Primary prevention
Prophylactic thiamine should be offered to patients experiencing alcohol withdrawal to prevent Wernicke's encephalopathy as these patients are at high risk for developing the disorder.[64][65][66] Choice of administration route of (oral or parenteral) will depend on whether the patient:
Is receiving ambulatory or inpatient treatment (for alcohol withdrawal or for any other acute illness or injury)
Is malnourished or at-risk of malnourishment
Has decompensated liver disease.
See Alcohol withdrawal.
Thiamine fortification is another strategy to reduce the prevalence of thiamine deficiency and, therefore, the risk of Wernicke's encephalopathy among vulnerable populations. In Australia, the introduction of thiamine-enriched bread flour reduced the prevalence of Wernicke's encephalopathy from 4.7% to 1.1%.[67] Other countries in which thiamine enrichment of food is mandatory or recommended include the US, the UK, Canada, Denmark, Japan, and Mexico. The overall impact of these measures on the prevalence of Wernicke's encephalopathy has not been rigorously assessed.
There are few mandatory thiamine fortification programs in low-and middle-income countries.[68] Future strategies in these regions must give due consideration to local or regional traditional dietary practices.
Secondary prevention
If appropriate, patients should be counselled about alcohol cessation and enrolled into appropriate community programmes. Periodic follow-up is recommended to ensure patients do not relapse and continue to adhere to recommendations concerning long-term thiamine supplementation and nutritional deficient correction.
See Alcohol use disorder.
Use of this content is subject to our disclaimer