Nutritional Emergencies

Consider In High Risk Patients * Alcoholics* GI disorders* Eating disorders* Starvation/poor diet* Extremes of age Thiamine (B1) deficiency * Causes damage to neurons and cardiac myocytes* Manifestations* Dry beriberi* Neuropathy* Paresthesias* Wernicke’s encephalopathy* Ophthalmoplegia* Ataxia* Altered mental status* Korsakoff syndrome* Ophthalmoplegia, ataxia, altered mental status* PLUS* Confabulation* Memory loss* Wet beriberi* Heart failure from cardiac damage* Treatment* High dose thiamine Niacin (B3) Deficiency * “Pellagra”* Clinical Triad* Diarrhea* Dementia* Dermatitis* Scaly rash* Neck* Dorsum of hands* Treatment* Vitamin B3 Folate (B9) Deficiency * Megaloblastic anemia* Treatment* Folate B12 Deficiency * Classically occurs in vegans (in addition to the previous high risk groups)* Manifestations* Megaloblastic anemia* PLUS* Neurologic complaints* Subacute combined (posterior and lateral column) degeneration of spinal cord* Posterior columns* Impaired vibratory sensation and propioception* Lateral columns* Sensory loss* Motor weakness Additional Reading * Thiamine Deficiency: Pearls and Pitfalls (emDOCs)