USMLE Wernicke-Korsakoff syndrome and beri-beri (dry vs wet)

[Vardy]

I can sort of make out and understand the underlying mechanisms of how thiamine deficiency can present in 3 different ways (WK syndrome, Dry beri-beri, and Wet beri-beri). And from FA, thiamine deficiency is associated with two groups of people, those who are alcoholics and those who are malnourished.

Is it correct to say that when due to Alcoholism, the result is WK syndrome (without the beri-beri stuff). And when due to being malnourished, the result is beri-beri: In the initial stages, it starts as dry beri beri, which can then progress to wet beri beri if not treated?

Is this correct, or an oversimplification?

It just irritates me how deficiency of the same vitamin can lead to two different presentations, depending on whether or not alcoholism was involved. I'm sure there is more to the story going on!

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[faisal 2000]

i have seen patient with severe recurrent vomiting get wk syndrome.
any ideas doctors

@Phloston
@Transposony

 

[Phloston]

I can sort of make out and understand the underlying mechanisms of how thiamine deficiency can present in 3 different ways (WK syndrome, Dry beri-beri, and Wet beri-beri). And from FA, thiamine deficiency is associated with two groups of people, those who are alcoholics and those who are malnourished.

Is it correct to say that when due to Alcoholism, the result is WK syndrome (without the beri-beri stuff). And when due to being malnourished, the result is beri-beri: In the initial stages, it starts as dry beri beri, which can then progress to wet beri beri if not treated?

Is this correct, or an oversimplification?

It just irritates me how deficiency of the same vitamin can lead to two different presentations, depending on whether or not alcoholism was involved. I'm sure there is more to the story going on!

i have seen patient with sever recurrent vomiting get wk syndrome.
any ideas doctors

@Phloston
@Transposony

First of all, the thiamine deficiency in alcoholics is because of being malnourished. Alcoholics fill up on EtOH (7kcal/g), so when they drink all day they're not eating other foods.

B1 deficiency, whether in an alcoholic or not, can cause dry/wet beriberi and/or WKS. Yeah, so correct, WKS does not have to occur in alcoholics insofar as the B1 deficiency is there (Wernicke-Korsakoff syndrome of nonalcoholic origin. - PubMed - NCBI). My assumption is it's merely that alcoholics are the population most prone to B1 deficiency, especially in Western countries, because of their poor diet. I would not attempt to formulate a strict sequence in which B1 deficiency signs and symptoms will manifest. Some patients might get BB but not WKS, and some the other way around.

When I was on my third-year IM rotation, I had asked a cardiologist about alcoholic DCM vs wet beri-beri (e.g., B1 deficiency in alcoholics), and he said they're completely different. Basically EtOH has direct toxic effect on tissues (large quantities over an extended period of time), causing myocardial and bone marrow damage (i.e., DCM, non-megaloblastic macrocytic anaemia). Direct tissue damage can occur even when the alcoholic is thiamine-replete, and that's HY for USMLE.

Combining the above two points, whilst WKS need not occur in alcoholics, if one were to posit that WKS is more alcohol-specific, unrelated to the greater propensity for B1 deficiency in this group, then we could infer that it's probably a direct tissue-damage effect of the EtOH itself on mammillary body and thalamic medial dorsal nucleus tissue.

 

[cellsaver]

View attachment 221899

And from FA, thiamine deficiency is associated with two groups of people, those who are alcoholics and those who are malnourished.

Is it correct to say that when due to Alcoholism, the result is WK syndrome (without the beri-beri stuff).

"less filling, tastes great". Cheap beer will do that. Who can forget the Miller Lite advertising campaign?
View attachment 221899

Yet it ended pretty well for these 2 ladies. Really funny Miller Lite Catfight TV commercial that has a very surprising ending @1:05.