Wijnia et al identified a number of situations where the clinician may fail to properly diagnose or manage a patient with Wernicke’s encephalopathy secondary to thiamine deficiency. A delay in diagnosis or management can have serious sequelae for the patient. The authors are from Rotterdam in The Netherlands.


Failures in the diagnosis or management of Wernicke’s encephalopathy:

(1) failure to admit the patient to the appropriate service

(2) failure to recognize the cause of delirium or confusion, often ascribing it to alcohol withdrawal or head injury

(3) failure to recognize alcohol abuse (elderly, affluent, respected, etc)

(4) failure to recognize self-neglect and malnutrition

(5) failure to recognize Wernicke’s encephalopathy with an atypical presentation

(6) failure to recognize the significance of an impaired gait or mobility

(7) failure to administer a sufficient dose of thiamine intravenously


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