Wernicke encephalopathy: a medical emergency

Thiamine is an essential vitamin critical to glucose metabolism. Without thiamine, glucose is metabolized through less-efficient anaerobic pathways, which produces lactic acid. Acidosis affecting periventricular structures (i.e., thalami, mammillary bodies, oculomotor nuclei, cerebellar vermis) accounts for the clinical pres entation.2 Because thiamine crosses the blood-brain barrier via passive and active transport, correction of brain thiamine deficiency can be promoted by maximizing serum2 thiamine concentrations.4 Oral ab - sorp tion is unreliable in patients at risk of [Wernicke] enceph alopathy, which emphasizes the importance of pa ren teral treatment.1,4