I-Wernicke Encephalopathy: Ukunqongophala kwe-Thiamine (B1) eAcute, i-Eye Palsy, i-Ataxia, kunye ne-Glucose Trap¶

I-Wernicke encephalopathy yimeko esongela ubomi, ixesha elibaluleke kakhulu kwi-neurological emergency ebangelwa ukuphelelwa ngamandla, ngokukhawuleza kwe-thiamine (vitamin B1)* kwi-brainstem, i-thalamus, imizimba ye-mammillary, kunye ne-cerebellum. Ngenxa yokuba umzimba womntu unokugcina kuphela i-thiamine eyaneleyo esibindini ukuze ihlale ** 14 ukuya kwiintsuku ze-18 ** kwaye idinga i-thiamine pyrophosphate njenge-coenzyme enyanzelekileyo ye-brain glucose metabolism, nayiphi na imeko ethintela ukutya okunomsoco okanye ukukhawuleza ukugabha ngaphezu kweeveki ezimbini ukuya kwezintathu kunokuphelisa ngokukhawuleza ukugcinwa kwamandla obuchopho. Ngelixa ngokwembali linxulunyaniswa nengxaki yokusetyenziswa kotywala okungapheliyo, phantse ** i-50 yeepesenti yeemeko ze-Wernicke encephalopathy zanamhlanje zenzeka kwizigulana ezingezizo utywala , kubandakanywa nabasetyhini abakhulelweyo abanesifo esibi kakhulu sasekuseni (hyperemesis gravidarum ), izigulane ezibuyela ku- ** bariatric weight-loss surgery (isisu sesisu okanye i-Roux-en-Y bypass), abantu abafumana i-chemotherapy okanye abanesifo somhlaza, ukuhlaselwa ngokukhawuleza, ukunyanzeliswa komhlaza, i-chemotherapy okanye i-chemotherapy. izigulane, kunye nezigulana ezilaliswe esibhedlele ezifumana ulwelo olufakwa emithanjeni ngaphandle kweevithamini. Ukushiywa kungaphathwanga, i-Wernicke encephalopathy ebukhali ibangela ukopha kunye ne-necrosis yeselula kwimemori enzulu kunye namaziko okuzimela kwengqondo, ukuqhubela phambili ngokukhawuleza ukuya kwi-coma, ukuwa kwe-cardiovascular, ukufa (ukuya kwiipesenti ze-20 zeemeko), okanye isigxina, i-amnesia engenakuguquleka kunye ne-confabulation eyaziwa ngokuba yi- Korsakoff8 syndrome (kwi-syndrome ye-Korsakoff80 *) Ukuba umntu osemngciphekweni wokungondleki okanye ukugabha ixesha elide uvela ngesiquphe ukubhideka okanye ukungakhathali, ukuhamba okuzinzile okusekelwe kwindawo ebanzi (ataxia), okanye ukuxhuzula/ ukunqumla amehlo kunye nokubona kabini (nystagmus okanye i-ophthalmoplegia yesithandathu), fowunela indawo ohlala kuyo. amanani kaxakeka ngoko nangoko. Ngelixa ulinde i-paramedics, jonga kwakhona izikhokelo ezinxulumeneyo ukunxila kotywala, i-hangover, kunye nesithuthi esikhuselekileyo, iimeko ezingxamisekileyo zeswekile kunye ne-hypoglycemia, kwaye ukuqaphela istroke kunye noncedo lokuqala.

Ngenxa yokuba ukondla i-carbohydrates, iziselo ezineswekile, okanye i-intravenous dextrose (iglucose) kwingqondo ephelelwe yi-thiamine kudla iimolekyuli zokugqibela ze-vitamin B1 kwaye ibangele i-brainstem necrosis ngequbuliso kunye ne-lactic acidosis, owona mgaqo wakho ubalulekileyo woncedo lokuqala ngu- ** "Thiamine Ngaphambi kweGlucose" Umgaqo oqinisekisiweyo we-hypoglycemic coma, ngaphandle kokuba umntu unike iswekile ijusi yeswekile. isoda, ilekese, okanye ukutya okunesitatshi phambi kokuba oogqirha basesibhedlele bakhuphe idosi ephezulu ye-thiamine ngemithambo**.

