What is the optimum thiamine dose to treat or prevent Wernicke's encephalopathy or Wernicke–Korsakoff syndrome? Results of a randomized controlled trial

Dingwall, Kylie; Delima, Jennifer; Binks, Paula; Batey, Robert; Bowden, Stephen C.

doi:10.1111/acer.14843

Cited by 24 publications

(10 citation statements)

References 60 publications

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“…(2001) in which AUD patients received a daily dosage of either 5, 20, 50, 100, or 200 mg of intramuscular thiamine, a dose depending effect of thiamine on cognitive functioning, specifically on working memory, was reported. However, this finding could not be replicated in a consecutively conducted study ( Dingwall et al. 2022 ) by the same research group.…”

Section: Discussionmentioning

confidence: 75%

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Can thiamine substitution restore cognitive function in alcohol use disorder?

Listabarth

Vyssoki

Marculescu

et al. 2023

Alcohol and Alcoholism

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Aims While clinical consequences of thiamine deficiency in alcohol use disorder (AUD) are severe, evidence-based recommendations on dosage, type of administration and duration of thiamine substitution (TS), and its’ target levels remain sparse. This study aimed to compare the effect of two best practice TS regimens on thiamine blood levels (i.e. thiamine pyrophosphate, TPP) and cognitive function. Methods In 50 patients undergoing in-patient alcohol-withdrawal treatment, TPP levels were determined at baseline and end of weeks 1, 2 and 8 following administration of oral TS (3 × 100 mg/day for 7 days followed by 1 × 100 mg/day thereafter) either with or without preceding intravenous TS (3 × 100 mg/day for 5 days). An extensive psychiatric assessment was conducted at baseline, including an evaluation of AUD severity and depressive symptoms. Additionally, cognitive function and depressive symptoms were repeatedly evaluated. Results Relevant increases (mean increase by 100.2 nmol/l [CI 76.5–123.8], P < 0.001) in peripheral blood TPP levels were observed in all patients at the end of weeks 1 and 2. Furthermore, no relevant difference between the intravenous and the oral group was found (average difference between increases: 2.3 nmol/l, P = 0.912). Importantly, an association between the ‘extent of the response’ to TS and the performance in a memory task was revealed in secondary analyses. Conclusion TS was associated with improving cognitive function in patients with AUD, independently of the substitution regime. Thus, in clinical practice, oral TS might be a sufficient but obligatory medication to prevent cognitive decline in AUD in the absence of Wernicke–Korsakoff Syndrome.

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Section: Discussionmentioning

confidence: 75%

“…utilization of thiamine esters in patients with alcohol-related liver disease, the presence of additional nutritional deficiencies such as magnesium deficiency) potentially interfering with thiamine metabolism complicates research efforts concerning this matter ( Martin et al. 2003 ; Dingwall et al. 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Can thiamine substitution restore cognitive function in alcohol use disorder?

Listabarth

Vyssoki

Marculescu

et al. 2023

Alcohol and Alcoholism

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“…Imaging of the head and cerebral spinal fluid studies may be required (144). It is also important to rule out Wernicke encephalopathy as a cause for altered mental status because it has its own prognostic and management implications (145,146), especially when considering LT for patients with ALD.…”

Section: Hepatic Encephalopathymentioning

confidence: 99%

ACG Clinical Guideline: Alcohol-Associated Liver Disease

Jophlin,

Singal,

Bataller

et al. 2023

Am J Gastroenterol

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Alcohol-associated liver disease (ALD) is the most common cause of advanced hepatic disease and frequent indication for liver transplantation worldwide. With harmful alcohol use as the primary risk factor, increasing alcohol use over the past decade has resulted in rapid growth of the ALD-related healthcare burden. The spectrum of ALD ranges from early asymptomatic liver injury to advanced disease with decompensation and portal hypertension. Compared with those with other etiologies of liver disease, patients with ALD progress faster and more often present at an advanced stage. A unique phenotype of advanced disease is alcohol-associated hepatitis (AH) presenting with rapid onset or worsening of jaundice, and acute on chronic liver failure in severe forms conveying a 1-month mortality risk of 20%–50%. The model for end stage disease score is the most accurate score to stratify AH severity (>20 defined as severe disease). Corticosteroids are currently the only available therapeutic with proven efficacy for patients with severe AH, providing survival benefit at 1 month in 50%–60% of patients. Abstinence of alcohol use, a crucial determinant of long-term outcomes, is challenging to achieve in ALD patients with concurrent alcohol use disorder (AUD). As patients with ALD are rarely treated for AUD, strategies are needed to overcome barriers to AUD treatment in patients with ALD and to promote a multidisciplinary integrated care model with hepatology, addiction medicine providers, and social workers to comprehensively manage the dual pathologies of liver disease and of AUD. Liver transplantation, a definitive treatment option in patients with advanced cirrhosis, should be considered in selected patients with AH, who are unresponsive to medical therapy and have a low risk of relapse to posttransplant alcohol use. Level of evidence and strength of recommendations were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations system. This guideline was developed under the American College of Gastroenterology Practice Parameters Committee.

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“…3 There is no consensus on the optimal dose and duration of parenteral thiamine, but its short half-life and water solubility suggest that divided dosing (2 or 3 times daily) would lead to better tissue repletion than once-daily dosing. [3][4][5][6]…”

Section: Qmentioning

confidence: 99%

“…3,4,5,7 A recent single-center randomized controlled trial comparing different dosages of parenteral thiamine found no evidence of an effect of dose on neurologic and cognitive outcomes in patients at risk for Wernicke encephalopathy; however, this study was limited by small sample size, high attrition, and short duration of follow-up. 6 Fortunately, adverse effects from parenteral thiamine administration are uncommon. Although early case reports of anaphylaxis from rapid administration of intravenous thiamine have raised concern, the risk is now believed to be exceedingly rare, especially when thiamine is administered over 30 minutes.…”

Section: ■ Thiamine Treatment: Route Dosing and Durationmentioning

confidence: 99%