Alcohol

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What happens if you give glucose to an alcoholic without thiamine?

Thiamine is a cofactor in carb metabolism. If you give glucose you trigger carb metabolism, which depletes thiamine stores. This can precipitate Wernicke's encephalopathy
Wernicke encephalopathy
- Acute encephalopathy
- Nystagmus
- Ophthalmoplegia
- Ataxia
Korsakoff syndrome
- Chronic psychosis seen in alcoholics
- Retrograde amnesia, confabulation
- Irreversible!!
- Caused by damage to mammary bodies and thalamic nuclei
Stages of alcohol withdrawal:
- 1. Acute--12--48 hours--tremors, sweating, hyperreflexia, seizures
- 2. Alcoholic hallucinations--24--72 hours--auditory and visual hallucinations
- 3. DT--2--7 days--hallucinations, confusion, autonic instability (sweating, tachycardia, fever), can be fatal
Why is peripheral neuropathy seen in alcoholics?

Thiamine deficiency
Mechanism of Disulfiram
- Inhibits aldehyde dehydrogenase, causes nausea and vomiting with drinking
- (cephalosporins and metronidazole have a similar effect when taken with alcohol)
Fetal alcohol syndrome
- Mental retardation
- Microcephaly
- Microphthalmia
- Short palpebral fissures
- Midfacial hypoplasia
- Cardiac defects
Most common cause of hypoglycemia

Alcohol abuse
Management of non-bleeding varices

Non-selective beta blockers (propranolol, nadolol, timolol)