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  1. #1
    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
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    Dont Forget Your Vit.

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

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

  2. #2
    md90's Avatar
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    Quote Originally Posted by IMG SURVIVOR View Post
    B vitamin names
    "The Rhythm Nearly Proved Contagious":
    · In increasing order: Thiamine (B1) Riboflavin (B2) Niacin (B3) Pyridoxine (B6) Cobalamin (B12)
    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.
    "SLAM-DUNK THE STEPS"

    “Peace, it does not mean to be in a place where there is no noise, no trouble, or no hard work…..it means to be in the midst of those things and still be calm in your
    heart.”

  3. #3
    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
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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
    Moderator: USMLE AND Residency Forums.

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

  4. #4
    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
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    what area of the brain will this patient have damage?
    Moderator: USMLE AND Residency Forums.

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

  5. #5
    md90's Avatar
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    Quote Originally Posted by IMG SURVIVOR View Post
    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
    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...
    "SLAM-DUNK THE STEPS"

    “Peace, it does not mean to be in a place where there is no noise, no trouble, or no hard work…..it means to be in the midst of those things and still be calm in your
    heart.”

  6. #6
    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
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    more bumping ahead
    Moderator: USMLE AND Residency Forums.

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

  7. #7
    dr_asim is offline Newbie 510 points
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    nice discussion ..

  8. #8
    jokerusmle is offline Newbie 510 points
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    nice

    nice thread, very useful

  9. #9
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    Quote Originally Posted by IMG SURVIVOR View Post
    B vitamin names
    "The Rhythm Nearly Proved Contagious":
    · In increasing order: Thiamine (B1) Riboflavin (B2) Niacin (B3) Pyridoxine (B6) Cobalamin (B12)
    thanks for the mnemonic .its very useful

  10. #10
    Biochemist259 is offline Newbie 510 points
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    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.

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