Wernicke-Korsakoff Syndrome Medication

  • Author: Glen L Xiong, MD; Chief Editor: David Bienenfeld, MD   more...
 
Updated: Sep 15, 2011
 

Medication Summary

Wernicke-Korsakoff syndrome results from thiamine deficiency. The treatment is replacement of this essential vitamin. The usual dose is 100 mg/day via oral, IV, or IM administration. However, the dosing and duration of thiamine treatment has not been sufficiency studied. In a systematic review from the Cochrane Database, Day et al only found 2 randomized studies that were of sufficient quality.[18] There was a significant difference in favor of 200 mg/day, as compared with 5 mg/d, when the outcomes were measure after 2 days.

Overall, the current standard of care involves the use of thiamine 100 mg/day for acute prophylaxis. Duration of treatment varies greatly and depends on the comorbid conditions and etiology. For example, thiamine would be administered indefinitely for patients with absorption problems. However, when used as prophylaxis for acute alcohol withdrawal/detoxification, thiamine can be discontinued once dietary intake is adequate. When in doubt, a serum thiamine level may be obtained to guide treatment.

For persistent cognitive impairment (eg, Korsakoff dementia), cognitive enhancers such as acetylcholinesterase inhibitors and memantine have demonstrated some benefit.[19, 20] However, the findings were negative in a small comparison study with rivastigmine.[21]

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Nutrients

Class Summary

In treating Wernicke-Korsakoff syndrome, the objective is to replenish vitamin B-1 stores. In adults, 60-180 mEq of potassium, 10-30 mEq of magnesium, and 10-40 mmol/L of phosphate per day appear necessary to achieve optimum metabolic balance.

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Thiamine

 

Thiamine is a water-soluble vitamin that combines with adenosine triphosphate (ATP) to form the coenzyme thiamine pyrophosphate, which is necessary for carbohydrate metabolism. The B vitamins are readily absorbed from the gastrointestinal tract (except in cases of malabsorption syndromes). Alcohol inhibits the absorption of thiamine, which occurs primarily in the duodenum.

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Magnesium sulfate

 

Magnesium sulfate is a cofactor in a number of enzyme systems; it also is involved in neurochemical transmission and muscular excitability. Patients with chronic alcoholism and patients who are malnourished usually have inadequate magnesium stores.

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Potassium acid phosphate (K-Phos)

 

Potassium is essential for transmission of nerve impulses, contraction of cardiac muscle, maintenance of intracellular tonicity, skeletal and smooth muscles, and maintenance of normal renal function. Gradual potassium depletion occurs via renal excretion, through gastrointestinal loss, or because of low intake. Patients with chronic alcoholism and those who are malnourished usually have inadequate nutrient stores. Potassium depletion sufficient to cause a 1-mEq/L drop in serum potassium requires a loss of about 100-200 mEq of potassium from the total body store.

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Contributor Information and Disclosures
Author

Glen L Xiong, MD  Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, Department of Internal Medicine, University of California Davis School of Medicine; Attending Psychiatrist, Sacramento Mental Health Treatment Center; Attending Physician, Sacramento County Primary Care Clinic

Glen L Xiong, MD is a member of the following medical societies: American College of Physicians, American Psychiatric Association, and Sierra Sacramento Valley Medical Society

Disclosure: Lippincott Williams & Wilkins Royalty Book Editor; PGxHealth Consulting fee Consulting; National Alliance for Research in Schizophrenia and Depression Grant/research funds Independent contractor

Coauthor(s)

G Patrick Daubert, MD  Assistant Professor, Assistant Medical Director, Sacramento Division, California Poison Control System; Director of Clinical and Medical Toxicology Education, Department of Emergency Medicine, University of California, Davis Medical Center

G Patrick Daubert, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Medical Toxicology, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Chief Editor

David Bienenfeld, MD  Professor of Psychiatry, Vice-Chair and Director of Residency Training, Department of Psychiatry, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Alan DeAngelo, MD, and Alan Halliday, MD, to the development and writing of the source article.

References

  1. Thomson AD, Marshall EJ. The natural history and pathophysiology of Wernicke's Encephalopathy and Korsakoff's Psychosis. Alcohol Alcohol. Mar-Apr 2006;41(2):151-8. [Medline]. [Full Text].

  2. McEntee WJ, Mair RG. Memory enhancement in Korsakoff's psychosis by clonidine: further evidence for a noradrenergic deficit. Ann Neurol. May 1980;7(5):466-70. [Medline].

  3. Kesler A, Stolovitch C, Hoffmann C, Avni I, Morad Y. Acute ophthalmoplegia and nystagmus in infants fed a thiamine-deficient formula: an epidemic of Wernicke encephalopathy. J Neuroophthalmol. Sep 2005;25(3):169-72. [Medline].

