The adherence to the guidelines for assessing and treating Wernicke's encephalopathy in patients with alcohol withdrawal
Background: The current clinical approach to administering intravenous (IV) Pabrinex for patients admitted with alcohol withdrawal is based on the risk of Wernicke’s encephalopathy (WE). In patients at risk of WE, clinical features, such as ophthalmoplegia and nystagmus, are essential in determining...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
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| Series: | Clinical Medicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S147021182500185X |
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| Summary: | Background: The current clinical approach to administering intravenous (IV) Pabrinex for patients admitted with alcohol withdrawal is based on the risk of Wernicke’s encephalopathy (WE). In patients at risk of WE, clinical features, such as ophthalmoplegia and nystagmus, are essential in determining the duration and dosage of intravenous (IV) Pabrinex. At our institution, the recommended dose for treating WE is two pairs of Pabrinex three times a day for 3–5 days, while high-risk patients without WE features receive one pair once a day for 3–5 days. This audit aimed to evaluate adherence to the WE risk assessment and treatment protocol for patients admitted with alcohol withdrawal since its implementation by our health board in August 2023. Method: A retrospective case note review was conducted using the electronic patient records and electronic prescriptions (HEPMA) of all patients prescribed IV Pabrinex in the acute medical unit at the Royal Infirmary of Edinburgh between 1 December 2024 and 15 February 2025. The following parameters were assessed: the documentation of WE symptoms; the dose prescribed; and the treatment duration. Results: A total of 803 doses of IV Pabrinex were prescribed for 86 consecutive patients during the specified period. In 93% of patients, Pabrinex was prescribed as part of the treatment for alcohol withdrawal. 46% of patients exhibited symptoms of WE and, in 23% of cases, the presence or absence of clinical features of WE was not documented. Nonetheless, all patients (100%) were prescribed Pabrinex at the treatment dose for WE (two pairs three times daily) upon admission, which indicated that, in 56% of cases, the dosing did not adhere to the guidelines. Similarly, there was considerable variation in the duration of treatment. The mean duration in those displaying features of WE was 4.4 days (range 0.7–26); 50% received fewer than the recommended doses, while 22% continued treatment for more than 5 days (with the recommendation being 3–5 days). Among those without features of WE, the mean duration was 2.3 days (range 0.3–20.3). If we assume that this group were at a high risk of WE and should have received only one pair of IV Pabrinex once daily for a maximum of 5 days, the excess doses prescribed amounted to 515. Overall, 807 (50%) pairs used in alcohol withdrawal were unnecessary. Conclusion: Our findings indicate that, despite the introduction of clear guidelines for assessing and treating WE, many prescriptions were inappropriate. Those displaying features of WE were predominantly undertreated, while those without WE features received more doses than recommended. This audit also underscores the variability in documenting the assessment and clinical features of WE, which can affect the prescribing of Pabrinex. Further education on the risk assessment of WE and its treatment is essential, and integrating the guidelines into the alcohol withdrawal protocol could facilitate appropriate prescribing. |
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| ISSN: | 1470-2118 |