Wernicke encephalopathy is underdiagnosed, and the full triad of confusion, ataxia and eye signs is present in only a minority. Patients with heavy alcohol use, malnutrition or prolonged vomiting are at risk, and a glucose load can precipitate or worsen it when thiamine stores are low.
The established approach is to give parenteral thiamine to any at-risk patient on admission, before or alongside intravenous glucose, and to have a low threshold for treatment doses when there is any unexplained confusion or unsteadiness.
- Give parenteral thiamine on admission to patients with heavy alcohol use or malnutrition.
- Give it before or with intravenous glucose, not after.
- Treat unexplained confusion or ataxia in an at-risk patient as possible Wernicke encephalopathy.
- Continue thiamine through the admission and into discharge where intake remains poor.
Why it matters
The classic triad is usually incomplete, so waiting for it means missing the diagnosis.
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