In a patient at risk of thiamine deficiency, a glucose load increases thiamine consumption and can precipitate or worsen Wernicke encephalopathy. The classical triad of confusion, ataxia and eye signs is present in only a minority, so the diagnosis is easily missed.
Parenteral thiamine is cheap and safe. Giving it before or with glucose, at a treatment dose when Wernicke encephalopathy is suspected, is established practice on any medical ward.
- Give parenteral thiamine before or with intravenous glucose in alcohol-dependent or malnourished patients.
- Suspect Wernicke encephalopathy with any one of confusion, ataxia or eye movement abnormality in an at-risk patient.
- Use a treatment dose, not a prophylactic one, when Wernicke encephalopathy is suspected.
- Remember at-risk groups beyond alcohol: hyperemesis, bariatric surgery, refeeding and prolonged vomiting.
Why it matters
Wernicke encephalopathy is preventable, and the full triad is the exception rather than the rule.
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