Table 2.

Clinical evaluation of patients at risk of thiamine deficiency [Adapted from Thomson et al. 2009]

Early signs and symptoms of thiamine deficiency

• Loss of appetite

• Nausea/vomiting

• Fatigue, weakness, apathy

• Giddiness, diplopia

• Insomnia, anxiety, difficulty in concentration

• Memory loss

Later signs and symptoms

• Classic triad: oculomotor abnormalities, cerebellar dysfunction (ataxia) and confusion

• Quiet global confusion with disorientation in time/place

• Confabulation/hallucination

• Onset of coma

Operational criteria for Wernicke’s Encephalopathy (Caine et al. 1997): 2 of the following

• Dietary deficiencies

• Oculomotor abnormalities

• Cerebellar dysfunction

• Either altered mental state or mild memory impairment

Reproduced with permission from Practical Gastroenterology, June 2009