Vitamin prophylaxis and treatment of Wernicke's encephalopathy in alcohol use

Pabrinex (parenteral vitamins B & C) is used for the rapid correction of severe depletion or malabsorption in alcohol use.

General notes:

Continue Pabrinex 1 pair od iv/im if memory continues to improve
Hypomagnesia should be screened for and corrected
Pabrinex should be given before glucose or nutritional support
Rarely anaphylaxis can occur with Pabrinex, this is less common with IM administration
IV Pabrinex should be administered over 30 minutes
Facilities for treating anaphylaxis, including resuscitation facilities should be available when parenteral Pabrinex is administered.
Review oral thiamine after three months and discontinue if not drinking harmfully or dependently, and no evidence of malnourishment.
If overt Wernicke’s is suspected, consider this a medical emergency requiring management in an acute hospital setting.

Overt Wernicke's

Any of the following symptoms present

Treatment regime

Day 1 Pabrinex 2-3 pairs tds iv
Day 2 Pabrinex 2-3 pairs tds iv
Day 3 Pabrinex 1 pair od iv/im
Day 4 Pabrinex 1 pair od iv/im
Day 5 Pabrinex 1 pair od iv/im
Day 6 Pabrinex 1 pair od iv/im
Day 7 Pabrinex 1 pair od iv/im (Continue Pabrinex 1 pair od iv/im if memory continues to improve)
Day 8 Thiamine 100mg tds oral

Alcohol dependence without Wernicke’s symptoms

Harmful drinkers with decompensated liver disease or malnourished (MUST 2+)

Day 1 Pabrinex 1 pair od iv/im
Day 2 Pabrinex 1 pair od iv/im
Day 3 Pabrinex 1 pair od iv/im
Day 4 Pabrinex 1 pair od iv/im
Day 5 Pabrinex 1 pair od iv/im (Continue Pabrinex 1 pair od iv/im if memory continues to improve)
Day 6 Thiamine 100mg tds oral

Day 1 Thiamine 100mg tds oral