Yenza oku ngoku¶

1. Fowunela inombolo yakho yexesha likaxakeka ngoko nangoko kwaye uxele umrhanelwa we-Wernicke encephalopathy. Cofa u-911 eUnited States naseKhanada, 112 kulo lonke elase-European Union, 999 eUnited Kingdom, 000 e-Australia, okanye ujonge uluhlu lwethu lwe amanani kaxakeka. Yitsho ngokucacileyo: "Kurhanelwa ukuba i-Wernicke encephalopathy ebukhali / ukunqongophala okukhulu kwe-thiamine: ukudideka okukhulu, ukuhamba ngokungazinzanga, kunye nokushukuma okungaqhelekanga kwamehlo emva kokugabha ixesha elide / utyando lwe-bariatric / ukusetyenziswa kotywala."
2. YEKA zonke iziselo ezineswekile, incindi yeziqhamo, isoda eqhelekileyo, iziselo zezemidlalo, iilekese, iilekese, okanye ukutya okunecarbohydrate eninzi ngokukhawuleza (I-Glucose Trap). Xa ilungu lentsapho libuthathaka, linesiyezi, okanye libhidekile emva kweentsuku zokugabha (ezifana naxa likhulelwe okanye lisela utywala kakhulu), abakhathaleli ngokuqhelekileyo babanika iglasi yejusi yeorenji, iti yeswekile, ijinja yegazi, ijinja okanye ijinja yegazi. Xa kunqongophala kakhulu i-thiamine, ukuphuphuma kwegazi ngeglucose ngaphandle kwevithamin B1 yongamela umjikelo we-Krebs okhubazekileyo ebuchotsheni, nto leyo ebangela uqhushumbo intracellular lactic acidosis, i-cerebral edema, kunye nomonakalo ongenakulungiseka Korsakoff yobuchopho ngeeyure.
3. Jonga iqondo leswekile yegazi kwiminwe ukuba ikhona iglucometer (kwaye uxelele aboncedo lokuqala ukuba isigulane sidinga i-IV Thiamine ecaleni okanye phambi kwayo nayiphi na i-IV Dextrose). Ekuphela kwemeko apho i-glucose ayinakulinda yinyani, i-hypoglycemia ebeka ubomi esichengeni (iswekile yegazi ingezantsi 3.0 to 3.9 mmol/L [54 to 70 mg/dL]). Nangona kunjalo, i-paramedics engxamisekileyo kunye noogqirha besibhedlele balawula ** i-thiamine ye-intravenous (200 ukuya kwi-500 mg IV) ** ngaxeshanye okanye ngokukhawuleza emva kwe-dextrose bolus ukuze ingqondo ibe ne-coenzyme efunekayo ukutshisa ishukela ngokukhuselekileyo.
4. Ncedisa umntu ukuba ahlale okanye angqengqe ngokukhawuleza ukuze athintele ukwenzakala entloko kwi-cerebellar truncal ataxia. Kwi-Wernicke encephalopathy, indlala ekhethiweyo ye-cerebellar vermis ephezulu iyonakalisa ibhalansi yomzimba gyroscope (**vestibulocerebellar ataxia **); Izigulana zihlala zibhukuqa ngasemva okanye emacaleni njengomthi ogawulweyo ngaphandle kokubeka izandla zazo ngaphandle, zibulawa yi-subdural hematomas.
5. UNGAthembeli kwiipilisi ze-vitamin B1 zomlomo ezingaphaya kwe-counter ukunyanga i-Wernicke encephalopathy. Amathumbu amancinci omntu afunxa i-thiamine yomlomo ngokusebenzisa isithuthi esilinganiselweyo esivala ngexesha lokungondleki, ukuvutha kotywala, okanye ukugabha, ukufunxa kuphela 4.5 milligrams-0milligrams i-tablet. nokuba isigulane siginya i-tablet eyi-1.* Ukuhlangula ingqondo kufuna idosi ephezulu yabazali (i-intravenous okanye intramuscular) i-thiamine (200 ukuya kwi-500 mg IV kathathu ngosuku) ngoko ukugxila okuphezulu kwegazi kunokunyanzela i-thiamine ngokudlulayo kumqobo wegazi-ubuchopho.
6. Jonga iqondo lobushushu bomzimba kwaye ugcine umntu egqunywe ngokufudumeleyo ngeengubo ezomileyo. Umonakalo kwi-posterior hypothalamus kwi-Wernicke encephalopathy kudla ngokuyonakalisa i-thermostat yangaphakathi yomzimba, ibangele i-central hypothermia (ubushushu bomzimba obungundoqo buhla ngezantsi 35.0 C [95.0 F]) kunye noxinzelelo lwegazi oluphantsi (** i-beriberi emanzi / i-dysautonomia **) nangaphakathi kwegumbi elifudumeleyo.

Umthi wesigqibo: ukudideka okukhulu, ukuhamba ngendlela engazinzanga, iintshukumo zamehlo ezingaqhelekanga, kunye ne-thiamine triage¶

flowchart TD
    Start["Ukubhideka okuAcute, uLahleko lweMemori, ukuHamba okumangalisayo (i-Ataxia), umbono ophindwe kabini, okanye amehlo angcangcazelayo (Nystagmus)"] --> CheckRisk{"Inyathelo loku-1: Ngaba isigulana sinayo nayiphi na i-Thiamine-Depletion Risk Factor (Kuphela i-14 ukuya kwiintsuku ze-18 zokungenwa kakuhle / ukugabha okufunekayo)?"}

