I was recently assigned a patient with a history of alcohol abuse who was admitted to the hospital with a diagnosis of Wernicke-Korsakoff syndrome (WKS). My knowledge of WKS was limited, so I prepared to care for this patient by conducting a mini knowledge brush-up. I want to share some of what I learned.
Wernicke-Korsakoff syndrome, also known as "wet brain" or alcohol-related dementia is caused by thiamine deficiency. The syndrome is a combination of 2 separate conditions, Wernicke's encephalopathy, and Korsakoff syndrome. The most common cause of WKS is long-term heavy alcohol use. Alcoholics are often deficient in thiamine (B1) because of:
But WKS can also be caused by other conditions that lower thiamine levels. These causes may include:
WKS occurs in 1-2 percent of the U.S. population. However, the percentage may be higher because WKS is not always detected by healthcare providers. Males carry a slightly higher risk, and the condition occurs evenly in people between the ages of 30-70.
Wernicke's encephalopathy (WE) is a neuropsychiatric disorder and usually occurs first in WKS. Symptoms can present suddenly, sometimes progressing in just hours. Wernicke's requires immediate medical intervention, but the symptoms are frequently missed or misdiagnosed. It's often assumed the patient's behavior and physical symptoms are simply related to alcohol intoxication. Symptoms of WE may include:
If treatment is not given in time, irreversible brain damage or even death may occur.
A clinical diagnosis of WE in alcoholics requires two of the following four signs to be present:
Diagnostic tests, such as labs and radiographic studies, are important in ruling out other potential causes for the patient's symptoms.
The goal of treatment is to quickly correct the B1 deficiency with intravenous or intramuscular administration of thiamine.
If left untreated, Wernicke's encephalopathy can lead to permanent brain damage and death. However, the condition may be reversed with early diagnosis and treatment. Once thiamine is administered, some symptoms begin to improve within hours. Memory impairments are slower to improve and often do not return the patient's baseline.
Around 80 to 90 percent of people who develop Wernicke's encephalopathy go on to develop Korsakoff's psychosis.
Korsakoff syndrome is the chronic stage of WKS and can be long-lasting. Nerve cells in the brain and spinal cord are damaged, resulting in severe cognitive and memory deficits and difficulty performing day-to-day tasks. Other symptoms include:
Research has suggested around 25% of patients with Korsakoff syndrome recover fully, about 50% make a partial recovery, and 25% experience no change in their condition.
As in WE, diagnostic tests are important in ruling out other potential causes for an accurate WKS diagnosis.
The following diagnostics are used to diagnose WKS:
Blood tests for:
WKS usually requires hospitalization, administration of IV thiamine and management of symptoms. Thiamine therapy also treats some common symptoms, such as vision, eye problems and confusion/disorientation.
All of the symptoms of WKS are not always reversible but the progression of the syndrome can be prevented if thiamine levels remain stable. This requires abstinence from alcohol, a balanced diet and treatment of other underlying medical problems. Some patients will require physical and/or occupational therapy to help them become as independent as possible in their daily life. The condition is fatal if left untreated.
What conditions or topics do you need to brush up on your knowledge?
References
Wernicke-Korsakoff Syndrome Information Page
32 minutes ago, LibraNurse27 said:I find this diagnosis very sad. Thank you for helping me learn more. Alcohol withdrawal was one of the 2 most common diagnoses on my Stepdown floor. Watching people who came in totally confused/immobile/incontinent become alert and oriented after a few days and educating them on possible consequences of continuing current habits, hearing they were motivated to make changes and seeing them leave for rehab was inspiring.
But, in other cases seeing the same people in and out for the same thing, some with the desire to change but finding it very difficult, and others who stated they wanted to drink until they died, was quite depressing. Most of the patients were nice people with difficult social backgrounds/situations. Seeing people who had progressed to the stage they were unable to care for themselves was heartbreaking.
Many young people with permanent brain damage, social worker looking for long term placement for them. They didn't qualify for psych institutions because no psych diagnoses, didn't qualify for nursing homes because too young/no insurance. Many stayed on our Med/Surg units for months or even years just because no place to go. I would love to learn more about prevention/treatment for addiction.
Look into the concept of Harm Reduction related to substance abuse. I'm actually working on an article on it for allnurses.
1 hour ago, J.Adderton said:I've been sober for almost 5 years and don't think I would have lived through pandemic. I think I would have several episodes of alcohol poisoning. I thought ICUs must be caring for more alcohol and drug related illnesses.
Glad to hear that you have made such a positive change for your life, and the lives of those around you. In addition to alcohol poisoning, we have had more fatal drug overdoses in the past six months, most likely from contaminated street drugs.
It's so sad to see people that either do not want to attempt to change their behavior, or have tried and been unsuccessful in achieving sobriety, the damage to families, and the patients themselves, is so far reaching.
On 1/11/2021 at 9:50 AM, TheMoonisMyLantern said:Look into the concept of Harm Reduction related to substance abuse. I'm actually working on an article on it for allnurses.
Cool! Can't wait to read it =)by harm reduction do you mean cutting back if they can't quit completely? Or things like safe injection sites, needle exchange, etc?
LibraNurse27, BSN, RN
972 Posts
I find this diagnosis very sad. Thank you for helping me learn more. Alcohol withdrawal was one of the 2 most common diagnoses on my Stepdown floor. Watching people who came in totally confused/immobile/incontinent become alert and oriented after a few days and educating them on possible consequences of continuing current habits, hearing they were motivated to make changes and seeing them leave for rehab was inspiring.
But, in other cases seeing the same people in and out for the same thing, some with the desire to change but finding it very difficult, and others who stated they wanted to drink until they died, was quite depressing. Most of the patients were nice people with difficult social backgrounds/situations. Seeing people who had progressed to the stage they were unable to care for themselves was heartbreaking.
Many young people with permanent brain damage, social worker looking for long term placement for them. They didn't qualify for psych institutions because no psych diagnoses, didn't qualify for nursing homes because too young/no insurance. Many stayed on our Med/Surg units for months or even years just because no place to go. I would love to learn more about prevention/treatment for addiction.