In anyone admitted with heavy alcohol use, give thiamine before or with intravenous glucose, because glucose can precipitate Wernicke encephalopathy in a thiamine-deficient patient. Confusion, ataxia and eye-movement abnormalities should prompt treatment without waiting for the full triad.
Check glucose, magnesium and potassium early, and reassess the withdrawal score at regular intervals rather than relying on a single assessment at admission.
- Give thiamine before or with intravenous glucose
- Treat suspected Wernicke encephalopathy without waiting for the full triad
- Check glucose, magnesium and potassium early
- Reassess the withdrawal score regularly through the admission
Why it matters
The sedative chosen matters less than missing a treatable cause of confusion.
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