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Wernicke's encephalopathy

Key sources
The following summarized guidelines for the evaluation and management of Wernicke's encephalopathy are prepared by our editorial team based on guidelines from the European Federation of Neurological Societies (EFNS 2010).


1.Screening and diagnosis

Population at risk: consider the diagnosis of WE in patients at risk for thiamine deficiency, such as patients with alcohol abuse, bariatric surgery, hyperemesis gravidarum, starvation, gastrointestinal tract disease, AIDS, malnutrition, cancer, dialysis-dependent kidney disease, chronic vomiting, stem cell transplantation, or thyroid disease.
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  • Diagnostic criteria

2.Diagnostic investigations

Thiamine levels: obtain a blood sample for measurement of total thiamine immediately before administration of thiamine in patients with suspected WE.

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  • Brain MRI

3.Medical management

Thiamine supplementation, patients with suspected or manifest WE: administer intravenous thiamine (200 mg IV q8h) in patients with suspected WE. Initiate thiamine prior to giving any carbohydrates.

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  • Thiamine supplementation (patients at risk)

4.Specific circumstances

Patients post bariatric surgery
Initiate parenteral thiamine supplementation after bariatric surgery.
Monitor thiamine status for at least 6 months after bariatric surgery.

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  • Patients dying from WE