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).