    CheckRisk -->|"Ukukhulelwa kwe-Hyperemesis Gravidarum, uTyando lweBariatric (i-Gastric Bypass / Sleeve), ukugabha ixesha elide / ukuzila ukudla / ukubetha kwendlala, ukuxhatshazwa kokusetyenziswa kotywala, ukuphazamiseka kokutya, umhlaza / i-Chemo, okanye i-Dialysis"| CheckCaine{"Inyathelo lesi-2: Faka i-Caine Operations Criteria ye-Wernicke Encephalopathy (Ifuna NAYIPHI NA i-2 ye-4 Iimpawu): 1. Ukunqongophala kokutya, 2. Iimpawu ze-Oculomotor (i-Nystagmus / i-Eye Palsy), 3. I-Cerebellar Ataxia, 4. Imeko yengqondo etshintshileyo / iMemory Memory Menor"}

    CheckCaine -->|"Udibana ne-2 okanye ngaphezulu kwe-Caine Criteria (OKANYE nayiphi na i-1 ye-Neuro Sign kwi-High-Risk Patient)"| Wernicke["OKUSOMELELWA U-WERNICKE ENCEPHALOPATHY: Tsalela umnxeba kwiiNkonzo eziNgxamisekileyo (911 / 112 / 999) Ngoko nangoko; UNgxamiseko lwezoNyango lokuThintela isiqaqa kunye neKorsakoff Amnesia engaguqulekiyo"]

    CheckRisk -->|"AKUKHO izinto ezinobungozi kwisondlo; Ngesiquphe umzuzu o-1 wokuwa kobuso kwicala elinye, ubuthathaka bengalo, okanye intetho engacacanga."| StrokeCheck["ISIFOWULO ESESIQHELEKILEYO SESIQHELEKILEYO SANGAPHAMBILI: Tsalela umnxeba iiNkonzo eziNgxamisekileyo ngoko nangoko (Jonga iSikhokelo seStroke)"]

    Wernicke --> CheckSugar{"Inyathelo lesi-3: Jonga iFingerstick Blood Glucose (ukuba iGlucometer Iyafumaneka) phambi kokuba unike nantoni na"}

    CheckSugar -->|"IGlucose yeGazi eQhelekileyo okanye ePhakamileyo (70 mg/dL / 3.9 mmol/L okanye ngaphezulu) OKANYE engaziwayo kunye neSigulana siVukile"| NoSugar["UMTHETHO WE-GLUCOSE TRAP: Nika iziselo ze-ZERO Sugary, i-ZERO Carbs, kunye ne-ZERO IV Dextrose phambi kwe-High-Dose IV Thiamine"]

    CheckSugar -->|"Imeko eNgxamisekileyo ye-Hypoglycemic yokwenyani (Ngaphantsi kwe-70 mg/dL / 3.9 mmol/L nge-stupor/seizure)"| DualTreat["Nyanga i-Hypoglycemia Ngokukhawuleza Ngelixa usebenzisa i-High-Dose Parenteral Thiamine (200 ukuya kwi-500 mg IV/IM) ngaxeshanye"]

    NoSugar --> HospitalBundle["I-Bundle yokuvuselela izibhedlele ngokukhawuleza (i-EFNS / iKholeji yaseRoyal yeziKhokelo zoGqirha): i-200 ukuya kwi-500 mg ye-Thiamine ye-Intravenous ifakwe ngaphezu kwemizuzu ye-30 ngamaxesha e-3 imihla ngemihla (i-600 ukuya kwi-1,500 mg / ngosuku) + IV Magnesium Sulfate (I-Cofactor efunekayo ye-Thiamine Molytoring Elefection) +"]
    DualTreat --> HospitalBundle

I-Pathophysiology: kutheni iivenkile zabantu ze-thiamine ziphela ngeentsuku nje ezili-14 ukuya kwezili-18¶

Ngokungafaniyo namavithamini anyibilikayo ngamafutha (afana nevithamini A kunye no-D) okanye ivithamin B12, egcinwa sisibindi ngobuninzi obukwazi ukuhlala iminyaka, ** i-thiamine (i-vitamin B1) yivithamin enyibilikayo emanzini kunye nequla elincinane lokugcina umzimba we-25 ukuya kwi-30 milligrams **, kunye ne-biological half-life of 18 days ** 9 ukuya nje. Ngenxa yokuba iiseli zomntu azikwazi ukuhlanganisa i-thiamine kwaye zilahlekelwe yi-vitamin B1 engasetyenziswanga kumchamo yonke imihla, umntu omdala ufuna ukutya okuqhubekayo kwansuku zonke ** 1.1 ukuya kwi-1.5 milligrams ngosuku ** (ukwanda ngexesha lokukhulelwa, ukuncelisa, umkhuhlane, i-hyperthyroidism, kunye nokutya okuphezulu kwe-carbohydrate).

