Wernicke encephalopathy

Acute emergency due to severe thiamine deficiency. Classic triad: ophthalmoplegia, ataxia, confusion. Without urgent parenteral thiamine progresses to irreversible Korsakoff syndrome with amnesia and confabulations.

ICD-10 E51.21 drug

Also known as: Wernicke-Korsakoff syndrome, Acute B1 deficiency

Drugs used for this condition

AThiamineFirst line · Water-soluble vitamin B1Parenteral thiamine is the cornerstone of acute Wernicke encephalopathy treatment. EFNS and the Royal College of Physicians recommend thiamine 500 mg IV three times daily for 2–3 days, then 250 mg/day IV or IM for 5–7 days, followed by oral maintenance. Oral 300 mg tablets give inadequate bioavailability in acute Wernicke – parenteral route is required. The UK uses Pabrinex (thiamine plus other B vitamins) IV on a similar schedule. Cochrane 2013 acknowledges scarce high-quality RCTs but clinical practice and physiological data give thiamine emergency-treatment status.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit