The treatment of patients at risk of developing Wernicke's encephalopathy in the community.

AIM: To review the process of identifying alcohol-dependent patients at risk of developing Wernicke's encephalopathy (WE) in the community, and prophylactic treatment options.

METHODS

Non-systematic literature review of the diagnosis of thiamine deficiency and of its treatment in the community. The role of supplementation of beer and bread with thiamine was evaluated.

RESULTS

The diagnosis of thiamine deficiency is not always made, and treatment apparently may sometimes be inadequate.

CONCLUSIONS

Alcohol-dependent patients in the community who are at risk of developing WE should be given thiamine 250 mg, intramuscularly, daily for 3-5 days as part of a community detoxification programme. Further work is essential to determine the optimum dose of thiamine required to prevent permanent brain damage (Korsakoff's Psychosis). Neurotoxicity, due to the metabolism of excessive alcohol in patients with chronic and severe alcohol dependence, must be considered as an important factor in determining the long-term outcome of treatment.