Wernicke's encephalopathy occurs in alcoholic patient due to deficiency of?

Appeared in: NORCET 3 - 2022 (Shift-1)

Explanation

Wernicke's encephalopathy is a neurological emergency caused by a severe deficiency of thiamine (Vitamin B1).
Chronic alcoholism is the most common cause in developed countries because it impairs thiamine absorption, storage, and utilization.
Thiamine is a vital coenzyme in brain glucose and lipid metabolism; its absence leads to neuronal injury and the classic triad of confusion, ataxia, and ophthalmoplegia.
The condition is reversible with prompt thiamine administration, but delay can lead to irreversible brain damage (Korsakoff syndrome) or death.

Option A: Niacin (Vitamin B3) deficiency causes pellagra, not Wernicke's encephalopathy.
Option C: Folic acid (Vitamin B9) deficiency is also common in alcoholism but primarily leads to megaloblastic anemia and is not the direct cause of Wernicke's encephalopathy.
Option D: Riboflavin (Vitamin B2) deficiency results in a condition called ariboflavinosis.

Clinical Relevance

Nursing practice connection: Use the key finding related to Wernicke's encephalopathy and its association with vitamin deficiency in alcoholism to guide bedside assessment, documentation, and the next nursing action.
A critical patient safety principle for nurses is to administer thiamine BEFORE glucose to any patient with suspected thiamine deficiency (e.g., from alcoholism, malnutrition, or hyperemesis gravidarum).
Giving glucose first can rapidly consume the last reserves of thiamine for its metabolism, acutely precipitating or worsening Wernicke's encephalopathy.
What if? If a confused alcoholic patient is brought to the emergency department and needs IV fluids for dehydration, the nurse's priority action is to advocate for and administer IV thiamine before starting the dextrose-containing infusion.

How to Approach the Question

First, identify the key terms in the question: 'Wernicke's encephalopathy' and 'alcoholic patient'.
Recognize that Wernicke's encephalopathy is a specific neurological syndrome with a well-known cause.
Recall the link between chronic alcoholism and nutritional deficiencies, particularly B vitamins.
Systematically review the options. Associate each vitamin with its classic deficiency disease.
Niacin is linked to Pellagra. Folic acid to megaloblastic anemia. Riboflavin to ariboflavinosis.
Conclude that Thiamine is the vitamin directly responsible for Wernicke's encephalopathy.

Concept Tested & Keywords

Concept Tested: Wernicke's encephalopathy and its association with vitamin deficiency in alcoholism.
Stem keywords: Wernicke's encephalopathy, alcoholic patient, deficiency
Lead-in keywords: due to
Clinical cues: The patient's history of alcoholism is a major clue pointing towards a thiamine deficiency.

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E6 Medicine Davidson Principles Practice 24e p. 734-736

E6 Medicine Harrison 22e Part 2 p. 510-512

E6 textbook of Applied Biochemistry and Nutrition & DieteticsHarbans Lal (pp 26-464 of 479) p. 366-368

Practise the full NORCET 3 - 2022 (Shift-1)

Attempt every question from this paper in a timed mock, then review the full solution for each one.