Index

Wernicke's Encephalopathy Guidelines

Offer prophylactic oral thiamine to harmful or dependent drinkers if:

Malnourished or at risk, or
Decompensated liver disease, or
In acute withdrawal, or
Before and during a planned medically assisted alcohol withdrawal

IV thiamine can be offered if the patient is in the emergency department or admitted to hospital.

When IV thiamine is indicated in the context of Wernicke's encephalopathy, IV Pabrinex is usually used rather than just thiamine alone and is routinely recommended in trust guidelines.

IV Pabrinex contains vitamin B1 (thiamine), B2, B6, vitamin C, nicotinamide, and glucose.

DO NOT give IV glucose before giving IV thiamine or Pabrinex in the context of Wernicke's encephalopathy, as it may precipitate or worsen Wernicke's encephalopathy.

This is because vitamin B1 (thiamine) is an essential co-factor for glucose metabolism. When glucose is given to someone who is already thiamine-deficient, the increased glucose metabolism will rapidly consume the body's already depleted thiamine stores.

Offer IV thiamine for at least 5 days → followed by oral thiamine

When IV thiamine is indicated in the context of Wernicke's encephalopathy, IV Pabrinex is usually used rather than just thiamine alone and is routinely recommended in trust guidelines.

IV Pabrinex contains vitamin B1 (thiamine), B2, B6, vitamin C, nicotinamide, and glucose.

DO NOT give IV glucose before giving IV thiamine or Pabrinex in the context of Wernicke's encephalopathy, as it may precipitate or worsen Wernicke's encephalopathy.

This is because vitamin B1 (thiamine) is an essential co-factor for glucose metabolism. When glucose is given to someone who is already thiamine-deficient, the increased glucose metabolism will rapidly consume the body's already depleted thiamine stores.

Korsakoff Syndrome Guidelines

There are no official NICE guideline on Korsakoff syndrome but the management principle is:

Supporitve care (e.g. fluid and electrolyte replacement), and
IV thiamine (does not treat or reverse Karsakoff syndrome but can prevent or slow down progression)

References

NICE guideline Alcohol-use disorders: diagnosis and management of physical complications

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Wernicke's Encephalopathy and Korsakoff Syndrome

Wernicke's Encephalopathy Guidelines

Korsakoff Syndrome Guidelines

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Wernicke's Encephalopathy and Korsakoff Syndrome

Wernicke's Encephalopathy Guidelines

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Korsakoff Syndrome Guidelines

Management

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