Most commonly in alcoholics; also in surgical patients on iv's × weeks without thiamine supplement; rarely, refed starving patients

Si:

• Ophthalmoplegia especially nystagmus (85%) progressing to paralysis of lateral gaze, ie, abducens palsies
• Global confusion
• Ataxia
• Hypothermia

May recover partially over 1 yr (Nejm 1985;312:16)

Korsakoff's psychosis (80%), confabulating responses

Lab:

Path:Circummamillary body congestion and hemorrhage at base of brain on postmortem, and along floors of 3rd and 4th ventricles

Rx:Preventively put thiamine in all alcoholic drinks perhaps, esp wine (Nejm 1978;299:285)?

Thiamine 100 mg im, iv (is safe—Jama 1995;274:562) or po qd × 3 d; always give 1st dose before start iv glucose