Thiamine bij een alcoholstoornis en Wernicke-encefalopathie

• Patients with alcohol use disorder frequently have a thiamine deficiency.
• A potential life-threatening complication of thiamine deficiency is Wernicke’s encephalopathy.
• Since it is clinically difficult to recognize Wernicke’s encephalopathy, this condition is often treated inadequately.
• Early supplementation of thiamine is important to avoid irreversible neurological damage.
• There are differences between the Dutch guidelines regarding the supplementation of thiamine for the treatment of alcoholic use disorder, and those for Wernicke’s encephalopathy.
• There are no solid evidence-based recommendations about the best dosage, route of administration and duration of thiamine supplementation for the treatment of alcohol use disorder and Wernicke’s encephalopathy.
• Based on the pharmacokinetic properties of thiamine, it is more appropriate to give patients with alcohol use disorder 25 mg four times a day rather than 50 mg twice a day.
• Patients at high risk of Wernicke’s encephalopathy should immediately receive an intravenous or intramuscular dose of thiamine; patients with suspected Wernicke’s encephalopathy should preferably receive an intravenous dose.
• Reports of anaphylactic reaction to parenteral administration of thiamine are rare and are not a reason to refrain from parenteral treatment.

Conflict of interest and financial support: none declared.