Alcohol and Alcoholism Advance Access originally published online on December 29, 2005
Alcohol and Alcoholism 2006 41(2):159-167; doi:10.1093/alcalc/agh250
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THE TREATMENT OF PATIENTS AT RISK OF DEVELOPING WERNICKE'S ENCEPHALOPATHY IN THE COMMUNITY
1 Molecular Psychiatry Laboratory, Windeyer Institute of Medical Science, Department of Mental Health Sciences, Royal Free and University College London, Medical School, 46 Cleveland Street, London W1T 4JF, UK, 2 Kent Institute of Medicine and Health Science, University of Kent at Canterbury, UK and 3 National Addiction Centre, Box 048, Institute of Psychiatry, Kings College London, De Crespigny Park, London SE5 8AF, UK
* Author to whom correspondence should be addressed at: Tel: +44 207 919 2345; Fax: +44 207 919 2349; E-mail: jane.marshall{at}iop.kcl.ac.uk
(Received 21 December 2004; first review notified 16 February 2005; in revised form 1 November 2005; accepted 2 November 2005)
Aim: To review the process of identifying alcohol-dependent patients at risk of developing Wernicke's encephalopathy (WE) in the community, and prophylactic treatment options. Methods: Non-systematic literature review of the diagnosis of thiamine deficiency and of its treatment in the community. The role of supplementation of beer and bread with thiamine was evaluated. Results: The diagnosis of thiamine deficiency is not always made, and treatment apparently may sometimes be inadequate. Conclusions: Alcohol-dependent patients in the community who are at risk of developing WE should be given thiamine 250 mg, intramuscularly, daily for 3–5 days as part of a community detoxification programme. Further work is essential to determine the optimum dose of thiamine required to prevent permanent brain damage (Korsakoff's Psychosis). Neurotoxicity, due to the metabolism of excessive alcohol in patients with chronic and severe alcohol dependence, must be considered as an important factor in determining the long-term outcome of treatment.
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