What is Wernicke's (Wernicke) encephalopathy?

From the Guidelines

Wernicke encephalopathy should be treated with immediate administration of thiamine, with a recommended dose of 100-500 mg/day for 12-24 weeks, as stated in the guidelines for the management of alcoholic liver disease 1. The treatment of Wernicke encephalopathy is crucial to prevent permanent brain damage and improve the patient's quality of life.

• The guidelines recommend thiamine administration before giving IV fluids containing glucose, as glucose can precipitate acute thiamine deficiency 1.
• The dose of thiamine can vary from 100-500 mg/day, depending on the severity of the condition, and should be administered for a period of 12-24 weeks 1.
• In addition to thiamine, patients should receive other B vitamins and proper nutrition during recovery to support their overall health and well-being.
• It is essential to note that glucose should never be given before thiamine in at-risk patients, as it can worsen the condition by depleting remaining thiamine stores.
• Long-term abstinence from alcohol and nutritional support are crucial for those with alcohol use disorder to prevent recurrence of Wernicke encephalopathy.
• The treatment should be individualized, and the patient's response to therapy should be closely monitored to adjust the treatment plan as needed.
• Other medications, such as benzodiazepines, may be used to manage symptoms like agitation or seizures, but thiamine remains the primary treatment for Wernicke encephalopathy 1.

From the Research

Wernicke Encephalopathy Treatment

• Wernicke's encephalopathy (WE) is a medical emergency that requires prompt treatment with thiamine 2.
• The use of prophylactic thiamine in low-risk patients is not universally indicated, but high-risk patients need parenteral treatment with a recommended posology of 250 mg daily for 3 to 5 days 2.
• In cases where the diagnosis of WE is suspected or confirmed, a curative treatment with high-dose IV thiamine is justified, with treatment regimens consisting of 500 mg IV 3 times daily for 3 to 5 days, followed by 250 mg IV daily for a minimum of 3 to 5 additional days 2.

Thiamine Dosage

• High-dose IV thiamin (i.e., >100 mg) can treat neurological symptoms and cognitive dysfunction in WE and should be considered for first-line treatment 3.
• A randomized controlled trial found no significant differences between different thiamine doses (100 mg daily, 100 mg thrice daily, or 300 mg thrice daily) for the prevention of WE in asymptomatic at-risk patients 4.
• Another study found that high-dose thiamine (≥500 mg) appears safe and efficacious for use in patients with suspected WE, with 73% of patients displaying symptom resolution or improvement after treatment 5.

Clinical Diagnosis and Treatment

• WE is a clinical diagnosis, and the common findings include mental status changes, ocular dysfunction, and a gait apraxia, present in only 10% of cases 6.
• Recognition of nutritional deficiency and any portion of the classic triad should prompt treatment, and clinical judgment should be exercised in diagnosis and treatment (dosage, frequency, route of administration and duration) in all cases of WE 6.
• Overdiagnosis and overtreatment may be preferred to prevent prolonged or persistent neurocognitive impairments given the excellent safety profile of thiamine 6.