Wernicke's encephalopathy is under-diagnosed because the full triad of confusion, ataxia and eye signs is present in only a minority. Parenteral thiamine is cheap and safe, so it is given to patients with alcohol dependence who are malnourished, withdrawing, or have any one of the features, rather than waiting for all three.
Do not delay treatment of hypoglycaemia to give thiamine first; give both.
- Give parenteral thiamine to patients with alcohol dependence who are withdrawing or malnourished.
- Treat at treatment doses if any of confusion, ataxia or eye movement abnormality is present.
- Never withhold glucose for hypoglycaemia while waiting for thiamine.
- Continue oral thiamine after discharge.
Why it matters
Waiting for the classic triad means missing most cases.
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