Thiamine supplementation for Wernicke encephalopathy

Wernicke encephalopathy is a life-threatening complication of thiamine deficiency, characterised by ophthalmoplegia, ataxia and confusion. It is generally associated with alcohol dependence, but also occurs in association with bariatric surgery, cancer, and recurrent vomiting or chronic diarrhoea. Immediate therapy is required to minimise irreversible neurological damage and progression to Korsakoff syndrome.

For the prevention or treatment of Wernicke encephalopathy due to alcohol dependence, there is insufficient evidence from randomised controlled trials to guide the optimal dose, frequency, route or duration of thiamineLatt, 2014American Society of Addiction Medicine (ASAM), 2020. However, to treat Wernicke encephalopathy, expert opinion favours high-dose parenteral thiamine therapy with at leastHaber, 2021Latt, 2014:

thiamine 200 to 500 mg intravenously or intramuscularly, 3 times daily for 3 to 5 days1(American Society of Addiction Medicine (ASAM), 2020) thiamine thiamine thiamine

FOLLOWED BY EITHER

thiamine 300 mg intravenously or intramuscularly, daily for 1 to 2 weeks1 thiamine thiamine thiamine

OR

thiamine 100 mg orally, 3 times daily for 1 to 2 weeks. thiamine thiamine thiamine

Once the high-dose thiamine therapy course is complete, the patient should receive maintenance therapy. A suitable maintenance regimen is:

thiamine 100 mg orally, daily. thiamine thiamine thiamine

Thiamine should be given before administering glucose for hypoglycaemia to patients with Wernicke encephalopathy, or as soon as possible thereafter.

For additional information on the presentation and management of Wernicke encephalopathy, including the importance of managing electrolyte abnormalities, see Wernicke encephalopathy in alcohol dependence.

1 For intramuscular doses larger than 2 mL, consider dividing the dose among multiple injection sites. Do not use the intramuscular route for patients with coagulopathy(Haber, 2021).Return