bakang ho akheha, ho akheha kapa ho tsietsana) hang-hang e beha bophelo kotsing ka mor’a metsotso e seng mekae, athe ho fokotseha ha thiamine ho senya boko ka mor’a lihora tse ngata. Ka hona, litataiso tsa morao-rao tsa meriana ea tšohanyetso li bolela hore HA U LOKELA ho thibela kapa ho liehisa tsoekere e pholosang bophelo ho mokuli ea netefalitsoeng hore o na le hypoglycemic e matla; ho e-na le hoo, lingaka le lingaka tsa maemo a tšohanyetso li fana ka dextrose ka methapo hang-hang ho pholosa boko ho tloha lefung la hypoglycemic ha ba ntse ba kenya tekanyo e phahameng ea thiamine (200 ho 500 mg IV) ka nako e ts'oanang (kapa hang-hang ka mor'a moo) kahoo boko bo na le vithamine B1 e hlokahalang ho senya tsoekere eo ka mokhoa o sireletsehileng.

Mokhachane ea nang le lefu la hoseng (hyperemesis gravidarum) kapa mokuli oa ho buuoa ka bariatric a ka hlahisa Wernicke encephalopathy kapele hakae?¶

Hobane sebete sa motho se boloka limiligrama tse 25 ho isa ho tse 30 tsa vithamine B1 e qhibilihang metsing, polokelo eohle ea motho e moholo ea phelang hantle e nka matsatsi a 14 ho isa ho a 18 feela a sa je. Ho mokhachane ea nang le hyperemesis gravidarum e matla (moo lesea le ntseng le hōla le ntseng le hōla le eketsa tlhokahalo ea thiamine ka karolo ea 40 lekholong ha ho hlatsa ho sa khaotse ho thibela ho ja lijo) kapa mokuli ea hlaphoheloang ka mor'a ho buuoa ka mpeng kapa Roux-en-Y bypass opereishene, boko bo matla ba Wernicke encephalopathy bo ka hlaha ka mor'a matsatsi a 10 ho isa ho a 21 feela a ntse a hlatsa. Mokuli leha e le ofe oa moimana kapa oa post-bariatric ea qetileng nako e fetang beke a hlatsa o tlameha ho fumana motsoako oa thiamine oa parenteral pele a amohela lero leha e le lefe le nang le dextrose.

Hobaneng o sa khone ho alafa Wernicke encephalopathy lapeng ka lipilisi tsa vithamine B1 tse rekisoang?¶

Tšilo ea lijo ea motho e monya thiamine ea molomo ka liprotheine tse tsamaisang tse khethehileng ka har'a duodenum tse nang le moeli o tiileng oa lebelo: esita le ho motho ea phetseng hantle ka ho feletseng, ho koenya letlapa le leholo la 100-milligram kapa 500-milligram vithamine B1 feela ho fella ka hoo e ka bang limiligrama tse 4,5 tse hlileng li kenang mali. Ho motho ea hlatsang, ea haelloang ke phepo e nepahetseng, opereishene ea post-bariatric, kapa ea noang joala, ho monya mala ho theoha le ho feta (ho ea tlase ho 1 milligram). Ho pholosa lisele tsa boko tse bolailoeng ke tlala sebakeng se hlobaetsang sa Wernicke encephalopathy ho hloka thiamine ea intravenous (kapa intramuscular) ea 200 ho isa ho 500 mg makhetlo a 3 ka letsatsi ho phahamisa maemo a mali ho lekana ho qobella vithamine B1 ka ho toba ho pholletsa le mokoallo oa mali le boko ka ho hasana feela.

