• alcoholism;
  • diagnosis;
  • guidelines;
  • prevention;
  • thiamine;
  • treatment;
  • Wernicke encephalopathy

Background:  Although Wernicke encephalopathy (WE) is a preventable and treatable disease it still often remains undiagnosed during life.

Objectives:  To create practical guidelines for diagnosis, management and prevention of the disease.

Methods:  We searched MEDLINE, EMBASE, LILACS, Cochrane Library.

Conclusions and recommendations:   

  • 1
     The clinical diagnosis of WE should take into account the different presentations of clinical signs between alcoholics and non alcoholics (Recommendation Level C); although prevalence is higher in alcoholics, WE should be suspected in all clinical conditions which could lead to thiamine deficiency (good practice point – GPP).
  • 2
     The clinical diagnosis of WE in alcoholics requires two of the following four signs; (i) dietary deficiencies (ii) eye signs, (iii) cerebellar dysfunction, and (iv) either an altered mental state or mild memory impairment (Level B).
  • 3
     Total thiamine in blood sample should be measured immediately before its administration (GPP).
  • 4
     MRI should be used to support the diagnosis of acute WE both in alcoholics and non alcoholics (Level B).
  • 5
     Thiamine is indicated for the treatment of suspected or manifest WE. It should be given, before any carbohydrate, 200 mg thrice daily, preferably intravenously (Level C).
  • 6
     The overall safety of thiamine is very good (Level B).
  • 7
     After bariatric surgery we recommend follow-up of thiamine status for at least 6 months (Level B) and parenteral thiamine supplementation (GPP).
  • 8
     Parenteral thiamine should be given to all at-risk subjects admitted to the Emergency Room (GPP).
  • 9
     Patients dying from symptoms suggesting WE should have an autopsy (GPP).