Substance Abuse and Abuse Q 44
Ryan who is a chronic alcohol abuser is being assessed by Nurse Gina. Which problems are related to thiamine deficiency?
A. Cardiovascular symptoms, such as decreased hemoglobin and hematocrit levels.
B. CNS symptoms, such as ataxia and peripheral neuropathy.
C. Gastrointestinal symptoms, such as nausea and vomiting.
D. Respiratory symptoms, such as cough and sore throat.
Correct Answer: B. CNS symptoms, such as ataxia and peripheral neuropathy
Wernicke’s encephalopathy is a CNS disorder caused by acute thiamine deficiency in people who abuse alcohol. Other symptoms, besides ataxia and peripheral neuropathy, are acute confusion or delirium. Deficiency of thiamine can affect the cardiovascular, nervous, and immune system, as is commonly seen in wet beriberi, dry beriberi, or as Wernicke-Korsakoff syndrome. Wet and dry beriberi often have overlapping features, and in either condition, paresthesias may be a presenting feature.
Option A: Cardiovascular symptoms are usually associated with alcohol abuse. The patient may have hypertension (HTN) or insomnia initially. In later stages, the patient may complain of nausea/vomiting, hematemesis, abdominal distension, epigastric pain, weight loss, jaundice, or other symptoms or signs suggestive of liver dysfunction. They may be asymptomatic early on.
Option C: Gastrointestinal symptoms are associated with alcohol abuse; they are not caused by thiamine deficiency. On exam, they may exhibit signs of cerebellar dysfunction, such as ataxia or difficulty with fine motor skills. They may exhibit slurred speech, tachycardia, memory impairment, nystagmus, disinhibited behavior, or hypotension. They may present with tremors, confusion/mental status changes, asterixis, ruddy palms, jaundice, ascites, or other signs of advanced liver disease. There may also be spider angiomata, hepatomegaly/splenomegaly (early; liver becomes cirrhotic and shrunken in advanced disease).
Option D: Respiratory problems are not usually directly related to alcohol. Marijuana smoke can also cause respiratory problems, including chronic bronchitis. Smoking crack cocaine can cause lung damage and severe respiratory problems. The use of some drugs, such as opioids, may cause breathing to slow, block air from entering the lungs, or make asthma symptoms worse.