Pharmacology Notes

Thiamine should be given to chronic alcoholic patients in whom Wernicke's encephalopathy is suspected. In these cases it should be given intravenously initially. Thiamine should not be given routinely to all patients presenting with coma, as Wernicke's encephalopathy is a very uncommon cause of coma. Far more commonly it presents with confusion, ataxia and ophthalmoplegia. Although coma is a rare presentation of Wernicke's, the consequences of missing the diagnosis are severe, so if doubt exists, intravenous thiamine should be given. The risk of severe allergic reactions to intravenous thiamine has been overstated in the past.