Xa i-thiamine intake iyeka okanye ukugabha kuthintela ukufunxwa nje 2 ukuya kwiiveki ezi-3, ii-enzymes ezintathu eziphambili ezixhomekeke kwi-thiamine ngaphakathi kwee-neuron zobuchopho kunye neeseli zeglial zisila zime:

1. I-Pyruvate Dehydrogenase Complex (PDH): Idibanisa i-glycolysis kumjikelezo we-Krebs (citric acid); ukungaphumeleli kwayo kunciphisa ukuveliswa kwamandla e-ATP kunye nezikhukhula ze-neurons nge **lactic acid **, ezibangela i-cytotoxic cerebral edema kunye nokuqhekeka komqobo wegazi-ubuchopho.
2. I-Alpha-Ketoglutarate Dehydrogenase (KGDH): I-enzyme yokunciphisa izinga ngaphakathi komjikelezo we-Krebs ekwalawula amanqanaba e-neurotransmitter ** glutamate **; Ukungaphumeleli kwayo kubangela ukuqokelelana okukhulu kwe-excitotoxic ye-glutamate, kubangela ukufa kweeseli ze-excitotoxic ** (i-neuron zidubula ngokoqobo zibulale nge-calcium overload).
3. I-Transketolase: I-enzyme ephambili ye-pentose phosphate pathway, eyenza i-myelin sheaths ekhusela i-nerve fibers kwaye ivelise i-NADPH* ukukhusela iiseli zengqondo ngokuchasene nomonakalo ongenayo i-oxidative free-radical.

Kutheni imimandla ethile yobuchopho itshatyalaliswa ngokukhethiweyo (Izibonda ze-Symmetric Midline Perventricular Lesions)¶

I-Wernicke encephalopathy ayonakalisi yonke ingqondo ngokulinganayo. Endaweni yoko, ibangela i-symmetric, i-pinpoint hemorrhagic necrosis kwizakhiwo ezine zomgca ophakathi kunye nomda we-ventricles yesithathu kunye neyesine ezaliswe lulwelo kunye ne-cerebral aqueduct (**i-periventricular grey matter **), eneyona nguqu iphezulu ye-glucose ye-metabolic kunye nesidingo esiphezulu se-thiamine kwinkqubo ye-nervous:

• I-Mammillary Bodies kunye neDorsomedial Nuclei yeThalamus: Ii-master relay hubs ze Papez memory circuit; Umonakalo apha ubangela ukubhideka okukrakra, ukudideka, kwaye, ukuba akutshintshwanga phakathi kweeyure ukuya kwiintsuku, ukungakwazi okusisigxina ukwenza iinkumbulo ezintsha (Korsakoff amnestic syndrome).
• ** I-Oculomotor (CN III), iTrochlear (CN IV), kunye ne-Abducens (CN VI) Nuclei kwi-Midbrain kunye ne-Pons: ** I-nuclei ye-brainstem elawula ukunyakaza kwamehlo okuhambelanayo; umonakalo apha ubangela othe tye nathe nkqo nystagmus, bilateral sixth-nerve palsy (ukungakwazi ukuguqula amehlo ngaphandle), kunye ne-conjugate gaze palsies.
• I-Superior Vermis yeCerebellum kunye neVestibular Nuclei: Iziko lonxibelelaniso lokuma, ibhalansi yesiqu, kunye nokuhamba; umonakalo apha ubangela kakhulu i-wide-based truncal and gait ataxia.
• I-Posterior Hypothalamus kunye neDorsal Motor Nucleus yeVagus: Iziko lolawulo oluzimeleyo; umonakalo apha kubangela ** i-hypothermia ephakathi , i-orthostatic hypotension, i-tachycardia yokuphumla ( imveliso ephezulu emanzi ye-beriberi heart failure **), kunye nokuwa kwe-autonomic circulatory ngokukhawuleza.

Abantu aba-6 abangengabo utywala kuMngcipheko oMkhulu ("I-Wernicke Encephalopathy efihliweyo")¶

Ngenxa yokuba iincwadi zezifundo zonyango kumashumi eminyaka zijolise ikakhulu kwingxaki yokusetyenziswa kotywala engapheliyo, oogqirha kunye neentsapho ezingxamisekileyo zihlala ziphosakele i-Wernicke encephalopathy engeyiyo utywala de i-autopsy okanye umonakalo osisigxina wobuchopho. Hlala uthe qwa nakweliphi na kula maqela mathandathu emva kwe-eveki ezi-2 zokugabha okanye ukungondleki kakuhle*:

