All right, so welcome back to the Internet Book of Critical Care podcast. I'm here with Adam

Thomas and we're going to talk about Warnakey encephalopathy. Josh, we were talking offline, but I think

we both agree that we cover up front for this like the shotgun approach and then we get lucky

probably most of the time. So I think it's really interesting to make us sit down and really think at length about what this is

and what are the implications for our patients. So we'll cover the clinical diagnosis, the workup and

treatment and all the things in between there. So let's go back to it because Josh, you are the

thiamine aluminy, shall we say?

Thymin goes around a lot.

And I'm all about this.

So we've talked about this in other posts.

Let's really come into perivate, lactate, and if that screws up, the citric acid cycle.

So what is the biochemistry here and why is it important?

It's pretty complicated. And we're not going to drag you through all of the ins and outs of the biochemistry, but thiamen is a co-factor for a lot of enzymes involved

in intermediary metabolism. So if you run out of thiamine, your tricyclic acid cycle basically

stops working. You accumulate a lactic. You can develop a lactic acidosis or hyperlactatemia if you

prefer that terminology. When in the brain, things like clutamate can accumulate and they can cause neurotoxicity.

So let's move on to the pharmacology of thymine in itself.

So if I have a normal diet versus a non-normal diet, how does this get into my body?

Yeah.

So generally, it's consumed through the gastrointestinal tract.

And absorption of thiamine is a little bit complicated.

There's probably an active and also

...