Wernicke’s encephalopathy treated with high dose intravenous thiamine: a case report

Abstract

Wernicke’s encephalopathy (WE) is a dangerous and potentially fatal neurological condition associated with thiamin deficiency. The standard treatment for WE is intravenous (IV) thiamin, but limited research describes optimal dosing. We present a case of a 40-year-old male with severe alcohol use disorder (AUD) and chronic malnourishment who developed WE. Upon administration of 100 mg IV thiamin, symptoms of WE persisted, but when the dose was increased to 500 mg, altered mental status and ophthalmoplegia resolved rapidly. IV thiamin is a reliable and low-risk treatment for WE, even when administered at high doses. High-dose IV thiamin (i.e., >/100 mg) can treat neurological symptoms and cognitive dysfunction in WE and should be considered for first-line treatment. Further study of WE diagnostic and treatment guidelines is warranted to maximize recovery potential.

Keywords:

• Wernicke’s encephalopathy
• alcohol
• high dose thiamin
• vitamin B1

Acknowledgements

The authors would like to thank Erika Woodrum for the scientific illustrations provided in this paper.

Authors’ contributions

MA: conceptualization, wrote original manuscript, wrote final manuscript. ACW: wrote original manuscript, edited final manuscript. RB: conceptualization, wrote original manuscript, edited final manuscript. JW: conceptualization, methodology, supervision, edited final manuscript. AA: conceptualization, methodology, edited original manuscript, wrote final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.