What is the role of parental thiamine in the treatment of Wernicke-Korsakoff syndrome (WKS)?

Updated: May 16, 2018
  • Author: Glen L Xiong, MD; Chief Editor: David Bienenfeld, MD  more...
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Answer

Most recommendations for the initial use of parental thiamine are based on the poor bioavailability of oral thiamine, which is estimated to be between 3.7% and 5.3%. [47] Studies have suggested that 8.3 mg is the maximum that can be absorbed from a single oral thiamine dose, suggesting an absorption pathway that is easily saturated. [48] This seemed to be confirmed when another study showed very little thiamine is excreted in urine when oral doses greater than 2.5 mg are given. [49]

The most prominent study was in 52 prisoners of war in a report published in 1947. All developed Wernicke-Korsakoff syndrome during a period of starvation and/or nutritional deficiency (eg, living on white rice). Fifteen patients were treated with oral thiamine only and 67% (10 patients) died. Of the 37 who received intramuscular thiamine, 11 died, a mortality rate of 30%. [50]

Recent studies have challenged this and demonstrated that high-dose oral thiamine (500-1500 mg) can achieve correspondingly high blood levels in healthy subjects. [51] However, these studies have generally been in healthy subjects without comorbidities and no measurement has been made of the biological effect or tissues absorption of thiamine, especially in the brain. Until clinical studies have been undertaken on high-dose oral thiamine, the strong recommendation is that parental thiamine be the first line for the initial treatment of Wernicke-Korsakoff syndrome.


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