Wernicke's encephalopathy in alcoholics is cause due to?

DSSSB - 29 August 2019 (Shift-1)

Medical & Surgical Nursing

Easy

Appeared in: DSSSB - 29 August 2019 (Shift-1)

Explanation

Wernicke's encephalopathy is a neurological emergency caused by a severe deficiency of thiamine (Vitamin B1).
Thiamine is a crucial coenzyme for carbohydrate and energy metabolism in the brain.
Chronic alcoholism is the leading cause due to a combination of poor diet, impaired thiamine absorption, and reduced hepatic storage.
The condition presents with a classic triad of confusion, ataxia (gait and balance problems), and ophthalmoplegia (eye movement abnormalities).
Untreated, it can lead to the irreversible memory disorder known as Korsakoff syndrome.

Option B: Fluoride excess (fluorosis) primarily affects teeth and bones, causing dental mottling and skeletal deformities. It is not associated with acute encephalopathy.
Option C: Iodine deficiency is the primary cause of hypothyroidism and goiter (enlargement of the thyroid gland). While severe hypothyroidism can cause cognitive symptoms (myxedema coma), it does not cause the specific triad of Wernicke's encephalopathy.
Option D: Vitamin D deficiency leads to impaired calcium absorption, causing rickets in children (bone deformities) and osteomalacia in adults (bone softening and pain). It is not a cause of acute neurological syndromes like Wernicke's.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain The nutritional cause of Wernicke's encephalopathy in the context of alcoholism as background academic context rather than a clinical decision trigger.
The most critical nursing action for a patient with suspected Wernicke's encephalopathy is the prompt administration of parenteral thiamine.
A key patient safety issue is to ALWAYS give thiamine BEFORE administering any glucose-containing intravenous fluids. Giving glucose first can deplete the last reserves of thiamine and precipitate or worsen the encephalopathy.
Nurses should have a high index of suspicion for thiamine deficiency in any patient with a history of chronic alcoholism, malnutrition, or bariatric surgery who presents with acute confusion or ataxia.

How to Approach the Question

First, identify the key terms in the question: 'Wernicke's encephalopathy' and 'alcoholics'.
This is a factual recall question that asks for the direct cause of a specific medical condition.
Recall or look up the pathophysiology of Wernicke's encephalopathy. The condition is classically linked to a specific vitamin deficiency.
Consider the context: 'alcoholics'. This group is at high risk for nutritional deficiencies due to poor diet and malabsorption caused by alcohol.
Evaluate the options. Thiamine (Vitamin B1) deficiency is the well-established cause of Wernicke's encephalopathy.
Eliminate the other options by recalling the primary diseases associated with them (Fluoride -> bones/teeth, Iodine -> thyroid, Vitamin D -> bones).

Concept Tested & Keywords

Concept Tested: The nutritional cause of Wernicke's encephalopathy in the context of alcoholism.
Stem keywords: Wernicke's encephalopathy, alcoholics, cause
Lead-in keywords: BEST, MOST RELEVANT CLUE
Clinical cues: The patient population is specified as 'alcoholics', which is a major risk factor for the condition.

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 1289-1291

E6 Medicine Harrison 22e Part 2 pp. 511-513, 510-512