  4. Chiossi G, Neri I, Cavazzuti M, Basso G, Facchinetti F. Hyperemesis gravidarum complicated by Wernicke encephalopathy: background, case report, and review of the literature. Obstet Gynecol Surv. Apr 2006;61(4):255-68. [Medline].

  5. Singh S, Kumar A. Wernicke encephalopathy after obesity surgery: a systematic review. Neurology. Mar 13 2007;68(11):807-11. [Medline].

  6. Alcaide ML, Jayaweera D, Espinoza L, Kolber M. Wernicke's encephalopathy in AIDS: a preventable cause of fatal neurological deficit. Int J STD AIDS. Oct 2003;14(10):712-3. [Medline].

  7. Harrison RA, Vu T, Hunter AJ. Wernicke's encephalopathy in a patient with schizophrenia. J Gen Intern Med. Dec 2006;21(12):C8-C11. [Medline].

  8. Yae S, Okuno S, Onishi H, Kawanishi C. Development of Wernicke encephalopathy in a terminally ill cancer patient consuming an adequate diet: a case report and review of the literature. Palliat Support Care. Dec 2005;3(4):333-5. [Medline].

  9. Ueda K, Takada D, Mii A, Tsuzuku Y, Saito SK, Kaneko T, et al. Severe thiamine deficiency resulted in Wernicke's encephalopathy in a chronic dialysis patient. Clin Exp Nephrol. Dec 2006;10(4):290-3. [Medline].

  10. Harper C, Fornes P, Duyckaerts C, Lecomte D, Hauw JJ. An international perspective on the prevalence of the Wernicke-Korsakoff syndrome. Metab Brain Dis. Mar 1995;10(1):17-24. [Medline].

  11. Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. May 2007;6(5):442-55. [Medline].

  12. Maschke M, Weber J, Bonnet U, Dimitrova A, Bohrenkamper J, Sturm S, et al. Vermal atrophy of alcoholics correlate with serum thiamine levels but not with dentate iron concentrations as estimated by MRI. J Neurol. Jun 2005;252(6):704-11. [Medline].

  13. Zuccoli G, Gallucci M, Capellades J, Regnicolo L, Tumiati B, Giadas TC, et al. Wernicke encephalopathy: MR findings at clinical presentation in twenty-six alcoholic and nonalcoholic patients. AJNR Am J Neuroradiol. Aug 2007;28(7):1328-31. [Medline].

  14. Fei GQ, Zhong C, Jin L, Wang J, Zhang Y, Zheng X, et al. Clinical characteristics and MR imaging features of nonalcoholic Wernicke encephalopathy. AJNR Am J Neuroradiol. Jan 2008;29(1):164-9. [Medline].

  15. Traviesa DC. Magnesium deficiency: a possible cause of thiamine refractoriness in Wernicke-Korsakoff encephalopathy. J Neurol Neurosurg Psychiatry. Aug 1974;37(8):959-62. [Medline].

  16. Hack JB, Hoffman RS. Thiamine before glucose to prevent Wernicke encephalopathy: examining the conventional wisdom. JAMA. Feb 25 1998;279(8):583-4. [Medline].

  17. Harper CG, Sheedy DL, Lara AI, Garrick TM, Hilton JM, Raisanen J. Prevalence of Wernicke-Korsakoff syndrome in Australia: has thiamine fortification made a difference?. Med J Aust. Jun 1 1998;168(11):542-5. [Medline].

  18. Day E, Bentham P, Callaghan R, Kuruvilla T, George S. Thiamine for Wernicke-Korsakoff Syndrome in people at risk from alcohol abuse. Cochrane Database Syst Rev. 2004;CD004033. [Medline].

  19. Cochrane M, Cochrane A, Jauhar P, Ashton E. Acetylcholinesterase inhibitors for the treatment of Wernicke-Korsakoff syndrome--three further cases show response to donepezil. Alcohol Alcohol. Mar-Apr 2005;40(2):151-4. [Medline].

  20. Rustembegovic A, Kundurovic Z, Sapcanin A, Sofic E. A placebo-controlled study of memantine (Ebixa) in dementia of Wernicke-Korsakoff syndrome. Med Arh. 2003;57(3):149-50. [Medline].

  21. Luykx HJ, Dorresteijn LD, Haffmans PM, Bonebakker A, Kerkmeer M, Hendriks VM. Rivastigmine in Wernicke-Korsakoff's syndrome: five patients with rivastigmine showed no more improvement than five patients without rivastigmine. Alcohol Alcohol. Jan-Feb 2008;43(1):70-2. [Medline].

 
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