Snapshot A 40-year-old man is brought to the emergency department due to lethargy and confusion. The patient is accompanied by his friend, who reports he has been having trouble decreasing his alcohol consumption. Per his friend, the patient has 20 years of alcohol use. On physical examination, the patient has horizontal nystagmus and is ataxic. He is immediately started on intravenous thiamine. (Wernicke encephalopathy) Introduction Vitamin B1 is a water soluble vitamin (and thus excreted in the urine) the biologically active form of this vitamin is thiamine pyrophosphate (TPP) Biochemistry TPP serves as a coenzyme for login to view 6 more bullets Clinical correlate thiamine deficiency can result in decreased ATP production because of thiamine's role in dehydrogenase-catalyzed reactions involved in energy production login to view 1 more bullet thiamine deficiency results from chronic alcoholism due to login to view 1 more bullet diet mainly composed of polished rice thiamine deficiency results in Wernicke-Korsakoff syndrome login to view 1 more bullet beriberi can be divided into login to view 5 more bullets