Q: 52 year old alcoholic male who is frequent flyer at your ED presents again with symptoms of Wernicke encephalopathy. Despite quick repletion of Thiamine upto 300 mg IV - symptoms persist. What could be the missing point?



Answer: Hypomagmesemia

Patients with Wernicke encephalopathy may not response to parenteral thiamine in the presence of low magnesium level. Once magnesium is repleted thiamine will have effect, the blood transketolase activity will return to normal and clinical symptoms will resolve.

Please request pharmacy to provide fresh Thiamine solution, since old solutions quickly get inactive.