treatment of thiamine deficiency

Last reviewed 05/2021

Thiamine must be replaced. It is given i.v. or i.m. in a dose appropriate to the deficiency:

  • mild chronic deficiency - 10-25 mg daily
  • severe deficency - 200-300 mg daily

Prevention and treatment of Wernicke's encephalopathy (1)

  • treatment is urgent as once the amnesic syndrome - Korsakoff psychosis - is established
  • only 50% of patients can be expected to show any improvement
  • untreated, the condition is fatal
  • offer thiamine to people at high risk of developing, or with suspected, Wernicke's encephalopathy. Thiamine should be given in doses toward the upper end of the 'British national formulary' range. It should be given orally or parenterally as follows:
    • offer prophylactic oral thiamine to harmful or dependent drinkers:
      • if they are malnourished or at risk of malnourishment or
      • if they have decompensated liver disease or
      • if they are in acute withdrawal or - before and during a planned medically assisted alcohol withdrawal
    • offer prophylactic parenteral thiamine followed by oral thiamine to harmful or dependent drinkers:
      • if they are malnourished or at risk of malnourishment or
      • if they have decompensated liver disease
      • and in addition
        • attend an emergency department or
        • are admitted to hospital with an acute illness or injury
    • offer parenteral thiamine to people with suspected Wernicke's encephalopathy. Maintain a high level of suspicion for the possibility of Wernicke's encephalopathy, particularly if the person is intoxicated. Parenteral thiamine should be given for a minimum of 5 days, unless Wernicke's encephalopathy is excluded. Oral thiamine should follow parenteral therapy

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