special subjects
Wernicke Encephalopathy
Treatment of Wernicke Encephalopathy
Parenteral thiamin Parenteral magnesium Treatment of Wernicke encephalopathy consists of immediate administration of thiamin 100 mg IV or IM, continued daily for at least 3 to 5 days. Magnesium is a necessary cofactor in thiamin-dependent metabolism, and hypomagnesemia should be corrected using magnesium sulfate 1 to 2 g IM or IV every 6 to 8 hours or magnesium oxide 400 to 800 mg orally once/day. Supportive treatment includes rehydration, correction of electrolyte abnormalities, and general nutritional therapy, including multivitamins. Patients with advanced disease require hospitalization. Alcohol cessation is mandatory. Because Wernicke encephalopathy is preventable, all undernourished patients should be treated with parenteral thiamin (typically 100 mg IM followed by 50 mg orally once/day) plus vitamin B12 and folate (1 mg orally once/day for both), particularly if IVdextroseis necessary. Thiamin is also prudent before any treatment is begun in patients who present with a reduced level of consciousness. Patients who are undernourished should continue to receive thiamin as outpatients. 