Thiamine


Thiamine should be given routinely to all patients with alcohol intoxication, with a history of alcohol abuse or physical examination findings suggesting liver disease or Wernicke's encephalopathy.
Its routine use in patients with poisoning severe enough to require admission to an intensive care unit is probably justifiable given the difficulties in diagnosing encephalopathy in these patients.

The dose is 100 mg IM daily for five days (or until the need for it can be reassessed).

Oral thiamine may be poorly absorbed by patients with a history of alcohol abuse (particularly if they have a stomach full of charcoal).

Thiamine should always be administered prior to IV glucose.

REFERENCES


Hoffman RS, Goldfrank LR. The poisoned patient with altered consciousness. Controversies in the use of a 'coma cocktail'. JAMA 1995;274:562-569.
Zubaran C, Fernandes JG, Rodnight R. Wernicke-Korsakoff syndrome. Postgraduate Medical Journal 1997; 73(855):27-31.