Which patients hospitalized with alcohol withdrawal syndrome should receive high-dose parenteral thiamine?

Abstract

All patients hospitalized with alcohol withdrawal syndrome who have severe or complicated withdrawal (eg, severe symptoms, hallucinations, seizures, or withdrawal delirium) and evidence of malnutrition or malabsorption and patients admitted to the intensive care unit to treat alcohol withdrawal should receive high-dose parenteral thiamine to treat Wernicke encephalopathy.1,2 We suggest using clinical criteria to risk-stratify all other patients hospitalized with alcohol withdrawal syndrome for Wernicke encephalopathy, as highrisk patients warrant treatment regardless of severity of withdrawal. Pharmacokinetic data indicate that currently available oral thiamine formulations are absorbed too slowly to replenish depleted brain stores, and parenteral thiamine administration is required.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.3–6