B vitamin names
"The Rhythm Nearly Proved Contagious":
· In increasing order: Thiamine (B1) Riboflavin (B2) Niacin (B3) Pyridoxine (B6) Cobalamin (B12)

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why even bother with the obvious. Just know where you are need it and where you can help the most.

question:
A 47-year-old woman who is semi-comatose comes into the clinic; order Dextrose 5%/Normal saline to be hung.. then all of a sudden, the patient develops confusion, nystagmus, eye weakness; your eyes are wide-open, and wondered what the crap did you just do????? What happened and why??... explain the mechanism please.

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You forgot to give B1 before glucose,

Now I get a little confuse with wernickel syndrome
wernickel kostokof syndrome



Mechanism I live that to you guys I dont want to be the only one having fun answering

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Moderator: USMLE AND Residency Forums.


why even bother with the obvious. Just know where you are need it and where you can help the most.

what area of the brain will this patient have damage?

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Moderator: USMLE AND Residency Forums.


why even bother with the obvious. Just know where you are need it and where you can help the most.

Wernicke syndrome--ataxia, nystagmus, and confusion whereas Korsakoff's is memory deficits...;

Mechanism--the little thiamine that this person had got used up when the glucose went to pyruvate to acetyl CoA... needed to give IV thiamine before the IV fluids...

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more bumping ahead

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Moderator: USMLE AND Residency Forums.


why even bother with the obvious. Just know where you are need it and where you can help the most.

nice discussion ..

nice thread, very useful

thanks for the mnemonic .its very useful

The alcoholic patient was borderline B1 deficient so by giving him IV Dextrose, you started the glycolytic process which metabolizes a 6 carbon sugar (glucose) into two 3 carbon pyruvates yielding a net gain of 2 ATP via Pyruvate Kinase and 2 NADH via Glyceraldehyde-3-Phophate DH. The reason the patient went into a confused state is b/c the PDH enzyme that converts Pyruvate --> Acetyl-CoA req the cofactors Thiamine, Riboflavin, Niacin, Pantothenic acid & alpha lipoic acid. So whatever little Thiamine the patient had left was used up in this RXN which then caused damage to his mammillary bodies and his symptoms of Wernicke's encephalopathy.