Rationale and published recommendations for the use of thiamine in hospitalized patients
Several times recently on wards we have discussed thiamine administration in hospitalized patients. My literature search on this topic found two very helpful reviews linked below: Wernicke Encephalopathy—Clinical Pearls Mayo Clinic Proceedings Volume 94, Issue 6 p1065-1072June 2019 Myths and misconceptions of Wernicke's encephalopathy: what every emergency physician should know Ann Emerg Med Volume 50, Issue 6 p715-721December 2007 Here are the key points from these articles: Although treatment and prevention of WE are overlapping categories, thiamine is most effectively used as prevention. In other words, if you wait to give thiamine until you “ suspect” WE you have probably waited until it's too late. Approximately 80% of patients recognized as WE already have dementia. The recommended route for thiamine is IV not PO. Although dose recommendations are not supported by high-level data, published recommendations range from 200 mg q12 hour...