Acute Encephalopathy & the Unresponsive ICU Patient

The Zombies are coming!! Just kidding… well, kind of – they may already be here…  Dr. Sam Wood is a brilliant EM/IM/CC trained physician who came all the down to Baltimore from Maine Medical Center to try to break down the expansive differential for the unresponsive ICU patient.  During her talk, Dr. Wood makes a pretty solid case that a number of patients who experience prolonged delirium in the ICU are the direct results of the medications and sedative agents we are using on a daily basis.  If you want to learn more about how to approach these diagnostic dilemmas, as well as how to NOT turn your patient into a zombie, you have to listen to this lecture.

Wood – Encephalopathy & the Unresponsive ICU Patient.mp3


  • Stop withholding glucose prior to thiamine administration in the altered patient.  There is minimal evidence that giving glucose before thiamine will precipitate a Wernicke’s encephalopathy.
  • Sedation with benzodiazepines is highly associated with ICU delirium for DAYS after cessation of treatment.  Midazolam and diazepam infusions are the frequent causes of prolonged delirium.
  • Consider an EEG in the comatose patient who is not waking up.  Literature estimates that approximately 8-10% are actually having non-convulsive status epilepticus!
  • Bonus Pearl: Zombies exist –Even in the PubMed literature!!

Suggested Reading

  1. Weiss N, Regard L, Vidal C, et al. Causes of coma and their evolution in the medical intensive care unit. J Neurol. 2012 Jul; 259(7):1474-7.
  2. Schabelman E, Kuo D. Glucose before thiamine for Wernicke encephalopathy: a literature review. J Emerg Med. 2012 Apr;42(4):488-94.

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  1. Alfred Papali

    Don’t make light of the impending zombie apocalypse. Even the CDC takes it seriously:

    “If zombies did start roaming the streets, CDC would conduct an investigation much like any other disease outbreak. CDC would provide technical assistance to cities, states, or international partners dealing with a zombie infestation.”

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