Table 1.

Differential diagnosis of confusion, agitation, or drowsiness in patients with alcohol use disorder admitted to our center because of suspected Wernicke-Korsakoff syndrome.

Complications of alcohol abuse

Alcohol intoxication    Alcohol withdrawal: delirium tremens, seizures    Hypoglycemia, acidosis a    Electrolyte disorders: hyponatremia, hypomagnesemia

Acute or progressive cerebral disorders

Wernicke encephalopathy b    Osmotic demyelination syndrome    Head injury: subdural hematoma, concussion    Stroke    Space-occupying lesion of the brain    Hepatic encephalopathy    Alcoholic cerebellar degeneration    Marchiafava-Bignami disease b

Severe infections a

Pneumonia, urinary tract infection, urosepsis, sepsis of unknown origin, abscesses, empyema, meningitis, endocarditis, spondylodiscitis, other infections

Acute abdominal conditions

Gastrointestinal bleeding: ulcers, esophageal varices    Portal hypertension, alcoholic hepatitis, liver cirrhosis    Alcoholic pancreatitis    Peritonitis associated with ascites    Acute mesenteric ischemia, other vascular diseases

Decompensation in response to other conditions

Dysregulation of diabetes mellitus, dehydration, nephropathy (renal loss of thiamine)    Myocardial infarction, heart failure, cardiomyopathy a    Severe chronic obstructive pulmonary disease, emphysema, hypoxia, hypercapnia c    Malignancy: mouth, throat, lung c    Esophagus stenosis (Barrett, carcinoma)

Delirious state

May accompany all causes listed above

Other neuropsychiatric conditions

Korsakoff syndrome b    Dementia    Psychosis, schizophrenia    Personality disorders, e.g., schizotypal, paranoid    Depression and anxiety disorders

Other substance dependences or intoxications

Illicit drugs, benzodiazepines

^a Possibly caused by or in combination with thiamine deficiency. ^b Caused by thiamine deficiency. ^c In combination with smoking. Conditions were collected from medical records of patients admitted to Slingedael Korsakoff center, Rotterdam, The Netherlands.