Wernicke's encephalopathy Diagnosis and management Population at risk Q Does the patient have a clinical condition that can lead to thiamine deficiency? No Consider alternative diagnoses. Yes Consider the diagnosis of WE in patients at risk for thiamine deficiency, such as patients with alcohol abuse, bariatric surgery, hyperemesis gravidarum, starvation, gastrointestinal tract disease, AIDS, malnutrition, cancer, dialysis-dependent kidney disease, chronic vomiting, stem cell transplantation, or thyroid disease. E Thiamine supplementation Patients at risk Q Is the patient at risk for Wernicke's encephalopathy? Q Is the patient admitted to the emergency room? Yes to any Administer IV thiamine in all patients at risk for WE admitted to the emergency room. E No to all Diagnostic criteria Q Does the patient have 2 of the following criteria for Wernicke's encephalopathy: dietary deficiencies, eye signs, cerebellar dysfunction, and either altered mental state or mild memory impairment? No Consider alternative diagnoses Yes Diagnose WE in patients with AUD who present with 2 of the following: dietary deficiencies eye signs cerebellar dysfunction altered mental state or mild memory impairment. B Consider using the same criteria to diagnose WE in patients not using alcohol. E Thiamine levels Obtain a blood sample for measurement of total thiamine immediately before administration of thiamine in patients with suspected WE. E Thiamine supplementation (patients with suspected or manifest WE) Administer intravenous thiamine (200 mg IV q8h) in patients with suspected WE. Initiate thiamine prior to giving any carbohydrates. B Brain magnetic resonance imaging Obtain an MRI of the brain to support the diagnosis of acute WE in patients with and without AUD. B