Adjuvant electrolyte treatment with thiamine administration

Q: Which adjuvant electrolyte treatment is recommended with thiamine administration in Wernick's Encephalopathy (WE)?

Answer: Magnesium

Magnesium is an essential cofactor of thiamine into its active diphosphate and triphosphate forms, and in its absence thiamine may not be utilized appropriately. Although it was established many decades ago, it still frequently gets missed in clinical practice.

It would be prudent to administer magnesium with thiamine in WE. It is common to have Mg deficiency in the presence of required thiamine storage, and refractory WE may precipitate.

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References:

1. Maguire D, Talwar D, Burns A, Catchpole A, Stefanowicz F, Robson G, Ross DP, Young D, Ireland A, Forrest E, Galloway P, Adamson M, Colgan E, Bell H, Orr L, Kerr JL, Roussis X, McMillan DC. A prospective evaluation of thiamine and magnesium status in relation to clinicopathological characteristics and 1-year mortality in patients with alcohol withdrawal syndrome. J Transl Med. 2019 Nov 21;17(1):384. doi: 10.1186/s12967-019-02141-w. PMID: 31752901; PMCID: PMC6873772.

2. Traviesa DC. Magnesium deficiency: a possible cause of thiamine refractoriness in Wernicke-Korsakoff encephalopathy. J Neurol Neurosurg Psychiatry. 1974 Aug;37(8):959-62. doi: 10.1136/jnnp.37.8.959. PMID: 4420329; PMCID: PMC494812.

3. Zieve L. Influence of magnesium deficiency on the utilization of thiamine. Ann N Y Acad Sci. 1969 Aug 15;162(2):732-43. doi: 10.1111/j.1749-6632.1969.tb13005.x. PMID: 5259566.