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Abstract: FR-PO222

Delirium in Renal Failure, Not Always Uremia: A Case of Thiamine Deficiency With Wernicke Encephalopathy

Session Information

  • Pharmacology
    November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pharmacology (PharmacoKinetics‚ -Dynamics‚ -Genomics)

  • 1900 Pharmacology (PharmacoKinetics‚ -Dynamics‚ -Genomics)

Authors

  • Ekiz, Esra, New York City Health and Hospitals Corporation, New York, New York, United States
  • Ramos, Marco, New York City Health and Hospitals Corporation, New York, New York, United States
  • Rodrigues, Prerana R., New York City Health and Hospitals Corporation, New York, New York, United States
  • Soe, Thin Thin, New York City Health and Hospitals Corporation, New York, New York, United States
  • Yee, Su Mon, New York City Health and Hospitals Corporation, New York, New York, United States
  • Shaha, Atin K., New York City Health and Hospitals Corporation, New York, New York, United States
  • Andrabi, Suhaib A., New York City Health and Hospitals Corporation, New York, New York, United States
  • Herbert, Leroy, New York City Health and Hospitals Corporation, New York, New York, United States
Introduction

Delirium is an acute confusional state that differs from individual’s norm. Thiamine plays role in propagating nerve impulses; its deficiency can present with neurologic symptoms. We report a case of delirium, attributed to uremic encephalopathy, who was found to have thiamine deficiency.

Case Description

67 year-old male with chronic kidney disease, type 2 diabetes, hypertension, polysubstance abuse including nicotine, ethanol, marijuana; admitted to hospital with a fall. Initially, vitals were within normal range, he was drowsy but oriented to three spheres. Physical exam was siginificant for wheezing on auscultation of lungs and tremors on outstretched hands.

Investigations showed blood urea nitrogen 117 mg/dl, creatinine 8.1 mg/dl, high anion gap metabolic acidosis, hypoalbuminemia and anemia. Ethanol level and urine toxicology were negative; ammonia was elevated. Computed tomography of the head revealed no acute intracranial abnormality. Meningitis work-up was negative. Chest x-ray showed bilateral pulmonary opacities.

Despite supplemental oxygen, antibiotics, lactulose; sensorium was poor and uremia was thought to be the precipitating factor. After a total of 10 hemodialysis sessions, patient continued to be lethargic and somnolent. Due to history of alcohol use disorder, he was at risk of nutritional deficiencies and high dose thiamine was started with dramatic improvement in sensorium over the course of 24 hours. He became alert, oriented and conversant.

Discussion

Delirium is a syndrome of disturbed consciousness or cognitive function developing over a short period of time. Chronic alcohol abuse-induced thiamine deficiency is one of the metabolic causes of altered sensorium, leading to Wernicke’s encephalopathy, characterized by mental confusion, ophthalmoplegia and ataxia. All features of the classic triad are present in only one-third of patients. Diagnosis is clinical and is mainly supported by the dramatic response of neurological signs to parenteral thiamine.

Azotemia is not always the cause of altered mentation in renal failure. Considering thiamine deficiency in cases with altered mental status is essential in regards to timely management of patients, prevention of complications and efficient use of resources by introduction of a safe, easily accessible medication: ie thiamine.