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Parenteral thiamine use in the prevention and treatment of Wernicke–Korsakoff syndrome

  • Claire McIntosh (a1), Valerie Kippen (a2), Fiona Hutcheson (a3) and Andrew McIntosh (a2)
Abstract
Aims and Method

A pre-/post-intervention audit of 163 case notes was conducted to assess the efficacy of printing information about the identification and treatment of the Wernicke–Korsakoff syndrome on the hospital alcohol detoxification sheet.

Results

Parenteral thiamine was indicated in 42 of 163 patients; 26 had symptoms suggestive of Wernicke's encephalopathy and 16 were at risk. The intervention increased the chance of appropriate parenteral treatment by an odds ratio of 5.9 (95% CI 1.3–27.8). Admission to a specialist alcohol unit increased the chance of appropriate treatment by an odds ratio of 7.0 (95% CI 1.52–32.25). The mean number of doses rose from 3.08 to 4.62.

Clinical Implications

A simple intervention may lead to improved treatment of patients with Wernicke–Korsakoff syndrome.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Parenteral thiamine use in the prevention and treatment of Wernicke–Korsakoff syndrome

  • Claire McIntosh (a1), Valerie Kippen (a2), Fiona Hutcheson (a3) and Andrew McIntosh (a2)
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eLetters

Parenteral thiamine

Alasdair J Macdonald, consultant psychiatrist
17 March 2005

I was delighted to see the article by McKintosh et al (Psychiatric Bulletin, March 2005, 29, 94-97) encouraging the use of parenteral thiamine for the early treatment of Wernicke-Korsakoff syndrome in alcoholism. Such treatment greatly improves outcome in some alcoholics (Guthrie & Elliott 1980; Macdonald 1994).

However the British National Formulary recommends one pair of high potency ampoules twice daily for seven days, so the guidelines given fall short of an adequate dose. Also, it is hard to detect any useful clinical response within two days; my own experience is that 3-4 weeks are requiredbefore improvement in memory function can be detected.

Guthrie, A. & Elliott, W.A. (1980) The nature and reversibility of cerebral impairment in alcoholism: treatment implications. J Studies Alcohol, 41, 147-155.

Macdonald, A.J. (1994). A paper that changed my practice: Reversible mental impairment in alcoholics. British Medical Journal, 308,1678.
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