BNF Recommendations for the Treatment of Wernicke's Encephalopathy: Lost in Translation?

Abstract

We have written extensively about the diagnosis and treatment of Wernicke's encephalopathy (Thomson et al ., 2008, 2009) highlighting the need for prompt treatment with intravenous thiamine. We are concerned that recent British National Formulary (BNF) recommendations are not clearly written and risk causing confusion and delay in the treatment of patients with this disorder, which is potentially reversible if treated appropriately. Recent NICE clinical guidelines on alcohol-use disorders (CG 100 and 115, NICE 2010, 2011) set out clear recommendations regarding the use of thiamine in the urgent treatment of suspected Wernicke's encephalopathy. Clinical Guideline 100 recommended that thiamine be given in doses ‘toward the upper end of the BNF range’ and that it should be given ‘parenterally’. This NICE guideline was published in June 2010, so it is likely that it was referring to what was written in BNF 58 (September 2009). BNF 58 did not specifically outline the treatment of suspected Wernicke's encephalopathy. It recommended …