MEDizzy - 45 year old man with a history of alcoholic cirrhosis

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Nutritional factors in disease

45 year old man with a history of alcoholic cirrhosis presents to the emergency department after being found unresponsive at home. On examination he is minimally responsive, disorientated, anicteric, cachectic and has restricted horizontal eye movement bilaterally. His lab results are notable for mildly elevated transaminases and low albumin. Treatment is initiated with parenteral multivitamin therapy. Which of the following is true regarding his most clinically significant vitamin deficiency?

ExplanationThis malnourished alcoholic patient presents with clinical features suggestive of Wernicke’s encephalopathy (delirium and ophthalmoplegia), which is a manifestation of thiamin (vitamin B1) deficiency. Thiamin is a water-soluble vitamin that acts as a co-factor in aerobic metabolism of glucose. Neuronal cells are most vulnerable to damage from thiamin deficiency as they exclusively utilise glucose for energy requirements. The liver has very limited stores of thiamin, so deficiency can manifest after only 1 month of a thiamin-free diet.