Thiamine for prevention and treatment of Wernicke-Korsakoff Syndrome in people who abuse alcohol

Day, Ed; Bentham, Peter; Callaghan, Rhiannon; Kuruvilla, Tarun; George, Sanju

doi:10.1002/14651858.cd004033.pub3

Cited by 104 publications

(108 citation statements)

References 28 publications

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“…However, there is little or no evidence base on which to determine the dose, frequency, route or duration of thiamine treatment for prophylaxis against or treatment of Wernicke-Korsakoff syndrome in this setting. 6 Several sets of guidance exist based primarily on pragmatic clinical consensus, 4,7,8 resulting in a lack of consistency, confusion and poor uptake of best practice. 9,10 If there is any suspicion of Wernicke's encephalopathy treatment should be instituted promptly (Box 2).…”

Section: Wernicke's Encephalopathymentioning

confidence: 99%

Acute alcohol toxicity and withdrawal in the emergency room and medical admissions unit

Morgan

2015

Clinical Medicine

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Alcohol-related hospital attendances and admissions continue to escalate despite a fall in alcohol consumption levels in the UK population overall. People with alcohol-related problems pose a significant and often disproportionate burden on acute medical services as their management is often complex and challenging. This article focuses on the management of alcohol intoxication, with particular emphasis on aggressive and possibly violent behaviour; alcohol withdrawal; fitting; and the prevention and treatment of Wernicke's encephalopathy. IntroductionPeople with alcohol problems are frequent attendees at accident and emergency departments and medical admission units. They manifest a wide range of problems, including alcohol intoxication, alcohol withdrawal and fitting, and aggressive and sometimes violent behaviour. In addition, they may have a whole host of other alcohol-related physical and psychosocial problems. Management of these individuals needs skill, knowledge and fortitude. However, opportunities should not be lost, whether patients are admitted or not, to assess their needs and refer appropriately to alcohol liaison services or other statutory/non-statutory bodies. Alcohol intoxicationIn naïve drinkers, blood alcohol concentrations of 150-250 mg/100 ml are usually associated with clinically apparent intoxication; concentrations of 350 mg/100 ml are associated with stupor and coma; while concentrations of >450 mg/100 ml are often fatal. Individuals who habitually misuse alcohol often develop tolerance to its effects and are significantly less likely to develop intoxication than non-habitual drinkers.Adults with mild to moderate intoxication can be managed satisfactorily in relatively simple surroundings with a minimum of medical support, but those who are severely intoxicated should be admitted and nursed in a high-dependency setting. Their level of consciousness should be assessed at least hourly; ABSTRACT their cardiac activity should be continuously monitored; their urine output should be carefully recorded; and blood glucose, plasma electrolytes and blood gases should be measured every 4 hours until recovery is assured.Intravenous fluids should be given to counter dehydration and to maintain urine output and plasma expanders may be required if circulatory collapse occurs; inotropic support may be necessary if severe hypotension persists. Hypoglycaemia should be corrected as quickly as possible with oral glucose, if the conscious level permits, or else with 5% or 10% IV dextrose, as required. Key pointsAlternative causes of impaired consciousness should be sought in adults with blood alcohol levels below 350 mg/100 ml.Aggressive, intoxicated individual should be assessed, if possible, to identify factors such as injury or infection which might confound the clinical picture.

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Section: Wernicke's Encephalopathymentioning

confidence: 99%

Acute alcohol toxicity and withdrawal in the emergency room and medical admissions unit

Morgan

2015

Clinical Medicine

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“…1 One of the most common neurologic complications of thiamine deficiency is Wernicke-Korsakoff syndrome, 2 which consists of 2 disorders: Wernicke encephalopathy (WE) and Korsakoff psychosis. 3,4 Petechial hemorrhage and demyelination within periventricular structures account for the classic triad of WE-confusion, gait ataxia, and ocular abnormalities-which may occur together or in various combinations. [1][2][3] WE can also progress to Korsakoff psychosis, which is characterized by severe memory impairment without any dysfunction in other intellectual parameters.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 Petechial hemorrhage and demyelination within periventricular structures account for the classic triad of WE-confusion, gait ataxia, and ocular abnormalities-which may occur together or in various combinations. [1][2][3] WE can also progress to Korsakoff psychosis, which is characterized by severe memory impairment without any dysfunction in other intellectual parameters. 3 Chronic alcohol use is one of the most common predisposing factors for WE.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] WE can also progress to Korsakoff psychosis, which is characterized by severe memory impairment without any dysfunction in other intellectual parameters. 3 Chronic alcohol use is one of the most common predisposing factors for WE. 2,5 WE has been reported to occur in 12.5% of those with chronic alcohol use, although it is widely suspected that this is an underestimate of the true prevalence of the disorder.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 Importantly, WE can cause substantial morbidity and mortality if left untreated, leading to death in up to 20% of cases and progression to Korsakoff psychosis in 85% of survivors, of whom 25% require long-term institutionalization. 3,[8][9][10] Up to 90% of patients with suspected WE do not present with the classic triad of symptoms. 3,8 Thus, a presumptive diagnosis of WE should be made in any patient with a history of alcohol abuse who may be at risk.…”

Section: Introductionmentioning

confidence: 99%

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Thiamine Prescribing Practices for Adult Patients Admitted to an Internal Medicine Service

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Does thiamine protect the brain from iron overload and alcohol‐related dementia?

Listabarth

König

Vyssoki

et al. 2020

Alzheimer's & Dementia

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Alcohol-related dementia (ARD) is a common and severe co-morbidity in alcohol use disorder (AUD). We propose brain iron overload (BIO) to be an important and previously neglected pathogenic process, accelerating cognitive decline in AUD. Furthermore, we suggest thiamine, which is frequently depleted in AUD, to be a key modulator in this process: Thiamine deficiency impairs the integrity of the blood-brain barrier, thereby enabling iron to pass through and accumulate in the brain. This hypothesis is based on findings from animal, translational, and neuroimaging studies, discussed in this article. To validate this hypothesis, translational studies focusing on brain iron homeostasis in AUD, as well as prospective clinical studies investigating prevalence and clinical impact of BIO in AUD, should be conducted. If proven right, this would change the understanding of ARD and may lead to novel therapeutic interventions in prevention and treatment of ARD.

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Thiamine for prevention and treatment of Wernicke-Korsakoff Syndrome in people who abuse alcohol

Abstract: Evidence from randomised controlled clinical trials is insufficient to guide clinicians in determining the dose, frequency, route or duration of thiamine treatment for prophylaxis against or treatment of WKS due to alcohol abuse.

Cited by 104 publications

References 28 publications

Acute alcohol toxicity and withdrawal in the emergency room and medical admissions unit

Acute alcohol toxicity and withdrawal in the emergency room and medical admissions unit

Thiamine Prescribing Practices for Adult Patients Admitted to an Internal Medicine Service

Does thiamine protect the brain from iron overload and alcohol‐related dementia?

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