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25 Cards in this Set
- Front
- Back
...: a combination of psychic and autonomic hyperactivity, occurring usually after 3 to 5 days of alcohol abstinence (can occur as late as 14 days later)
-Overall, only 5 to 6% of individuals develop this condition -30 to 40% of individuals who have withdrawal seizures and do not receive medical treatment will go on to develop this -These individuals are agitated, confused, hallucinating (visual, auditory), febrile, tachycardic, hypertensive, diaphoretic -Usually lasts about 3 days |
Delirium tremens
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Delirium tremens: Treatment
-... (administered before any ... is given so as not to precipitate Wernicke-Korsakoff Syndrome). Vitamin replacement -Benzodiazepines reduce anxiety and tremors and may also help prevent seizures (usually always utilized) -Beta-blockers or clonidine can help control autonomic dysfunction -Phenytoin or phenobarbital (an anticonvulsant) for seizures, if needed (can both be given by IV) |
Thiamine
glucose |
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Marchiafava-Bignami Disease:
Pathological changes in the ... of the ... (reason unknown) -Long-term alcohol use is a risk factor, but not the only one -This condition is very rare, and can be seen in non-alcoholics -Used to be thought to occur only in Italians, but has been seen in other populations Clinical presentation -Progressive dementia, disinhibited, or aggressive -... neurological deficits, often focal in nature (mini-strokes) -Seizures and impaired consciousness may be terminal events |
middle lamina
corpus callosum Transient |
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Thiamine (B1) Deficiency
... Syndrome The metabolically active form of thiamine is ... TPP is critical in the intermediary metabolism of carbohydrate TPP is involved in three enzyme systems -Pyruvate dehydrogenase (pyruvate to acetyl coenzyme A) -Alpha-ketogluterate dehydrogonase (alpha-ketogluterate to succinate) -Transketolase (catalyzes the pentose monophosphate shunt) |
Wernicke-Korsakoff
thiamine pyrophsphate (TPP) |
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Thiamine (B1):
-Most abundant in yeast, pork, legumes, grains, and rice -Total body stores is 30 to 100 mg (heart, skeletal muscle, liver, kidneys, and brain) and must be constantly replenished -Severe neurological problems may arise after... weeks of total depletion |
6
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... encephalopathy
-Confusion -Ataxia -Oculomotor palsies and nystagmus ... psychosis -Confusion -Memory impairment *Inability to form new memories |
Wernicke’s
Korsakoff’s |
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Thiamine (B1) Deficiency
Wernicke-Korsakoff Syndrome Patients at risk for deficiency -Carbohydrates derived primarily from ... -Alcoholics -... (vomiting due to pregnancy often develop this) -Eating disorders/ reduced caloric intake -After gastric bypass -Intractable vomiting following gastric stapling -Malabsorption MRI brain may show abnormal signal in ... structures, including the periaqueductal gray matter |
milled rice
Hyperemesis gravidarum midline |
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Thiamine (B1) Deficiency
Wernicke-Korsakoff Syndrome Neuropathological findings: -capillary proliferation and ... - degenerative changes in ... structures (medial thalamic nuclei, mammillary bodies, periaquaductal gray area of the mesencephalon, and pontine tegmentum -Degeneration of the superior cerebellar ... |
petechiae
midline vermis |
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Thiamine (B1) Deficiency
Wernicke-Korsakoff Syndrome Treatment -Administer 100 mg of thiamine ... followed by 100 mg ... daily for 3 to 5 days -Continue ... thiamine 50 mg daily -Address the cause, if possible Very important point! -Wernicke-Korsakoff Syndrome can be precipitated in a patient if ... is administered before thiamine Always give ... before ...! |
intravenously
intramuscularly oral glucose thiamine glucose |
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Cobalamin (vitamin ...) deficiency:
-Total body store is 2000 to 5000 mcg, half of which is stored in the liver -It takes about ... to ... years to deplete stores due to malabsorption and about ... to ... years due to strict vegetarian diet -The most common cause of deficiency is ... (autoimmune parietal cell dysfunction) Other causes of deficiency -Ileal resection -Parasitic infections -Crohn’s disease and other malabsorption states -Chronic alcoholism with poor diet -History of gastric resection |
B12
2 to 5 10 to 20 pernicious anemia |
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Cobalamin (B12) deficiency:
