Wernicke Korsakoff Syndrome : Wernicke Korsakoff Syndrome is primarily caused by the deficiency of thiamine, (Vitamin B1) usually due to chronic alcohol abuse. But Korsakoff Syndrome can have other origins other than alcohol abuse - chronic vomiting that may inhibit the absorption of Thiamine.

Neurological complications of alcohol abuse may also result from nutritional deficiency exacerbated by the excessive intake of alcohol which depletes Vitamin B1 - thiamine essential for normal nervous system. Sudden changes in blood chemistry specifically sodium, may cause central pontine myelinolysis, a condition of the brainstem in which nerves lose their myelin coating. Other complication include Liver disease and alcoholic cirrhosis.

Such conditions - if left untreated can progress to the onset of Wernicke encephalopathy - whose symptoms include marked confusion, delirium, disorientation, memory loss and drowsiness. Physical Examination may reveal abnormalities of eye movement, jerking of the eyes (nystagmus) and double vision. Even walking may seem hard to do as the patient has problems with balance and muscular co-ordination. If thiamine is not administered soon Wernicke encephalopathy may progress to stupor, coma and death.

If Thiamine is administered in time, the patient may escape from death but Korsakoff’s syndrome may still leave him/her crippled from permanent memory impairment - some may not remember events for a period of a few years before the onset of illness (retrograde amnesia) and unable to learn new information (anterograde amnesia).
Repeated episodes of Encephalopathy and/or prolonged alcohol abuse may lead to Korsakoff psychosis a form of dementia.

Alcoholic myopathy or muscular weakness due to breakdown of muscle tissue, is called as alcoholic rhabdomyolysis or alcoholic myoglobinuria. Usually men are affected by alcoholic myopathy about 4 times as often as women. Breakdown of muscle tissue (myonecrosis), can occur at any time during binge drinking or in the first days of alcohol withdrawal. Although this itself may not result in any apparent symptom in the initial stages, it can still be detected by temporary elevation in blood levels of an enzyme the MM fraction of creatine kinase - found in muscles.

Wernicke Korsakoff syndrome also known as Cerebral Beriberi, usually occurs in chronic alcoholics and affects the central nervous system (brain and spinal cord). It can be caused by a situation that aggravates a chronic thiamine deficiency, like an alcoholic binge or severe vomiting.

Vitamin B complex

B Vitamins - the group of water soluble vitamins essential for the normal functioning are not usually produced by our bodies and require to be replenished regularly.

Vitamin B1 - Thiamine
Vitamin B2 - Riboflavin
Vitamin B3 - Niacin, Niacinamide
Vitamin B5 - Pantothenic acid
Vitamin B6 - Pyridoxine
Vitamin B7 - Biotin
Vitamin B8 - Inositol
Vitamin B9 - Folic Acid
Vitamin B12 - Cyanocobalamin

Some Vitamin B Complex formulations, in addition to the above major B Vitamins, may contain Inositol, choline bitartrate and Para Amino Benzoic Acid - PABA.

Vitamin B1

Vitamin B1 or thiamine helps the body convert carbohydrates into energy and it is necessary for the heart muscles, nervous system and brain to function properly. Very low levels of Vitamin B1 can lead to Beriberi - a cardiovascular and neurological disease. Deficiency of Vitamin B1 can cause weight loss and weakness. Fortified breads, cereals, pasta, meat, fish, dried beans, leafy vegetables, whole grains, egg yolk, soy foods and peas contain Vitamin B1. Brewer's yeast is a natural source high in thiamine.

RDA - Recommended Daily Allowance:

Adults - Men: 1.2 mg
Adults - Women: 1.1 mg
Pregnant Women: 1.4 mg
Breastfeeding Women: 1.5 mg

Vitamin B1 is generally well tolerated and rarely produces adverse side effects with high doses. Deficiency of Vitamin B1 can result in Beriberi ( literally 'I can't' in Sinhalese language) - a disease with the symptoms of loss of appetite, weakness, irritability, tingling of nerves, poor muscles coordination and muscular pain in the calves. This disease is due to poor metabolization of glucose.

Vitamin B2

This is essential for converting carbohydrates into energy and produce red blood cells. Significantly, this vitamin is important for vision. Vitamin B2 or Riboflavin is essential for fat and protein metabolization. Vitamin B2 boosts the immune system, maintains healthy hair and helps functioning of the nervous system. Deficiency of Vitamin B2 can lead to acne, muscle cramps, carpal tunnel syndrome and migraine headache. Best natural sources of Riboflavin are meat, eggs, legumes, nuts, dairy products, green leafy vegetables, broccoli, asparagus, and fortified cereals.

RDA - Recommended Daily Allowance:

Adults - Men: 1.3 mg
Adults - Women: 1.1 mg
Pregnant Women: 1.4 mg
Breastfeeding Women: 1.6 mg

Vitamin B2 is generally well tolerated and rarely produces adverse side effects like sensitivity to light with high doses. Supplements of Riboflavin can result in bright yellow urine.

