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Psychiatrists arefrequenlly challenged to differentiateprimarypsychiatricsymptomsfrom those that arise secondary to medical illness. Errors in clinical assessment can lead to significant morbidity and even mortality. Wernicke's encephalopathy is a medical condition that presents, in part, as psychiatric symptomatology. Despite an estimated incidence of2%, 80% qf the cases are undiagnosed. Of its classic triad, ophthalmoplegia and ataxia call be quite subtle, oreven absent, whereas mental status changes are present in all but 10%ofcases. This disorder, although widely recognized as a complication ofalcoholism, has many lessftequently considered etiologies, including iatrogenic causes, which may constitute a largefraction ofthe unrecognized cases. The authorlooks at a caseofWemicke's encephalopathy that was iatrogenically induced andpresentedaspsychiatric symptomatology. Wernicke's ence phalopa thy is a medi ca l condition which results from impaired intestinal absorpt ion of thiamine. It s pr imary manifest ations a re neurological and psych iatric, however its neurologica l seque lae (ophtha lmo pleg ia a nd a taxia) are ofte n subt le and a high ind ex of suspicion is essen tia l to conside r th e diagnosis (I). Dist urbances of consciousness an d mentation are typica l and pr esen t in all but 10 pe rce nt of pat ients (2) . The following ca se illust rates a primarily psych iatric presentat ion of the illn ess, followin g int ravenou s fluid administ ration, in a 3 1-yea r-old man with hypere mesis and protract ed hiccups.

A Psychiatric Presentation of Wernicke's Encephalopathy Following Intravenous Fluid Administration