Prescribing thiamine to inpatients with alcohol use disorders: how well are we doing?

Thiamine deficiency is a potentially dangerous sequela of alcohol use disorders (AUDs). European and British guidelines recommend administering high-dose parenteral thiamine 3 times daily to avoid consequences of thiamine deficiency such as Wernicke-Korsakoff syndrome (WKS), and suggest that traditional thiamine dosages are likely inadequate. Research into thiamine and WKS has lagged in the United States, and to date, no study has examined how thiamine is prescribed to inpatients with AUD in an American hospital.

Thiamine prescribing data (amount, route, and frequency schedule) were collected for inpatients at a large, American, teaching hospital, who were referred to the addiction psychiatry service for AUD. Data were analyzed using Statistical Product and Service Solutions.

A total of 217 inpatients with AUD were included. A substantial percentage of them were not prescribed thiamine. Of those who were prescribed thiamine, nearly all were prescribed oral thiamine at traditional dosages, including high-risk patients.

This is the first study to report on the prescribing of thiamine to inpatients with AUD at an American teaching hospital. It serves to confirm what many already suspected: that more education is needed to improve the diagnostic challenges of WKS, the detection of risk factors for WKS, and the adequate dosing of thiamine for prevention and treatment of WKS.