High-dose thiamine strategy in Wernicke–Korsakoff syndrome and related thiamine deficiency conditions associated with alcohol use disorder

Abstract

Thiamine is essential for the activity of several enzymes associated with energy metabolism in humans. Chronic alcohol use is associated with deficiency of thiamine along with other vitamins through several mechanisms. Several neuropsychiatric syndromes have been associated with thiamine deficiency in the context of alcohol use disorder including Wernicke–Korsakoff syndrome, alcoholic cerebellar syndrome, alcoholic peripheral neuropathy, and possibly, Marchiafava–Bignami syndrome. High-dose thiamine replacement is suggested for these neuropsychiatric syndromes.

Wernicke Korsakoff syndrome in a teenage female as a complication of COVID‐19

“…Because thiamine is directly related to metabolism, daily intake is based on caloric intake with 1–2 mg recommended daily for the average adult. Depletion can occur in 2–3 weeks with the symptoms of WE appearing in 4–6 weeks 6,7,16,18 . In this case, our patient likely already had significant thiamine depletion before limiting her diet to crackers and was then profoundly depleted causing her initial symptoms to appear.…”

“…Depletion can occur in 2-3 weeks with the symptoms of WE appearing in 4-6 weeks. 6,7,16,18 In this case, our patient likely already had significant thiamine depletion before limiting her diet to crackers and was then profoundly depleted causing her initial symptoms to appear. On initial presentation, she did not have ophthalmoplegia but was ataxic and her mental status rapidly declined.…”

“…Thiamine is water soluble and 30–50 mg can be stored in the body with a half‐life of 10–18 days. 8 , 16 , 17 Because thiamine is directly related to metabolism, daily intake is based on caloric intake with 1–2 mg recommended daily for the average adult. Depletion can occur in 2–3 weeks with the symptoms of WE appearing in 4–6 weeks.…”

Alcohol Contribution to Total Energy Intake and Its Association with Nutritional Status and Diet Quality in Eight Latina American Countries

“…Chronic alcohol consumption is known to decrease the absorption of thiamine and the activation of thiamine pyrophosphate, which acts as a coenzyme for many enzyme reactions in the metabolism of carbohydrates and amino acids and the subsequent production of energy. Impairment of that process in the nervous system is strongly associated with severe neurological conditions such as Wernicke-Korsakoff syndrome, alcoholic peripheral neuropathies, and the Marchiafava-Bignami disease [ 55 ]. Heavy drinkers have been found to have lower intake of several nutrients, including calcium and iron compared to non-drinkers [ 50 ] and may have less favorable micronutrients status compared with moderate and non-drinkers.…”

Undiagnosed Wernicke’s encephalopathy. A case report on hyperactive delirium

“…Thiamine deficiency occurs due to poor intake of vitamin-rich foods, impaired intestinal absorption, decreased liver storage capacity or alcohol-induced kidney damage and excessive loss associated with medical conditions [6]. Insufficient intake of thiamine leads to decreased activity of thiamine-dependent enzymes causing a compromise in cell respiration.…”