Deplete and Delirious: A Report of Two Cases

A diagnosis of thiamine deficiency and Wernicke’s encephalopathy should be considered in all elderly patients presenting to the emergency department with acute neurological changes. Physicians have an increased suspicion for the diagnosis in alcoholic patients, but unfortunately this condition is often missed in non-alcoholic patients. Timely diagnosis and treatment of these conditions is imperative due to the associated morbidity and mortality. In this report, we describe two cases of elderly patients who experience severe neurological disturbances secondary to Wernicke’s encephalopathy. Both patients’ conditions were worsened with an infusion of dextrose containing fluids and promptly improved with infusion of thiamine. We believe that acutely ill, elderly patients are particularly susceptible to thiamine deficiency and the development of Wernicke’s encephalopathy. The recognition of this population as especially vulnerable is critical in order to improve long-term neurological outcomes in these patients.