Wernicke Encephalopathy

• Encephalopathy, ophthalmoplegia, ataxia only present in 15% of cases
• Clinical Diagnosis
• Treatment
  • Start empiric thiamine, give with glucose
    • Prehospital though, give glucose first since thiamine not available for EMS
  • 500mg IV Thiamine TID for 2-3 days
• Ocular changes improve in 1 day
• Ataxia and confusion may take a week to improve

HHS

• Typically T2DM
• Mortality 10-20%
• Complications- cerebral edema
• Evaluation
  • Glucose (Typically >600)
  • Osmolarity >320
  • Bicarb relatively normal
  • pH relatively normal
  • Ketones (Low or negative)
• Treatment 
  • Fluids typically 8-12 L deficit
  • ICU admission