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.