Wernicke Encephalopathy in Harmful or Dependent Drinkers with Malnourishment or Decompensated Liver Disease
This protocol applies when Wernicke encephalopathy occurs in harmful or dependent drinkers who are also malnourished, at risk of malnourishment, or have decompensated liver disease — and who present to an emergency department or are admitted to hospital with an acute illness or injury.
Clinical scenario
A harmful or dependent drinker presenting acutely to hospital or the emergency department in the setting of malnourishment (or risk of malnourishment) or decompensated liver disease. This combination defines a high-risk group requiring a specific, prompt prophylactic approach.
Treatment approach
The regimen centres on thiamine replacement therapy. The full protocol — including the form of administration, sequencing, and dosing guidance aligned with established formulary recommendations — is available in the structured regimen below.
References
- Offer prophylactic parenteral thiamine followed by oral thiamine to harmful or dependent drinkers: if they are malnourished or at risk of malnourishment or if they have decompensated liver disease, and in addition they attend an emergency department or are admitted to hospital with an acute illness or injury.
- Thiamine should be given in doses toward the upper end of the ‘British national formulary’ range.
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