Abstract
Aims and MethodA pre-/post-intervention audit of 163 case notes was conducted to assess the efficacy of printing information about the identification and treatment of the Wernicke–Korsakoff syndrome on the hospital alcohol detoxification sheet.ResultsParenteral thiamine was indicated in 42 of 163 patients; 26 had symptoms suggestive of Wernicke's encephalopathy and 16 were at risk. The intervention increased the chance of appropriate parenteral treatment by an odds ratio of 5.9 (95% CI 1.3–27.8). Admission to a specialist alcohol unit increased the chance of appropriate treatment by an odds ratio of 7.0 (95% CI 1.52–32.25). The mean number of doses rose from 3.08 to 4.62.Clinical ImplicationsA simple intervention may lead to improved treatment of patients with Wernicke–Korsakoff syndrome.
Highlights
A simple intervention may lead to improved treatment of patients with Wernicke-Korsakoff syndrome
The Wernicke-Korsakoff syndrome is due to thiamine deficiency and can be precipitated by alcohol withdrawal
It is important to have a low threshold for treatment in people at risk, such as patients undergoing alcohol detoxification
Summary
Parenteral thiamine was indicated in 42 of 163 patients; 26 had symptoms suggestive of Wernicke’s encephalopathy and 16 were at risk. The incidence of anaphylactic reactions to injectable thiamine preparations has been quoted as 4 per million pairs of intravenous ampoules sold in the UK and 1 per 5 million intramuscular ampoules sold in the UK. These are reports to the Committee on Safety of Medicines on Parentrovite (Cook & Thomson, 1997) and are far lower than the incidences reported for streptokinase or penicillin. The Royal Edinburgh Hospital devised a guideline for the treatment of Wernicke-Korsakoff syndrome in 1999 This identified patients in whom the presence of the syndrome should be considered (those with symptoms of ataxia, confusion, ophthalmoplegia/nystagmus, memory disturbance, hypothermia and hypotension or coma/ unconsciousness) and patients ‘at risk’ (those with diarrhoea, vomiting, poor diet, weight loss or physical illness).
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