Treatment of Wernicke encephalopathy in harmful or dependent drinking with malnourishment, decompensated liver disease, or alcohol withdrawal
Patients with harmful or dependent alcohol use who also carry specific nutritional or clinical risk factors represent a population requiring active prevention of Wernicke encephalopathy. This protocol addresses that group.
Clinical scenario
Harmful or dependent drinking, with any of the following:
- Malnourishment or at risk of malnourishment
- Decompensated liver disease
- Acute alcohol withdrawal
- Before and during a planned medically assisted alcohol withdrawal
Approach
The protocol calls for prophylactic oral thiamine supplementation for patients in this group. The full dosing guidance — including the specific level within the recommended formulary range — is set out in the complete regimen.
References
- Offer prophylactic oral thiamine to harmful or dependent drinkers:
- if they are malnourished or at risk of malnourishment or
- if they have decompensated liver disease or
- if they are in acute withdrawal or
- before and during a planned medically assisted alcohol withdrawal.
- Thiamine should be given in doses toward the upper end of the 'British national formulary' range.
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