High-dose Parenteral Thiamine in Treatment of Wernicke's Encephalopathy: Case Series and Review of the Literature

In Vivo. 2017 Jan 2;31(1):121-124. doi: 10.21873/invivo.11034.

Abstract

Background: Thiamine deficiency can lead to Wernicke's encephalopathy (WE), an acute and potentially life-threatening neurological disorder. Even though the main treatment modality for WE consists of thiamine replacement, evidence supporting an optimal dosing strategy and duration is unclear.

Patients and methods: We present a single-center case series of eleven patients that were admitted with possible WE and treated with high-dose parenteral thiamine.

Results: Patients with suspected WE were treated with ≥500 mg intravenous thiamine for a median of 3 days with 73% of patients (eight out of eleven) displaying symptom resolution or improvement after treatment. No significant correlation between symptom resolution and timing of high-dose thiamine initiation (median=92 h) was identified. In patients whose symptoms resolved compared to those whose symptoms did not, there were no differences in patient variables nor adverse effects related to thiamine treatment.

Conclusion: High-dose thiamine (≥500 mg) appears safe and efficacious for use in patients with suspected WE.

Keywords: Thiamine; Wernicke's encephalopathy; alcohol; vitamin B1.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Middle Aged
  • Prognosis
  • Thiamine / therapeutic use*
  • Thiamine Deficiency / complications*
  • Vitamin B Complex / therapeutic use*
  • Wernicke Encephalopathy / drug therapy*
  • Wernicke Encephalopathy / etiology

Substances

  • Vitamin B Complex
  • Thiamine