What is the treatment for Wernicke (Wernicke's) syndrome?

From the Guidelines

The treatment for Wernicke syndrome is immediate administration of thiamine (vitamin B1), with a recommended dose of 100-500 mg/day for 12-24 weeks, as stated in the kasl clinical practice guidelines: management of alcoholic liver disease 1. The standard regimen consists of administering thiamine before giving any glucose-containing fluids or food, as glucose can worsen the condition by depleting remaining thiamine stores. Treatment should begin as soon as the diagnosis is suspected, without waiting for confirmation, because delayed treatment can lead to permanent brain damage or death. In addition to thiamine replacement, supportive care including correction of electrolyte abnormalities (particularly magnesium), nutritional support, and management of other complications is important. Some key points to consider in the treatment of Wernicke syndrome include:

• Administering thiamine before glucose-containing fluids or food to prevent worsening of the condition
• Providing supportive care, including correction of electrolyte abnormalities and nutritional support
• Managing other complications, such as alcohol withdrawal, with benzodiazepines if necessary, as recommended in the management of alcohol-related liver disease: the french association for the study of the liver and the french alcohol society clinical guidelines 1
• Considering the use of multivitamin supplementation in patients with decompensated liver disease, as suggested in the easl clinical practice guidelines on nutrition in chronic liver disease 1
• Being aware of the potential for Wernicke's encephalopathy in patients with chronic liver disease, even in the absence of a history or clinical signs, as noted in the easl clinical practice guidelines on the management of hepatic encephalopathy 1. It's also important to note that thiamine deficiency is common in alcohol-dependent individuals, and prophylactic prescription of thiamine is recommended as part of the withdrawal process to prevent the onset of Wernicke's encephalopathy, as stated in the management of alcohol-related liver disease: the french association for the study of the liver and the french alcohol society clinical guidelines 1. Overall, the treatment of Wernicke syndrome requires prompt administration of thiamine and supportive care to prevent long-term damage and improve patient outcomes.

From the FDA Drug Label

In the treatment of Wernicke-Korsakoff syndrome, thiamine hydrochloride has been administered IV in an initial dose of 100 mg, followed by IM doses of 50 to 100 mg daily until the patient is consuming a regular, balanced diet. The treatment for Wernicke's syndrome is thiamine hydrochloride administered:

• IV in an initial dose of 100 mg
• Followed by IM doses of 50 to 100 mg daily until the patient is consuming a regular, balanced diet 2. Thiamine hydrochloride injection is effective for the treatment of thiamine deficiency or beriberi and should be used where rapid restoration of thiamine is necessary, as in Wernicke’s encephalopathy 2.

From the Research

Treatment for Wernicke Syndrome

The treatment for Wernicke syndrome, also known as Wernicke-Korsakoff syndrome, typically involves the administration of thiamine, as the primary cause of the syndrome is thiamine deficiency 3, 4, 5, 6, 7.

• The optimal dose of thiamine is still a matter of debate, with some studies suggesting that high doses may not be more effective than lower doses 3, 5.
• A study published in 2021 recommends a parenteral thiamine treatment of 500 mg three times per day in adults 4.
• Another study published in 2019 suggests that the route and dosage of thiamine remain controversial, and clinical judgment should be exercised in diagnosis and treatment 6.
• Thiamine replacement therapy has been shown to rapidly reverse neurologic symptoms and MRI findings in patients with Wernicke's encephalopathy 7.

Key Considerations

• Wernicke syndrome can occur in both alcoholic and non-alcoholic patients, with vomiting and extreme weight loss being strong predictors of non-alcoholic Wernicke-Korsakoff syndrome in adults 4.
• The classic triad of Wernicke-Korsakoff syndrome is characterized by confusion, ataxia, and eye-movement disorders, but not all patients present with these symptoms 4, 6.
• Early diagnosis and treatment are critical to prevent permanent neurological morbidity and mortality 6, 7.

Thiamine Administration

• Thiamine can be administered parenterally, and the dosage and frequency of administration may vary depending on the patient's condition and response to treatment 3, 4, 5, 6.
• The treatment should also consider the potential impact of other biochemical factors, such as magnesium and other B vitamin deficiencies 3.