From the Guidelines
The risk of developing Korsakoff syndrome or dry beriberi in a nonalcoholic individual is low but possible, primarily occurring in people with severe thiamine (vitamin B1) deficiency from causes other than alcohol abuse. These conditions can develop in individuals with prolonged malnutrition, prolonged vomiting (as in hyperemesis gravidarum or eating disorders), bariatric surgery, prolonged intravenous feeding without proper supplementation, or certain medical conditions that impair thiamine absorption such as celiac disease or chronic diarrhea 1. Genetic factors can also play a role, with some individuals having increased thiamine requirements or impaired thiamine metabolism. Korsakoff syndrome presents with severe memory impairment, confabulation, and cognitive deficits, while dry beriberi affects the nervous system causing peripheral neuropathy, muscle weakness, and pain.
Key Factors
- Prolonged malnutrition
- Prolonged vomiting
- Bariatric surgery
- Prolonged intravenous feeding without proper supplementation
- Certain medical conditions that impair thiamine absorption
Prevention and Treatment
Prevention involves adequate dietary intake of thiamine (found in whole grains, meat, and legumes) or supplementation (typically 100mg daily) for those at risk 1. Early recognition and prompt thiamine replacement (initially 100mg IV or IM for 3-5 days, followed by oral supplementation) are essential to prevent permanent neurological damage in at-risk individuals. It is also important to note that glucose should not be given before thiamin repletion due to the risk of deterioration of serum thiamin concentrations 1.
Recommendations
- Adequate dietary intake of thiamine or supplementation (typically 100mg daily) for those at risk
- Early recognition and prompt thiamine replacement (initially 100mg IV or IM for 3-5 days, followed by oral supplementation)
- Avoid giving glucose before thiamin repletion In cases where thiamine deficiency is suspected, prophylactic thiamin should be administered to patients with predisposing factors 1. Additionally, vitamin B12, copper, and vitamin E levels should be assessed and any deficiencies corrected 1.
From the Research
Risk of Developing Korsakoff Syndrome or Dry Beriberi in Nonalcoholic Individuals
The risk of developing Korsakoff syndrome or dry beriberi in nonalcoholic individuals is associated with thiamine deficiency, which can occur due to various factors such as malnutrition, hunger strike, or certain medical conditions.
- Thiamine deficiency can lead to Wernicke-Korsakoff syndrome (WKS), a neurological disorder characterized by confusion, ataxia, and eye-movement disorders 2, 3.
- Nonalcoholic WKS can occur in individuals with a history of hyperemesis gravidarum, cancer, bariatric surgery, or other conditions that lead to malnutrition 2.
- Dry beriberi, a condition characterized by neuropathy, can also occur due to thiamine deficiency and may mimic Guillain-Barré syndrome 4.
- The diagnosis of WKS and dry beriberi is often clinical, and treatment with thiamine should be started early to prevent irreversible neurological damage 5.
Factors Contributing to Thiamine Deficiency
Several factors can contribute to thiamine deficiency in nonalcoholic individuals, including:
- Malnutrition due to various causes such as hunger strike, anorexia nervosa, or Crohn's disease 2, 3
- Certain medical conditions such as cancer, bariatric surgery, or hyperemesis gravidarum 2
- Inadequate dietary intake of thiamine 6
- Increased demand for thiamine due to high glucose intake or other factors 6
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment of thiamine deficiency are crucial to prevent irreversible neurological damage and improve outcomes in nonalcoholic individuals with WKS or dry beriberi.