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|