1. Ukukhulelwa kunye nokugula kwasekuseni okubuhlungu (Hyperemesis Gravidarum)¶

Abasetyhini abakhulelweyo bane-*40 yeepesenti ephezulu yeemfuno zemihla ngemihla ze-thiamine ** ukutshisa i-fetus ekhulayo kunye ne-placenta. Xa umfazi okhulelweyo ehlushwa ** i-hyperemesis gravidarum ** (i-hyperemesis gravidarum engapheliyo, i-nausea yokuqala okanye yesibini-i-trimester engapheliyo kunye nokuhlanza, ukulahleka kwesisindo esidlula i-5 yepesenti ye-pre-pregnancy weight, kunye ne-ketonuria), i-thiamine reserves yesibindi inokwehla ukuya kwi-zero kwi- ** 10 kwiintsuku ze-14 **. - Isibetho esibuhlungu esibhedlele: Umfazi okhulelweyo one-hyperemesis uya kwikliniki yokhathalelo olungxamisekileyo okanye i-labour-and-delivery triage dehydrated kunye ne-ketotic. Ukuba unikwe iingxowa ze- intravenous Dextrose 5% kwi-Lactated Ringer's okanye i-Saline (D5LR / D5NS) kunye neyeza lokuchasa isicaphucaphu (ondansetron) *ngaphandle kwe-thiamine efakwe emthanjeni, unokuvuka ngentsasa elandelayo ebona kabini, engakwazi ukuhamba, ukudideka, kunye nokulahleka komntwana.

2. Utyando lwasemva kweBariatric Weight-Loss ("Bariatric Beriberi")¶

Izigulane eziye zatyhubela i-Roux-en-Y gastric bypass, i-sleeve gastrectomy, okanye biliopancreatic diversion zisemngciphekweni omkhulu phakathi kwe-*iveki ye-2 kunye ne-16 emva kotyando (kunye neminyaka kamva ukuba ziyayeka ukuthatha iivithamini ze-bariatric okanye ukuphuhlisa ukuqina kwesisu ngokugabha rhoqo). Ukudlula i-duodenum kunye ne-proximal jejunum kususa indawo yokuqala ye-anatomical apho i-vitamin B1 ifunxa khona, ngelixa ukwehla kobunzima okukhawulezayo kunye ne-pouch encinci yokugabha kuphelisa ngokukhawuleza iivenkile zomzimba.

3. Ukuzila ukutya ixesha elide, ukutya okuFadi ngokugqithisileyo, ukulamba, kunye ne-Anorexia Nervosa¶

Abantu abazibandakanya kumanzi kuphela ixesha elide lokuzila ukutya, ukutya okune-ketogenic okugqithisileyo/indlala ngaphandle kokutya okunesondlo esincinci, indlala yenkolo okanye yezopolitiko, okanye ukuphazamiseka kokutya okuthinteleyo kukhupha itanki ye-thiamine yeentsuku ezili-18. Eyona ngozi inkulu ibetha ngoSuku loku-1 "lokuqhawula ukutya"* xa umntu esitya isidlo esikhulu secarbohydrates (Refeeding Syndrome + Wernicke Precipitation).

4. I-Oncology, i-Chemotherapy, kunye ne-Bone Marrow Transplant izigulane¶

Ukwahlulahlula iiseli zomhlaza ngokukhawuleza (ingakumbi kwizifo ze-hematologic ezifana ne-leukemia kunye ne-lymphoma) zidla izixa ezikhulu ze-thiamine ejikelezayo, ngelixa isicaphucaphu, i-mucositis, kunye ne-anorexia zithintela ukutya.

5. Izigulana zesibhedlele kwi-Parenteral Nutrition (TPN), i-Chronic Dialysis, okanye i-High-Dose Loop Diuretics¶

• **I-Total Parenteral Nutrition (TPN) okanye ukugcinwa kwe-IV ye-fluid ixesha elide ** ngexesha lokunqongophala kwevithamini okanye ukukhutshwa kwemiyalelo.
• Unyango lokuTshintshwa kweeRenal ngokuqhubekayo (CRRT) / Hemodialysis: Ithiamine enyibilikayo emanzini ihluzwa ngokukhawuleza ngaphandle kwegazi kwinwebu ye-dialysis.
• Idosi ephezulu ye-intravenous loop diuretics (furosemide): Ibangela inkcitho emandla yomchamo kuzo zombini i-thiamine kunye ne-magnesium*.

6. Isigulo sokuSetyenziswa koTywala okuNgapheliyo¶

Utywala buyonakalisa imetabolism ye-thiamine ngeendlela ezine zangaxeshanye: (1) iikhalori zotywala zithatha indawo yokutya okutyebileyo kwevithamini, (2) i-ethanol ikhubaza ngokuthe ngqo iiproteni zothutho lwamathumbu asebenzayo (ThTr-1 kunye ne-ThTr-2) kwi-duodenum ukuze i-thiamine yomlomo idlule ngokuthe ngqo kwi-stearhosis ye-alcohol, kunye ne-3) umthamo ngeepesenti ze-70, kunye (4) utywala obungapheliyo bubangela ubukhali ** ukuchithwa kwe-magnesium **, okuthintela iiseli ekuguquleni i-thiamine eluhlaza ibe yinto esebenzayo ** i-thiamine pyrophosphate (TPP) **.