Clinical Features -Sensorimotor and autonomic ... neuropathy -... dysfunction (Dementia, psychosis) -Subacute combined degeneration (Demyelination of the posterior columns, corticospinal tracts, and ... matter of the cerebral hemispheres) Neurological Signs and Symptoms -Paresthesias, Numbness, Gait ataxia, Incontinence, Weakness, Cognitive dysfunction, Spasticity, Other non-specific complaints Laboratory Studies -Check serum ... level, homocysteine level, and methylmalonic acid level, intrinsic factor antibody |
peripheral
Cerebral white B12 |
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... exposure can lead to Cobalamin (B12) Deficiency
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Nitrous Oxide (NO)
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Nitrous oxide is a potent oxidizing agent which irreversibly oxidizes the cobalt core of cobalamin from a 1+ valence state to 3+ valence state, rendering ... inactive
-This effectively inhibits the conversion of homocysteine to ..., thus interdiciting the supply of S-adenosylmethionine |
methylcobalamin
methionine |
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Cobolamin (B12) Deficiency:
Treatment -... injections of 1000 mcg daily for 5 days, weekly for 4 weeks, then monthly -After IM treatment has replenished stores, can usually maintain level with oral or intranasal supplementation |
Intramuscular (IM)
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Pyridoxine (vitamin ...) deficiency
-Pyridoxyl phosphate is the active biochemical form -It is a coenzyme of amino acid metabolism, particularly tryptophan and methionine -Deficiency inhibits lipid and myelin synthesis -Because tryptophan is required for niacin production, secondary niacin deficiency can occur -Found in chicken, grains, oranges, tomato juice, bananas, avocados |
B6
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Pyridoxine (B6) deficiency:
Deficiency can result from -Poor ... -Patients on isoniazid and hydralazine (people being treated for ...) -Chronic ... use -Infants of pyridoxine-deficient mothers |
diet
tuberculosis alcohol |
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Pyridoxine (B6) deficiency:
Clinical features -Peripheral neuropathy (burning sensory neuropathy) -Skin changes (rough skin) very similar to pellagra (due to niacin deficiency) (Dementia, diarrhea, dermatological changes) -Depression, confusion, irritability -Neonatal seizures -Treatment is with ... |
oral replacement
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Vitamin E Deficiency
... is the most active form of vitamin E in humans Serves as an ... preventing free radical peroxidation and injury to cell membranes -Deficiency results in cell ... injury It is stored in ... tissue |
Alpha-tocopherol
antioxidant membrane adipose |
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Vitamin E Deficiency:
Clinical presentation -... (truncal and appendicular) -Areflexia -Posterior column dysfunction -Opthalmoplegia -Dysarthria -Generalized ... -... in individuals with abetalipoprotinemia Treatment: Oral or injectable replacement |
Ataxia
weakness Retinitis pigmentosa |
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...:
Pyridoxine excess produces a predominantly sensory neuropathy Vitamin E excess can cause muscle weakness (myopathy) Vitamin A excess can be associated with benign intracranial hypertension (pseudotumor cerebri) |
Hypervitaminoses
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...:
-First described in 1959 in malnourished alcoholics -Later noted to occur in hospitalized patients undergoing hydration Pathophysiology -Demyelinating lesions within the pons (lesions can also occur outside the pons) -Appears to related to overcorrection of hyponatremia (an increase of 25 mEq/L during the first 24-48 hours) (due to low sodium) Other possible contributing factors: -Hypoxic event -Severe liver disease |
Central Pontine Myelinolysis
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look at slide 49
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ok
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Central Pontine Myelinolysis:
Chronic hyponatremia should be corrected at a rate below ...mEq/L (slowly) during any 24 hour period Avoid delay in correcting acute hyponatremia, since symptomatic hyponatremia may result in ... insufficiency |
10
respiratory |
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...:
Potential complication of weight-reduction surgery Syndrome consisting of: -Acute to subacute sensory loss -Weakness -Areflexia -Encephalopathy identical to Wernicke-Korsakoff Syndrome -Usually follows a period of dramatic weight loss and repeated bouts of vomiting |
Postgastroplasty Polyneuropathy
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Postgastroplasty Polyneuropathy:
The pathophysiology is not known -May be due to rapid mobilization of ... -Likely not due simply to ... deficiency, since the condition can develop despite nutritional supplementation Treatment is supportive -Parenteral nutrition -Vitamins |
lipids
vitamin |