Vitamin B3

Food is turned into energy in the body by Niacin. Niacin or Vitamin B3 also helps maintain healthy skin and important nerve functions. The benefits of Vitamin B3 include good blood circulation and brain functioning. Vitamin B3 is also required in order to produce various hormones including progesterone and testosterone. Vitamin B3 - Niacin and its related compounds Nicotinic Acid and Nicotinamide plays an important role in lowering cholesterol levels and aiding widening of arteries. It plays a role in fat, protein and carbohydrate metabolization. Severe deficiency of Vitamin B3 can lead to Pellagra - diarrhea, scaly skin and dementia. This vitamin is naturally found in red meat, poultry, fish, fortified cereals and peanuts.

RDA - Recommended Daily Allowance:

Adults - Men: 16 mg
Adults - Women: 14 mg
Pregnant Women: 18 mg
Breast feeding Women: 17 mg

Vitamin B3 in high doses can result in burning, tingling sensation with/without red flushed skin. Niacin can also trigger hyperglycemia in the case of type 2 diabetes. Humans can synthesize Niacin from the amino acid Tryptophan in the presence of Vitamin B2 and Vitamin B6.

Vitamin B5

Vitamin B5 also known as Pantothenic acid is often used in combination with other B Vitamins in Vitamin B formulations. Vitamin B5 is primarily used for treating dietary deficiencies, acne, alcoholism, allergies, baldness, asthma, attention deficit-hyperactivity disorder (ADHD), autism, burning feet syndrome, yeast infections, heart failure, carpal tunnel syndrome, respiratory disorders, celiac disease, colitis, conjunctivitis, convulsions and cystitis. Some times Vitamin B5 is also used for controlling dandruff, depression,tongue infections, gray hair, headache, hyperactivity, low blood sugar, insomnia, irritability, muscular dystrophy, muscular cramps in the legs associated with pregnancy or alcoholism and improving athletic performance.

RDA - Recommended Daily Allowance:
Adults - Men: 5 mg
Adults - Women: 5 mg
Pregnant Women: 6 mg
Breastfeeding Women: 7 mg
Vitamin B5 is generally well tolerated in moderate doses but may produce adverse side effects like diarrhea with high doses.

Vitamin B6

Important for brain and nerve function, vitamin B6 - Pyridoxine helps the body break down the proteins and produce red blood cells. It is essential in making antibodies, maintaining nerve function and in the production of hemoglobin. Vitamin B6 also has a role in homocysteine metabolism. Vitamin B 6 deficiency leads to confusion, irritability and depression. Potatoes, bananas, beans, nuts, legumes, whole grains and poultry, fish, eggs, spinach and fortified cereals naturally contain Vitamin B6.

RDA - Recommended Daily Allowance:
Adults - Men below 50 years: 1.3 mg
Men - above 50 years: 1.7 mg
Adults - Women Below 50 years: 1.3 mg
Women Above 50 years: 1.5 mg
Pregnant Women: 1.9 mg
Breastfeeding Women: 2 mg

Vitamin B6 is generally well tolerated but may produce neurological disorders with high doses.

Vitamin B7

Vitamin B7 / Biotin plays a key role in breaking down of fats, proteins and Carbohydrates apart from regulating signals between cells. Some studies have indicated that supplementation of this Vitamin B / Biotin has some positive effect on hair loss and brittle nails.

Biotin or Vitamin B7: RDA - Recommended Daily Allowance:
Adults: 30 microgram
Biotin deficiency manifests in the form of scaly inflammation of the skin, poor appetite, hair loss, nausea, vomiting, anemia, depression and general weakness.

Vitamin B8

Inositol is part of the Vitamin B group and included as Vitamin B8. Our body manufactures Inositol from glucose. Next to Niacin, in terms of quantities, human body contains more Inositol, specifically in the spinal cord nerves, the brain and the cerebral spinal fluid. Inositol is a fundamental ingredient of cell membranes. It is necessary for proper functioning of nerves, brain and muscles in the body.

RDA - Recommended Daily Allowance:
It has not been established in any Scientific study as of now - about the minimum / maximum for this Vitamin B8 / Inositol. In many cases administration of this Vitamin B8 has been as high as 22gm without any adverse effects - indicating that this Vitamin is well tolerated.

Vitamin B9

Folate or Vitamin B9 is folic acid or folacin, that helps to produce red blood cells and it essential for DNA creation. Dried beans, legumes, green leafy vegetables, orange juice, asparagus, fortified bread, rice, and cereals are all good natural sources of Vitamin B9.

