What is the role of serum electrolyte levels in the workup of Wernicke encephalopathy (WE)?

Updated: Nov 20, 2018
  • Author: Philip N Salen, MD; Chief Editor: Andrew K Chang, MD, MS  more...
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Alterations in serum electrolyte levels, such as hypernatremia or hypercalcemia, can cause encephalopathy and must be excluded.

One case series suggested that patients with WE may exhibit a distinctive acid-base pattern consisting of a primary metabolic acidosis in conjunction with a primary respiratory alkalosis. The primary metabolic acidosis is secondary to thiamine's role in aerobic metabolism and the Krebs cycle; without thiamine, aerobic metabolism cannot progress and metabolic products, including lactate and pyruvate, are produced, which result in an anion gap acidosis (see the Anion Gap calculator). The role of thiamine in causing a primary respiratory alkalosis is unclear. [15]

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