Ukuqaphela i-Classic Triad vs. Iikhrayitheriya zokuSebenza zeCaine (Kutheni ukulinda zonke iimpawu ze-3 kuyabulala)¶

Wonke umfundi wezonyango ufunda I-Classic Triad ye-Wernicke Encephalopathy: (1) I-Encephalopathy (ukubhideka), (2) Ukungasebenzi kakuhle kwe-Oculomotor (ukuhamba kwamehlo okungaqhelekanga), kunye (3) ne-Gait ataxia (uhambo olugxadazayo olungazinzanga). Nangona kunjalo, izifundo ezinkulu ze-autopsy eziphawulekayo (Harper et al.) zibonakalise inyani eyothusayo yeklinikhi: ** zonke izinto ezintathu ze-classic triad zikhona kunye kuphela kwi-16 ukuya kwi-33 yeepesenti yezigulane ** ngexesha lokuxilongwa, kwaye ** i-19 yeepesenti yezigulane ayinayo impawu ze-triad zakudala ** phambi kokuba i-stupor okanye i-coma.

Ukuthintela oogqirha kunye neentsapho ukuba balinde zonke izibonakaliso ezintathu, izikhokelo zamazwe ngamazwe (European Federation of Neurological Societies [EFNS] kunye ne Royal College of Physicians) umyalelo usebenzisa i-Caine Operational Criteria, efezekisa 85 ukuya kwi-97 yeepesenti uvakalelo ngokuxilonga i-Wernicke encephalopathy4 nanini na i-domain* ilandelayo isigulane silandelayo: **

Indlela yokwenza iliso le-30-yesibini ecaleni kwebhedi kunye nokujonga ibhalansi¶

Ukuba ukrokrela ukusilela kwe-thiamine kumntu oye wagabha, wazila ukutya, watyandwa nge-bariatric, okanye wasela utywala: 1. Uvavanyo lweliso lokulandela umnwe (Ukukhangela iNystagmus kunye ne-CN VI Palsy): Ceba umntu ahlale phantsi kwaye agcine intloko yakhe ithule ngokupheleleyo. Bamba umnwe wakho wesalathiso malunga ne-30 yeesentimitha (i-intshi ezili-12)* phambi kwempumlo yabo, kwaye kancinane uhambise umnwe wakho ekunene, ubambe imizuzwana emi-3, uze ude uye ekhohlo, uphinde unyuse kwaye uhle. - Bukela iibhola zamehlo ngokusondeleyo: ingaba ziyagxuma okanye zixhuzule ngesingqi emva naphambili kwincam yokujonga (i-nystagmus ethe tyaba ehozisiweyo ijonge ehorizonti)? - Ngaba iliso elinye liyama kumgca ophakathi lize lisilele ukujika yonke indlela ukuya ngasetempileni ngelixa isigulana sikhalazela ukubona iminwe emibini (i-cranial nerve yesithandathu [abducens] palsy)? - Impendulo yoxilongo lommangaliso: Xa idosi ephezulu ye-thiamine ye-intravenous inikezelwa esibhedlele, i-6^th-nerve eye palsy kunye ne-nystagmus ihlala iqala ukuphucula ngokubonakalayo phakathi kwe- **2 kwiiyure ze-6 **, iqinisekisa ukuxilongwa kweso sithuba. 2. Iziqhelaniso kunye nokuJonga iMemori enamagama ama-3: Buza loo mntu ukuba yinyanga kunye nonyaka, uphi, uze umcele ukuba akhumbule izinto ezintathu ezilula ("Apple, Table, Penny"). Bacele ukuba baphinde amagama amathathu emva kwemizuzu emi-3. 3. ISit-and-Stand Balance Check: Ngabantu ababini beme macala omabini ukuze bababambe, jonga ukuba umntu uyahexa esinqeni xa ehleli elungqamekweni lwebhedi okanye ufuna ukuma okubanzi iinyawo ziqelelene kakhulu ukunqanda ukuwa ngomva.

Ukwahlula i-Wernicke Encephalopathy, i-Korsakoff Syndrome, i-Beriberi emanzi / eyomileyo, kunye nokunxiliswa kotywala¶

Ngenxa yokuba ukunqongophala kwe-thiamine kunokubetha ingqondo, imithambo-luvo, kunye nenkqubo yentliziyo ngaxeshanye, kwaye ngenxa yokuba i-Wernicke encephalopathy ihlala igxothwa "njengenxila nje" okanye "ukuyeka nje utywala," sebenzisa le theyibhile yokuthelekisa yeklinikhi:

Unyango oluchanekileyo lwesibhedlele: idosi ephezulu ye-IV thiamine regimens, iziphumo ze-MRI, kunye nothintelo lwe-Refeeding Syndrome¶

