Timing of efficacy of thiamine in Wernicke's disease in alcoholics at risk.

This study investigated an optimum window of effectiveness of oral thiamine in alcohol withdrawal in a jail setting using a Librium-based protocol. A total of 19 patients were identified with alcohol withdrawal at intake. Clinical Institute Withdrawal Assessment (CIWA-AR), Cut back, Annoyed, Guilty, Eye-opener (CAGE) questionnaire, and therapy were started immediately. Of these patients, 9 were identified as high risk and 2 developed an excited delirium consistent with Wernicke's disease. This study demonstrated an optimum window of 2 hours or less at intake with oral thiamine. The earlier an oral withdrawal protocol is started, the faster is recovery, regardless of initial presentation. Disease progression was significantly dependent on time to treat. Noncompliance with oral management is likely if treatment is delayed. The routine use of thiamine 100 mg daily during withdrawal and continuation for 30 days is recommended as the best clinical practice.