<prompt> Vitamin that should be first supplemented during treatment of alcoholic patient?CyanocobalamineFolic acidThiamineVitamin C  <response>: Ans. c Thiamine Ref H-17th442Wernickes encephalopathy is a condition that can produce nystagmus and a partial deficit of horizontal and vertical gaze that mimics a combined abducens and oculomotor nerve palsy. It occurs in malnourished or alcoholic patients and can be reversed by thiamine.Rx of ethylene glycol induced acidosis include prompt institution of a saline or osmotic diuresis, thiamine and pyridoxine supplements, fomepizole or ethanol, and hemodialysis.THIAMINE VITAMIN B, - FUNCTIONSIn the decarboxylation of a-ketoacids, such as pyruvate a-ketoglutarate, and branched-chain amino acidsCoenzyme for a transketolase reaction that mediates the conversion of hexose and pentose phosphates. Role in peripheral nerve conductionDeficiency syndrome: Wet beriberi cardiovascular symptoms can occur after 3 months of a thiamine-deficient diet. Patients present with an enlarged heart, tachycardia , high-output congestive heart failure, peripheral edema, and peripheral neuritis. Dry beriberi presents with a symmetric peripheral neuropathy of the motor and sensory systems with diminished reflexes. Alcoholic patients with chronic thiamine deficiency may also have CNS manifestations known as Wernickes encephalopathy, consisting of:- Horizontal nystagmus,- Ophthalmoplegia Loss of memory confabulatory psychosis Wernicke-Korsakoff synd.- Cerebellar ataxia, - Mental impairment. Transketolase activity measured before and after the addition of thiamine pyrophosphate. A 25 stimulation by the addition of thiamine pyrophosphate an activity coefficient of 1.25 is taken as abnormal. Rx: In acute thiamine deficiency with either cardiovascular or neurologic signs, 100 mgd of thiamine should be given parenterally for 7 days, followed by 10 mgd orally until there is complete recovery.VitaminsNutrientClinical Finding Dietary Level per Day Associated with Overt Deficiency in AdultsContributing Factors to DeficiencyThiamineBeriberi: neuropathy, muscle weakness and hyperemesis, wasting, cardiomegaly, edema, ophthalmoplegia, confabulation.0.3 mg1000 kcalAlcoholism, chronic diuretic useRiboflavinMagenta tongue, angular stomatitis, seborrhea, cheilosis0.6 mg NiacinPellagra: pigmented rash of sun-exposed areas, bright red tongue, diarrhea, apathy, memory loss, disorientation necklace sign9.0 niacin equivalentsAlcoholism, vitamin B6 deficiency, riboflavin deficiency, tryptophan deficiencyVitamin B6Seborrhea, glossitis convulsions, neuropathy, depression, confusion, microcytic anemia0.2 mgAlcoholism, isoniazidFolateMegaloblastic anemia, atrophic glossitis, depression, homocysteine100 mgdAlcoholism, sulfasalazine, pyrimethamine, triamtereneVitamin B12Megaloblastic anemia, loss of vibratory and position sense, abnormal gait, dementia, impotence, loss of bladder and bowel control, homocysteine, methylmalonic acid1.0 mgdGastric atrophy pernicious anemia, terminal ileal disease, strict vegetarianism, acid reducing drugs e.g., H2 blockersVitamin CScurvy: petechiae, ecchymosis, coiled hairs, inflamed and bleeding gums, joint effusion, poor wound healing, fatigue10 mgdSmoking, alcoholismVitamin AXerophthalmia, night-blindness, Bitots spots, follicular hyper-keratosis, impaired embryonic development, immune dysfunction300 mgdFat malabsorption, infection, measles, alcoholism, protein-energy malnutritionVitamin DRickets: skeletal deformation, rachitic rosary, bowed legs; osteomalacia2.0 mdAging, lack of sunlight exposure, fat malabsorption, deeply pigmented skinVitamin EPeripheral neuropathy, spinocerebellar ataxia, skeletal muscle atrophy, retinopathyNot described unless underlying contributing factor is presentOccurs only with fat malabsorption, or genetic abnormalities of vitamin E metabolismtransportVitamin KElevated prothrombin time, bleeding10 gdFat malabsorption, liver disease, antibiotic use 