Cases That Test Your Skills

Sobering facts about a missed diagnosis

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Parenteral thiamine, 100 mg/d for 5 to 7 days, is given for acute WE. Some patients who are genetically predisposed to thiamine deficiency may need up to 1,000 mg/d. Continue oral thiamine, 100 mg/d, after parenteral dosing.

Although anaphylaxis risk during a 10-minute thiamine infusion is less than 1 in 1 million, make sure cardiopulmonary resuscitation is available during treatment. Glucose load can precipitate or worsen WE in a thiamine-deficient patient, so give thiamine before giving glucose in any form, including everyday foods.

Watch for other vitamin and magnesium deficiencies common to patients with alcoholism, as these might compromise response to IV/IM thiamine.15 Also rule out stroke in men age >65 who present with signs of hemiparesis.

Related resources

Drug brand names

  • Chlordiazepoxide • Libritabs, Lithium
  • Divalproex sodium • Depakote
  • Paroxetine • Paxil
  • Risperidone • Risperdal
  • Trazodone • Desyrel


The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.


Dr. Tampi’s efforts were supported by funds from the Division of State, Community, and Public Health, Bureau of Health Professions, Health Resources and Services Administration, Department of Health and Human Services, under grant number 1 K01 HP 00071-01, and the Geriatric Academic Career Award ($57,007). The information is that of Dr. Tampi and should not be construed as the official position or policy of, nor should any endorsements be inferred by, the aforementioned departments or the United States government.


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