RDA - Recommended Daily Allowance:
Adults - Men: 400 mcg
Adults - Women: 400 mcg
Pregnant Women: 600 mcg
Breast feeding Women: 500 mcg

Vitamin B9 is generally well tolerated but may mask a Vitamin B12 deficiency with high doses. Deficiency of Folate can result in Megaloblastic Anemia which is also known as large cell Anemia or Macrocytic Anemia. Deficiency during the time of pregnancy or the period preceding pregnancy may result in neural tube defects in the fetus.

Vitamin B12

Vitamin B12 or cobalamin helps to make red blood cells and is important for brain and nerve cell functions. Vitamin B12 is effective in DNA synthesis, fatty acid synthesis and cell metabolism. Vitamin B 12 is found naturally in fish, red meat, poultry, milk, cheese, and eggs and also breakfast cereals. B12 deficiency leads to pernicious anemia - which manifests in the form of weakness, sore tongue, general apathy, back pain and tingling in the extremities. Vitamin B12 helps maintain a healthy digestive system, healthy skin and hair and protect against high blood pressure and heart disease. Vitamin B 12 helps protect against breast cancer, colon cancer and prostate cancer.

RDA - Recommended Daily Allowance:
Adults - Men: 2.4 mcg
Adults - Women: 2.4 mcg
Pregnant Women: 2.6 mcg
Breast feeding Women: 2.8 mcg

Vitamin B12 is generally well tolerated.

Delirium Tremens

Delirium Tremens or DT is a serious condition of alcohol withdrawal syndrome. DT leads to sudden and severe mental and nervous system changes.

Causes of Delirium Tremens

When a person suddenly stops drinking alcohol after a period of heavy consumption, and does not eat enough food, delirium tremens occurs. This means, a person consuming 4-5 pints (about 1880 ml ) of wine or 7-8 pints (about 3290 ml) of beer or a pint (about 470 ml ) of hard alcohol every day for several months. This could happen to people with more than a decade of drinking alcohol.

One important reason is that in long term drinkers, alcohol interferes with body's ability to regulate a neurotransmitter called GABA. In chronic alcohol abuse, the body mistakes alcohol for GABA and reacts to this by reducing its production of the neurotransmitter. As alcohol levels falls too low, it means there is not enough GABA for proper functioning. This can also occur due to infection, injury and illness in people with a history of heavy alcohol use and abuse.

Signs and symptoms of Delirium Tremens

Symptoms normally occur within 72 hours of the last drink, but they can also occur up to 10 days after the last drink. Common symptoms include:

• Body tremors
  
• Functional changes
  
• Agitation
  
• Anger and irritability
  
• Confusion and loss of focus
  
• Reduced attention span
  
• Deep sleep that lasts for a day or longer
  
• Excitement and fear
  
• Hallucination
  
• Hyperactivity
  
• Quick mood reversals
  
• Restlessness
  
• Sensitivity to light, sound and touch
  
• Sleeplessness and fatigue.
  

There could be seizures, most commonly in the first 12-48 hours after the last drink. As DT can temporarily reduce the amount of blood flow to the brain, symptoms as confusion, disorientation, stupor and loss of consciousness and hallucinations occur. There are other medical complications that can arise due to alcohol abuse. These include:

• Alcoholic liver disease
  
• Cardiomyopathy
  
• Neuropathy
  
• Blood clotting disorders
  
• Wernicke Korsakoff's syndrome, a brain disorder due to thiamine deficiency
  
• Injury from fall during seizures
  
• Irregular heartbeat which can be life threatening
  
• Delirium and injury to self/others in a state of confusion
  

The body goes through change due to withdrawal of alcohol when a person suddenly stops drinking after prolonged use. Alcohol has a slowing and sedating effect on the brain and the brain of a long term drinker is conditionally exposed to the depressant effect of alcohol. The brain starts producing naturally stimulating chemicals to compensate for the effect of alcohol. Hence, if the alcohol is withdrawn suddenly, the brain is lost. This dangerous condition of delirium tremens occurs in almost 1 out of every 20 persons. In this condition the brain is unable to read the chemistry after alcohol is stopped and therefore creates a temporary confusion leading to dangerous changes in the way the brain regulates body circulation and breathing. This creates risk of heart attack, stroke and death.

Diagnosis of DT

Blood tests can be done to assess blood magnesium and blood phosphate levels. Comprehensive metabolic panel and toxicology tests are also conducted. A stay in hospital in required for treatment. Regular checks of blood chemistry levels, such as electrolytes, body fluids level and vital signs such as temperature, pulse, breathing rate and blood pressure are monitored. Medications such as anticonvulsants, central nervous system depressants and sedatives are administered for symptoms such as seizures and irregular heartbeat. Sometimes the patient is put in a state of sedation for a week until withdrawal is complete. Benzodiazepine medications are given to treat seizures, anxiety and tremors. Only after the patient recovers from immediate symptoms is long term preventive treatment given. The doctor allows a ‘drying out' period in which no alcohol is consumed.