An Atypical Long-Term Thiamine Treatment Regimen for Wernicke Encephalopathy

Abstract

A patient with rapidly changing mental status responded to treatment with intramuscular or IV thiamine but not oral dosages, suggesting that presentation of thiamine deficiency can be highly variable, which can complicate the correct diagnosis and treatment.

Undiagnosed Wernicke’s encephalopathy. A case report on hyperactive delirium

“…Several studies suggest using a high dose of IV thiamine treatment (500 mg) three times a day for 3-5 days to facilitate diffusion across the blood-brain barrier and restore vitamin status [13]. This is then is followed by an oral regimen of 250-1000 mg of thiamine until alcohol reduction or abstinence [15]. One study completed by Nakamura et al illustrated that a high IV dose regimen was associated with a decrease in mortality [16].…”