1. Alcohol and Wernicke’s
encephalopathy
A public health perspective
Dr Gargi Sinha MBBS(LHMC,New Delhi),Grad Dip Public Health(Edith Cowan University Australia)
Dr Nilotpal Das FRANZCP,MD(AIIMS,New Delhi),DNB

2. Content
Introduction
Clinical features
Differential Diagnosis
Treatment
Summary

3. What is Wernicke’s encephalopathy
Wernicke’s encephalopathy is an
acute neuropsychiatric syndrome
resulting from thiamine
deficiency.
The condition can arise in many
clinical settings including chronic
alcohol abuse, malnutrition,
gastrointestinal surgical
procedures, recurrent vomiting,
chronic diarrhoea, chemotherapy,
malnutrition and starvation.

4. What are the social factors associated with
Wernicke’s encephalopathy

5. Complex
interplay of
factors

6. Clinical Traid of Wernicke’s encephalopathy

7. HowtodiagnoseWernicke'sencephalopathy?
Diagnostic workup is as for any case of delirium

8. Differential diagnoses
alcohol
withdrawal
delirium
temporal lobe
epilepsy.

9. Treatment Wernicke’s
encephalopathy is
a medical
emergency
Oral thiamine is generally of no benefit
Thiamine should be given early, as soon as the condition is suspected.

10. How much thiamine?
Although there are no consensus
guidelines, most common
practice is to provide 500 mg of
thiamine hydrochloride in 100 ml
of normal saline, given by
infusion, over a period of 30
minutes, three times per day, for
2-3 days. After this, thiamine
hydrochloride is continued at a
dose of 250 mg IV, once a day for
3-5 days.

11. Why thiamine before carbohydrate?
It is mandatory that thiamine is
given before any carbohydrate
load
a carbohydrate
challenge in the
presence of severe
thiamine
deficiency can
precipitate tissue
damage.

12. Prevention
strategies

13. Summary
ocular
abnormalities
(nystagmus,
ophthalmoplegia),
Clinical features

14. Treatment
summary
Do not give
carbohydrate
before
thiamine

15. references
• David, Antony; Fleminger, Simon; Kopelman, Michael; Lovestone,
Simon; and Mellers, John(2009) Lishman's Organic Psychiatry: A
Textbook of Neuropsychiatry,4rth edition ,wiley publication .
• WorldHealth Organisation Thiamine deficiency and its prevention
andcontrolinmajoremergenciewww.who.int/nutrition/publications/en/th
iamine_in_emergencies_eng.pdf

16. Thank you