ALAN M. NADEL, M.D.
To the editor: The long-recognized cause of Wernicke-Korsakoff encephalopathy has been thiamine deficiency, associated with poor nutrition in the alcoholic or nonalcoholic patient. Blass and Gibson (1) suggested a different cause, namely a genetic abnormality in transketolase, the thiamine-requiring enzyme. Even in their four patients, however, nutritional deprivation was necessary before the genetic expression appeared. Hence, nutritional deprivation has been a common theme in this disease.
Shorey and associates (2) propose that high doses of the diluent ethyl alcohol and propylene glycol given intravenously may produce this disease by a direct metabolic effect on thiamine metabolism. These authors should exclude
NADEL AM. Wernicke's Encephalopathy and High-Dose Nitroglycerin. Ann Intern Med. ;102:134. doi: 10.7326/0003-4819-102-1-134_2
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Published: Ann Intern Med. 1985;102(1):134.
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