Phapang ke efe lipakeng tsa Wernicke encephalopathy le Korsakoff syndrome?¶

Wernicke encephalopathy ke mohato o hlobaetsang, oa tšohanyetso oa bongaka oa khaello e matla ea thiamine bokong, e khetholloang ke pherekano, ho sisinyeha kapa ho holofala ha mahlo (nystagmus le pono e habeli), le ho tsamaea ho makatsang, ho sa tsitsang (ataxia). Haeba e phekoloa ka potlako ka thiamine le magnesium ea intravenous e phahameng haholo, Wernicke encephalopathy e ka khutlisoa ka botlalo. Korsakoff syndrome (Korsakoff psychosis) ke mohato o sa foleng, oa nako e telele oa lebali la boko le hlahang ho fihlela ho karolo ea 80 lekholong ea bakuli ha Wernicke encephalopathy e fosoa kapa e phekoloa morao haholo; bakuli ba lefu la Korsakoff ba lahleheloa ke bokhoni ba ho theha mehopolo leha e le efe e ncha ea nako e khutšoanyane ho tloha motsotsoana ho ea motsotsoana 'me ba sa tsebe ba iketsetsa lipale (confabulation) ho tlatsa likheo.

Hobaneng ha lingaka li fana ka magnesium e kenang methapong hammoho le thiamine e kenang ka methapong?¶

Vithamine B1 e tala e kentsoeng mothapong ha e sebetse ho fihlela enzyme e ka hare ho sele e hokela limolek'hule tse peli tsa phosphate ho e fetola thiamine pyrophosphate (TPP), 'me enzyme e' ngoe le e 'ngoe e itšetlehileng ka thiamine bokong e hloka hore li-ion tsa magnesium li sebetse. Hobane hoo e batlang e le boemo bo bong le bo bong bo bakang khaello ea thiamine (ho hlatsa ka nako e telele, hyperemesis gravidarum, opereishene ea bariatric, tlala, diuretics le tšebeliso ea joala) e boetse e hlobolisa 'mele oa magnesium, ho fana ka tekanyo e phahameng ea IV thiamine ho mokuli ea nang le magnesium e tlaase ho tšoana le ho kenya peterole ka koloing ntle le spark plug: mokuli a ke ke a fola ho fihlela a fuoa 2 g ea sulfate ea magnesium. hammoho le thiamine.

Mehloli le tataiso ea semmuso¶

• European Federation of Neurological Societies (EFNS, Europe): EFNS Guidelines for Diagnosis, Therapy and Prevention of Wernicke Encephalopathy (Glvin et al., European Journal of Neurology, Caine operational diagnostic criteria, non-alcoholic etiology prevalence, glucose precipitation physithiology TIDn0 mg physithiology)
• Royal College of Physicians (RCP) & National Institute for Health and Care Excellence (NICE, United Kingdom): Mathata a Tšebeliso ea Joala: Tlhahlobo le Tsamaiso ea Mathata a 'Mele (NICE Clinical Guideline CG100) le *RCP Report ka Wernicke-Korsakoff Syndrome in the Acute Medical-0 mg IVID ID ea motsoali * bakeng sa matsatsi a 3 ho isa ho a 5 le tsamaiso e kopanetsoeng ea magnesium).
• American College of Obstetricians and Gynecologists (ACOG, United States): ACOG Practice Bulletin No. 189: Nausea and Vomiting of Pregnancy (e tlamang intravenous thiamine 100 ho 500 mg pele ho infusion efe kapa efe ea dextrose ho basali ba bakhachane ba nang le hyperlomesis ea nako e telele e thibelang ho hlatsa kapa ho hlatsa).
• Mokhatlo oa Amerika bakeng sa Metabolic and Bariatric Surgery (ASMBS, United States): ASMBS Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient (thibelo, ho lemoha kapele, le tekanyo e phahameng ea IV thiamine pholoso protocol bakeng sa post-bariatric Wernicke encephalopathy le bariatric beriberi).
• American Society of Addiction Medicine (ASAM, United States): The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management (parenteral thiamine dosing and magnesium supplementation protocols).

Litataiso tse amanang¶

• Botahoa, botahoa, le lipalangoang tse sireletsehileng
• Maemo a tšohanyetso a lefu la tsoekere le tsoekere e tlase ea mali (hypoglycemia)
• Tlhokomeliso ea stroke (FAST) le thuso ea pele ea tšohanyetso
• Chefo ea lijo, lefu la sethoathoa se matla, le ho felloa ke metsi 'meleng
• Ho tsieleha le ho ferekana thuso ea pele