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Key Features

  • Caused by thiamine deficiency

  • In United States, occurs most commonly in patients with alcohol use disorder

  • It may also occur in patients with AIDS, in patients with hyperemesis gravidarum, or after bariatric surgery

Clinical Findings

  • Wernicke syndrome

    • Triad of confusion, ataxia, and nystagmus leading to ophthalmoplegia (lateral rectus muscle weakness, conjugate gaze palsies)

    • Peripheral neuropathy may be present

  • Korsakoff syndrome

    • Occurs in more severe cases of thiamine deficiency

    • Includes anterograde and retrograde amnesia and sometimes confabulation

    • May not be recognized until after an initial delirium has lifted


  • Confirmed by the response to treatment within 1 or 2 days, which must not be delayed while laboratory confirmation is obtained


  • In suspected cases, thiamine 100 mg, is given intravenously immediately and then intramuscularly on a daily basis until a satisfactory diet can be ensured after which the same dose is given orally

  • Initial doses of 200–500 mg intravenously three times daily for the first 5–7 days of treatment has been recommended

  • Intravenous glucose given before thiamine may precipitate the syndrome or worsen the symptoms

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