Why does glucose precipitate wernicke

Learn how your comment data is processed. Traditional teaching is to never treat hypoglycaemia prior to giving thiamine due to risk of precipitating Wernicke encephalopathy — this is a myth — never delay treatment of hypoglycemia The concern is that an excessive carbohydrate load will lead to the build up of toxic metabolites when the activity of these enzymes is reduced because of thiamine deficiency There are no reported instances of a single bolus of glucose precipitating Wernicke encephalopathy Prolonged carbohydrate administration e.

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Cookies Policy. Close Privacy Overview This website uses cookies to improve your experience while you navigate through the website. Thiamine is under standing orders in the state. Paramedics must make contact with the base-station physician at some point during standing orders, which include dextrose and then thiamine. The paramedic can make an individual decision when to contact the base-station physician.

Since our system uses drop down menus, a few potential patients were lost. In addition we only searched data using IV. It is possible that some patients received oral glucose loading and resolved without IV access; however, we believe this is rare since oral glucose loading is not under state standing orders. Lastly, we used GCS as a measure of mental status because it was available. However we acknowledge that GCS may decrease for other reasons than confusion. In our study, hypoglycemic patients treated by ALS had the same neurological outcomes after glucose administration regardless of the inclusion of thiamine.

On follow up, all 62 patients brought by ALS into our facility had complete resolution of their symptoms, 9 of whom had not received prehospital thiamine.

This is because most patients receiving the thiamine with glucose regimen are suffering from a complication of diabetic treatment and are not chronically malnourished or alcoholics. These patients require immediate glucose administration; therefore, delays due to thiamine administration, or the potential for anaphylaxis from thiamine, can be detrimental to patient outcome.

It remains possible that thiamine may indeed be necessary to avoid this condition. We found that routine administration of thiamine with glucose did not result in differences in respiratory rate, SBP, GCS or emergency department hospital discharge rates. Until further research is done to validate our results EMS leadership should consider whether the routine use of thiamine in the prehospital setting is appropriate for their system.

Conflicts of Interest: By the West JEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias.

The authors disclosed none. National Center for Biotechnology Information , U. West J Emerg Med. Mark A. David P. Author information Article notes Copyright and License information Disclaimer. Address for Correspondence: Mark A. Email: gro. This article has been cited by other articles in PMC. Methods: We evaluated a retrospective cohort of patients who received intravenous glucose for hypoglycemia comparing those who received thiamine supplementation versus those who did not. Results: There were no significant differences between the thiamine, and without-thiamine groups.

Open in a separate window. Pertinent references were traced back to their sources and also included in the literature review. The quality and content of each article was evaluated by the authors using the American Academy of Emergency Medicine literature review guidelines. Watson, A. Kissoon, Niranjan.

Day, Ed, et al. Ambrose, Margaret L. Bowden, and Greg Whelan. Hallwood, and Allan D. Wernicke's encephalopathy. Previous chapter: Myxoedema coma Next chapter: Carcinoid syndrome of neuroendocrine neoplasia. All SAQs related to this topic. All vivas related to this topic.

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