The guidance applies to all alcohol use disorders; hazardous, harmful and dependent.
Assess for Wernicke's encephalopathy
Does the patient have any of the following signs / symptoms: confusion, decreased consciousness, nystagmus, ataxia, opthalmoplegia, hypothermia / hypotension |
↓ |
If Yes - Presumptive diagnosis of Wernicke's encephalopathy (if symptoms otherwise unexplained). See Box A below for management. If No - Assess risk of Wernicke's encephalopathy. See Box B below for management. |
This requires urgent treatment.
Day 1-2 | Day 3-5 | Day 6 onwards |
Pabrinex® IV 2 pairs of vials three times a day Magnesium - check serum level urgently and give IV replacement if deficient. See hypomagnesaemia guideline. |
Pabrinex® IV / IM 1 pair of vials three times a day | Change to thiamine oral 50mg four times a day or continue with Pabrinex® IV / IM at the discretion of the medical team |
No risk factors | 1 risk factor | ≥2 risk factors or any single severe risk factor |
Thiamine oral 50mg four times daily | Pabrinex®IV / IM 1 pair of vials three times a day for 24 hours then change to thiamine oral 50mg four times daily | Pabrinex® IV / IM 1 pair three times a day for 48 hours then change to thiamine oral 50mg four times daily |
Guideline reviewed and last updated November 2020