Wernicke-Korsakoff Syndrome (Wks) as Side Effects of Alcoholism

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Alcoholism is very interesting to me and has been for years as my knowledge of addiction has increased. I recently listened to a podcast - Ted Radio Hour’s Conforming Stigma. One of the presenters discussed how we have been treating our addicts, incarcerating them, condoning their behavior, and forcing their sobriety. These tactics are killing our loved ones. Other countries have been solving the crisis with controlled drug use environments and replacing judgment with love. I made note of a quote: "the opposite of sobriety isn't addiction, it's connection." Someone very close to me is an addict and she is not connected - she's pushed everyone who loves her away. I wish so badly that she could have connection. I know it would help her, but instead she's dying from multiple conditions resulting from alcoholism. The speaker said that we should be giving our addicts more love, not less, and I wish so badly I could find a way to apply it worldwide, especially considering the fallout. Alcoholism was mentioned in our textbook in reference to electrolyte deficiencies, fetal alcohol syndrome, liver disease and other conditions; however, it was not discussed as its own disease. Even more specific, is Wernicke-Korsakoff syndrome (WKS), common in many alcoholics, but rare in itself. The syndrome was not mentioned in our book and I am covering this important topic now.

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The chemical composition and derivative of alcohol is ethyl alcohol (ethanol). It is an intoxicating ingredient in beer, wine, and liquor. According to the CDC, it is produced by fermented yeast, sugars and starches. Alcohol affects every organ in the body. It depresses the central nervous system and is rapidly absorbed into the bloodstream through the stomach and small intestine. It is metabolized by liver enzymes though in small amount, leaving excess alcohol to circulate throughout the body. The intensity of alcohol effects on the body is directly related to the consumption amount. Alcohol interferes with brain communication pathways, changing mood and behavior and making it more difficult to think clearly and move with coordination. Alcohol consumed over time or in excess on occasion can damage the heart and result in Cardiomyopathy (stretching/drooping of heart muscle, arrhythmias, stroke and high blood pressure. Alcohol can cause liver inflammations, fatty liver, hepatitis, Fibrosis and Cirrhosis. Even, more alcohol can cause trouble in relationships, work, school, social activities and thought processes as well as unintentional injuries from accidents, violence and suicide. Alcohol causes toxic pancreatic substances leading to pancreatitis, cancer risk and immune system deficiencies. Alcohol during pregnancy, especially in the first trimester, may cause behavioral or neurological consequences in the offspring.

According to the National Organization for Rare Disorders, one of the many side effects of alcoholism includes Wernicke-Korsakoff syndrome (WKS), which is caused by thiamine (vitamin B1) deficiency. Thiamine is a nutrient needed by all body tissues, but affects cells of the nervous and cardiovascular systems substantially more than within the cells of other organ systems. The majority of cases of WKS in the United States occur in alcoholics. Alcohol reduces thiamine absorption in the body, reduces thiamine storage in the liver and inhibits enzyme activity that activates thiamine. In rarer cases, the WKS occurs from malnutrition (from starvation, eating disorders and prolonged vomiting). In addition, cancer, AIDS, stomach disorders, kidney disorders and other chronic disorders may also cause WKS. Hereditary factors may cause genetic predisposition to developing WKS, but more research is required to determine what role genetics may play. Mostly, WKS comes from alcoholism.

WKS can be recognized by mental status changes such as confusion, uncoordinated voluntary movement and eye abnormalities - not necessarily all together. The main mental problem associated with WKS is confusion, which can develop over a few days or weeks. This may be accompanied by lethargy, inattentiveness, drowsiness and indifference. Delirium may occur in extreme cases. Untreated, affected individuals may lose consciousness that results in a coma. With uncoordinated movement, affected individuals may demonstrate a slow, unsteady gait or be unable to stand or walk. Ocular abnormalities experienced may include double vision, rapid eye movement, eye muscle paralysis and upper eyelid drooping. Nerve damage may occur, especially outside the central nervous system, and cause weakness in the extremities and difficulty walking. Cardiovascular issues may occur, including rapid heart rate, low blood pressure and loss of consciousness. Those affected may experience memory impairment, particularly the inability to form new memories, and may create imaginary memories to fill the gaps.

In the United States, WKS is prevalent in one to two percent of the population and affects more males than females between the ages of 30 and 70. The syndrome can be diagnosed through a clinical evaluation, obtained patient history, laboratory screens and liver function tests. Tests measure thiamine activity. CT scans and MRIs can also reveal brain changes such as shrunken mammillary bodies caused by WKS.

According to Healthline, Prompt WKS treatment needs to occur in order to delay or stop the syndrome’s progression and reverse nonpermanent brain abnormalities. Patients may be hospitalized and monitored for proper digestive system function, especially food absorption. Patients may be given vitamin B-1 intravenously, vitamin B-1 orally, a diet which keeps vitamin B-1 levels up and alcoholism treatment. Fast treatment may reverse neurological symptoms. Vitamin B-1 treatment can have a negative reaction, mainly for those with alcoholism, and can include alcohol withdrawal symptoms like insomnia, sweating or mood swings. Hallucinations, confusion or agitation may also occur.

WKS patient outcomes depend on the extent of the syndrome progression. Early treatment in advance of irreversible damage occurring dramatically improves a patient’s outlook. Otherwise, when WKS is untreated, mortality rates are high. Most deaths occur from lung infection, blood poisoning or irreversible brain damage. Avoiding alcohol allows for recovery of memory and mental function. WKS can be avoided by abstaining from drinking alcohol and eating a diet with vitamin B-1 such as rice, peas, spinach and oranges.

The bottom line is that to avoid WKS is to avoid alcohol. Alcoholism and WKS go hand-in-hand. I would encourage any patient abusing alcohol to speak with his or her healthcare provider to avoid the overwhelming complications from both of these terrible conditions. I would also provide other resources such as the National Drug and Alcohol Treatment Referral Routing Service, which offer many tools to coping with addiction.

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