Xa isigulana esikrokreleka ukuba i-Wernicke encephalopathy sifika kwisebe likaxakeka, ** unyango luqaliswa ngokukhawuleza ngokurhanelwa kweklinikhi kuphela ** (iiklinikhi azize zilinde amanqanaba e-vitamin B1 yegazi okanye i-MRI scan ngaphambi kokuxhoma isikhwama sokuqala se-thiamine emithanjeni):

1. Kutheni i-Thiamine ye-High-Dose ye-Intravenous (200 ukuya kwi-500 mg IV TID) inyanzelekile ngaphezu kwemilinganiselo ye-100 mg¶

Kangangamashumi eminyaka, iiseti zomyalelo wesibhedlele eziphelelwe lixesha ezimiselweyo "100 mg ye-thiamine yonke imihla." Izifundo zanamhlanje ze-pharmacokinetic kunye nezikhokelo zamazwe ngamazwe (** EFNS, iRoyal College of Physicians, ASAM, kunye ne-NICE **) ibonise ukuba i-100 mg imihla ngemihla ayisoloko yanele ukukhusela i-Korsakoff psychosis kuba: - I-Thiamine ine-plasma-half-life of only **96 imizuzu **; idosi enye yemihla ngemihla iyacinywa kumchamo kwiiyure ezi-3. - Ukuthuthwa okuqhelekileyo kuwo wonke umqobo wegazi-ubuchopho kusebenzisa iprotheni ethwala i-saturable eyonakaliswe kukungondleki kunye nokusela utywala. Kuphela idosi ephezulu ye-intravenous infusions enikwa kathathu ngemini ivelisa umnqantsa owaneleyo woxinzelelo egazini ukuze inyanzelise i-thiamine kumqobo wegazi lobuchopho nge-i-passive diffusion. - Izikhokelo ezisemthethweni zokuThatha iiRejimeni: - I-European Federation of Neurological Societies (EFNS) Izikhokelo: 200 mg ye-thiamine ye-intravenous ehlanjululwe kwi-100 mL ye-saline eqhelekileyo (UNGAZE i-dextrose), ifakwe kwimizuzu engama-30, kathathu imihla ngemihla (i-600 mg / imini yonke) de iimpawu ziyeke ukuphucula. - ** I-UK Royal College of Physicians (RCP) / NICE / BNF Protocol (Pabrinex IV): ** ** i-2 izibini ze-high-potency intravenous B kunye ne-vitamin C (eziqulethe i-500 mg ye-thiamine ngedosi) ehlanjululwe kwi-100 mL ye-saline eqhelekileyo ifakwe ngaphezu kwemizuzu ye-30, kathathu ngeentsuku ze-5 / iintsuku ze-5 (i-5 mg ngosuku, i-5 yonke imihla) I-250 ukuya kwi-500 mg IV / IM imihla ngemihla enye i-3 kwiintsuku ze-5. - ** I-American Society of Addiction Medicine (ASAM) kunye ne-Emergency Medicine Consensus: ** ** i-500 mg IV ifakwe ngaphezu kwemizuzu ye-30 kathathu imihla ngemihla (1,500 mg / ngosuku) kwi-3 kwiintsuku ze-5 **, ilandelwa ngu ** 250 mg IV / IM imihla ngemihla nge-3 kwiintsuku ze-5 **, emva koko ixesha elide lomlomo we-oral thiamine kunye ne-thiamine yemihla ngemihla ye-multi-vitamin.

2. UQinisekiso lwe-Brain MRI kunye nokuthintela i-Refeeding Syndrome¶

Ngelixa i-CT scan eqhelekileyo ayikwazi ukubona i-Wernicke encephalopathy, i-Brain MRI (i-FLAIR kunye ne-DWI sequences)* ine-**** 93 yeepesenti ezicacileyo ** (nangona ipesenti ze-53 kuphela uvakalelo, ngoko ke i-MRI eqhelekileyo ayisoze igweme isifo), ityhila i-symmetric ** isibonakaliso esicacileyo se-hyperintense kwimizimba ye-mammillary, i-medial plate, i-gray thalami, i-gray matter, i-periaque Ngexesha elifanayo, xa isigulane esiye sahlanza okanye sazila ukutya ngaphezu kwe-7 kwiintsuku ze-14 sifumana i-fluid kunye nesondlo emva kokuba i-thiamine iqaliswe, ukunyuka kwe-insulin kuqhuba ** i-phosphorus, i-potassium, ne-magnesium ** kwiiseli (** Refeeding Syndrome **); izibhedlele zibeke esweni kwaye zizalise ezi electrolytes rhoqo kwi-6 kwiiyure ze-12 ukukhusela i-cardiac arrhythmias kunye nokungaphumeleli kokuphefumula.

