Thiamine deficiency can cause a neuropsychiatric complication (Wernicke’s encephalopathy), which often occurs in chronic alcohol users and particularly during withdrawal. It is characterised by confusion, ataxia, hypothermia, hypotension, nystagmus and vomiting.
The classic triad of confusion, ataxia and ophthalmoplegia is only present in approximately 10% of patients with this condition and therefore a high index of suspicion is required. If untreated this condition can progress to Korsakoff’s psychosis. The severe short-term memory loss and functional impairment, which this condition results in, renders the patient to require permanent institutionalised care [6].
Thiamine administration
Thiamine should be administered to patients prior to a glucose load to prevent the diminished thiamine stores becoming exhausted and triggering Wernicke’s onset [1].
Oral thiamine is poorly absorbed in dependent drinkers and so parenteral thiamine may be considered in all patients and definitely if any features of Wernicke’s encephalopathy are present [11]. Oral thiamine should be given in divided doses to maximise absorption (300 mg per day) [9].
Learning Bite
Thiamine should be given to all ALD patients who come to the ED.