What is the role of thiamine in the treatment of delirium tremens (DTs)?

Updated: Nov 06, 2020
  • Author: Michael James Burns, MD, FACEP, FACP, FIDSA; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Thiamine is useful in preventing Wernicke encephalopathy, an acute disorder due to thiamine deficiency manifested by confusion, ataxia, and ophthalmoplegia, as well as the chronic Korsakoff syndrome, which is manifested by memory impairment and amnesia. Thiamine has no effect on the symptoms or signs of alcohol withdrawal or on the incidence of seizures or DTs. Routine use of thiamine is recommended because the development of Wernicke encephalopathy or Wernicke-Korsakoff syndrome is disastrous in these patients and can remain unrecognized. Because orally administered thiamine may have poor enteral absorption in individuals with alcoholism, high-risk patients should receive parenteral thiamine at 100-250 mg once daily for several days. Although it has been a commonly held belief that thiamine must be given before administering glucose to hypoglycemic patients with suspected thiamine deficiency to prevent Wernicke encephalopathy, there is a lack of evidence that this is the case. [13] Current evidence suggests that it is prolonged glucose administration without thiamine supplementation that is a risk factor for the development or worsening of Wernicke encephalopathy. A delay in administering glucose to hypoglycemic patients cannot be recommended, and prompt supplementation with thiamine should be done as soon as feasible.

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