Iinombolo zengingqi zikaxakeka kunye neeprothokholi ze-arhente¶

I-Wernicke encephalopathy ekrokrelwayo ifuna ukuthuthwa kwe-ambulensi ngokukhawuleza ukuya kwiSebe likaNgxamiseko esibhedlele elikwaziyo ukulawula idosi ephezulu ye-thiamine ye-intravenous, i-intravenous magnesium, kunye ne-electrolyte monitoring:

• I-United States neKhanada: Cofa 911. Cela isithuthi kwisebe likaxakeka esibhedlele (iikliniki ezizimeleyo zokhathalelo olungxamisekileyo azifane zibe nedosi ephezulu ye-thiamine ampules). Ukulawulwa phantsi kwe- ** I-American Society of Addiction Medicine (ASAM) **, ** I-American College of Obstetricians kunye ne-Gynecologists (i-ACOG Practice Bulletin No. 189 kwi-Hyperemesis Gravidarum) **, kunye ** i-American Society ye-Metabolic and Bariatric Surgery (ASMBS) ** izikhokelo.
• United Kingdom: Cofa 999 okanye uye ngokukhawuleza kwisibhedlele esikufutshane ISebe leNgxamiseko (A&E). Ukulawulwa phantsi kwe-klzzwxh:0083 kunye ne **Royal Coege of Physicians (RCP) i-high-dosPabrinex IV protocol.
• I-European Union: Cofa 112. Ukulawulwa phantsi ** I-European Federation ye-Neurological Societies (EFNS) Izikhokelo ze-Diagnostic, Therapy and Prevention of Wernicke Encephalopathy **.
• Ostreliya neNew Zealand: Cofa 000 e-Australia okanye 111 eNew Zealand. Ukulawulwa phantsi ** I-Royal Australian kunye neKholeji yaseNew Zealand ye-Obstetricians kunye neGynecologists (RANZCOG) ** kunye nezikhokelo zeklinikhi zotywala / zesondlo.
• ** I-Indiya kunye ne-Asia-Pacific: ** Ukudayela ** 112 ** (okanye ** 108 ** eIndiya), ** 995 ** eSingapore, ** 119 ** eJapan naseMzantsi Korea, okanye ** 999 ** eMalaysia naseHong Kong.

Imibuzo edla ngokubuzwa¶

Kutheni ukunika iswekile, iziselo ezineswekile, okanye i-IV dextrose ngaphambi kokuba i-thiamine ibe mandundu kwi-Wernicke encephalopathy?¶

Iiseli zobuchopho zifuna i-vitamin B1 (kwimo esebenzayo, i-thiamine pyrophosphate) njengeplagi yentlantsi efunekayo ye-enzyme pyruvate dehydrogenase ukutshisa i-glucose ngaphakathi kwe-mitochondria. Xa izitolo ze-thiamine zomntu ziphelile ngokupheleleyo kwaye zinikwa umthwalo weglucose ngokukhawuleza (mhlawumbi ngokusela ijusi emnandi, i-soda, okanye iziselo zezemidlalo ekhaya, okanye ngokufumana ingxowa ye-intravenous dextrose esibhedlele), i-neurons yengqondo ithatha iswekile kwaye iguqule ibe yi-pyruvate, ebetha udonga lwezitena ze-metabolic. I-pyruvate ebanjiweyo ijika ibe yityhefu ye-lactic acid ngaphakathi kwemithambo-luvo ebuthathaka yethalamus, imizimba ye-mammillary, kunye ne-brainstem, itya umkhondo wokugqibela wevithamin B1 kwaye ibangele ukudumba kwengqondo okubukhali, ukopha kakhulu, kunye nokulahleka kwenkumbulo ye-Korsakoff ngokusisigxina.

Kuthekani ukuba umntu ekucingelwa ukuba unengxaki yokunqongophala kwe-thiamine NAYE uneswekile ephantsi eyingozi ( hypoglycemia )?¶

Liyinyaniso elokuba, ihypoglycemia emandla (intonga yeswekile yegazi engaphantsi kwama-54 ukuya kuma-70 mg/dL [3.0 ukuya kwi-3.9 mmol/L] ebangela isithukuthezi, isiqaqa, okanye ukuxhuzula) ngoko nangoko ibeka ubomi esichengeni ngemizuzu nje embalwa, ngoxa ukuphela kwethiamine yonakalisa ingqondo ngeeyure. Ke ngoko, izikhokelo zonyango ezingxamisekileyo zanamhlanje zixela ukuba UNGAZE ubambe okanye ulibazise i-glucose esindisa ubomi kwisigulane esibonakaliswe ukuba si-hypoglycemic kakhulu; endaweni yoko, i-paramedics kunye noogqirha bengxamiseko balawula i-dextrose ye-intravenous ngokukhawuleza ukuze basindise ingqondo ekufeni kwe-hypoglycemic ngelixa i-injecting high-dose intravenous thiamine (200 ukuya kwi-500 mg IV) ngexesha elifanayo (okanye ngokukhawuleza emva koko) ngoko ingqondo ine-vitamin B1 efunekayo ukuze i-metabolize loo glucose ngokukhuselekileyo.