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J Neurol 2019 Feb 7. Epub 2019 Feb 7.

Department of Neurosciences, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy.

Palliat Support Care 2019 Jan 30:1-3. Epub 2019 Jan 30.

Department of Psychiatry and Cognitive-Behavioral Medicine,Nagoya City University Graduate School of Medical Sciences,Aichi,Japan.

Objective: Thiamine deficiency (TD) is recognized in various kinds of disease with associated loss of appetite including cancer; however, TD has not been recognized in the family caregivers of cancer patients to date.

Method: From a series of cancer patient caregivers, we reported an aged family caregiver who developed TD while caring for the cancer patient.ResultThe caregiver was a 90-year-old male. Read More

Lakartidningen 2019 Jan 24;116. Epub 2019 Jan 24.

Skane's University Hospital - Ear, nose and throat clinic Lund, Sweden - Lund, Sweden.

Wernicke encephalopathy is a condition in which thiamine deficiency causes cognitive dysfunction, ataxia and eye motor abnormalities. The condition is potentially reversible if treated with high doses of intravenous thiamine (vitamin B1). The video head impulse test, in which the vestibulo-ocular reflex is tested, can reveal an early specific sign of selective dysfunction in the medial vestibular nuclei by demonstrating selective dysfunction of the horisontal vestibulo-ocular reflex. Read More

Dtsch Med Wochenschr 2019 Jan 23;144(2):101-107. Epub 2019 Jan 23.

Delirium is a potentially life-threating acute disease accompanied by a mortality up to 30 % of all affected patients. It occurs more frequently in older patients ≥ 65 years. Delirium is defined as acute onset of disturbances in attention, awareness and cognition that develops within a short period of time and fluctuates in severity. Read More

Nutr Clin Pract 2019 Jan 15. Epub 2019 Jan 15.

Internal Medicine Department, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil.

Thiamin is a hydrosoluble vitamin that plays a role in several biological processes, mainly in glucose metabolism. There are several risk factors for developing thiamin deficiency, such as malnutrition, refeeding syndrome, gastrointestinal surgery, and alcoholism. Recently, the role of thiamin in critically ill patients has gained prominence, and the prevalence of thiamin deficiency was found to be increased in patients with severe burns, major surgery, septic shock, end-stage renal disease, and heart failure. Read More

Noro Psikiyatr Ars 2018 Dec 25;55(4):307-314. Epub 2018 Apr 25.

Department of Neurology, İstanbul Medical Faculty, University of İstanbul, Turkey.

Introduction: Wernicke's encephalopathy (WE) is an underdiagnosed neuropsychiatric disorder especially in non-alcoholic groups that causes morbidity-mortality if diagnosis is delayed. Korsakoff syndrome is a chronic consequence of this condition characterized by persistent memory impairment. In this study we present a series of non-alcoholic patients with WE. Read More

BMJ Case Rep 2018 Dec 27;11(1). Epub 2018 Dec 27.

Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA.

Thiamine is an important coenzyme, which is essential for metabolism and maintaining cellular osmotic gradient. Thiamine deficiency can cause focal lactic acidosis, alteration of the blood-brain barrier and the production of free radicals through cell death by necrosis and apoptosis. Wernicke encephalopathy (WE) is a clinical diagnosis. Read More

Acta Medica (Hradec Kralove) 2018 ;61(3):111-113

Department of Medicine E, Sheba Medical Center, Tel-Hashomer affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel.

Duodenal Switch procedure is a type of bariatric surgery that was reserved for severely morbid obese people. Patients undergoing this procedure are at high risk for nutrient deficiencies. In this report we present a case of a patient who had developed polyneuropathy, generalized muscle weakness, Wernicke encephalopathy, myocardial dysfunction and pericardial effusion six years following this operation. Read More

Lakartidningen 2018 12 7;114. Epub 2018 Dec 7.

Umea Universitet Medicinska fakulteten - Institutionen för klinisk vetenskap - psykiatri, Sunderby Forskningsenhet Umea, Sweden Umea Universitet Medicinska fakulteten - Institutionen för klinisk vetenskap - psykiatri, Sunderby Forskningsenhet Umea, Sweden.

Ann Indian Acad Neurol 2018 Oct-Dec;21(4):328-330

Department of Pathology, Yashoda Superspeciality Hospitals, Hyderabad, Telangana, India.

Rev Assoc Med Bras (1992) 2018 Oct;64(10):882-884

Ph.D. in Surgery, Chief of Bone Marrow Transplantation Service at Walter Cantidio University Hospital - Fortaleza (CE), Brasil.

Wernick's Encephalopathy (WE) is an acute neuropsychiatric syndrome caused by thiamine deficiency post hematopoietic stem cell transplant (HSCT). WE is associated with high mortality and morbidity rates, but due to its rare occurrence, it is rarely considered in patients submitted to this procedure. Considering that, the manuscript reports the clinical characteristics and the possible factors that predisposed the occurrence of WE in a patient with non-Hodgkin's lymphoma post-Autologous HSCT. Read More

Funct Neurol 2018 Jul/Sept;33(3):165-166

Clin Liver Dis 2019 Feb;23(1):141-155

Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, 7200 Cambridge Street, 9th Floor, MS:BCM609, Houston, TX 77030, USA. Electronic address:

Chronic alcohol use induces silent changes in the structure and function of the central and peripheral nervous systems that eventually result in irreversible, debilitating repercussions. Once identified, nutritional supplementation and cessation measures are critical in preventing further neurologic damage. The proposed mechanisms of neuronal injury in chronic alcohol abuse include direct toxic effects of alcohol and indirect effects, including those resulting from hepatic dysfunction, nutritional deficiencies, and neuroinflammation. Read More

J Neurol Sci 2019 Jan 12;396:121-122. Epub 2018 Oct 12.

Pathological Anatomy Unit, Sant'Andrea Hospital, La Spezia, Italy.

Behav Sci (Basel) 2018 Nov 12;8(11). Epub 2018 Nov 12.

EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France.

We report atypical magnetic resonance imaging (MRI) lesions in a case of Wernicke encephalopathy. The patient presented with isolated anterograde amnesia following a partial colectomy complicated by peritonitis. Fluid-attenuated inversion recovery and T2 MRI sequences were normal. Read More

Prion 2019 Jan 14;13(1):13-20. Epub 2018 Nov 14.

a Department of Neuropathology, Institute for Medical Science of Aging , Aichi Medical University , Nagakute , Japan.

An 83-year-old Japanese man presented with gait disturbance followed by rapidly-progressive cognitive impairment. Magnetic resonance diffusion-weighted images showed extensive hyperintense regions in the cerebral cortex. Four weeks after symptom onset, myoclonus appeared, and the patient developed difficulty swallowing; intravenous peripheral continuous infusions without vitamin supplementation were administered during the last two months of the patient's life. Read More

Neuropsychiatr Dis Treat 2018 8;14:2593-2598. Epub 2018 Oct 8.

Department of Psychiatry, Consultation-Liaison Psychiatry, Loyola University Medical Center, Maywood, IL 60153, USA,

This case discusses the course of a woman with a history of epilepsy, alcohol use disorder, herpes simplex virus (HSV) encephalitis, and Wernicke encephalopathy (WE) who presented with altered mental status following approximately 48 hours of vomiting. After experiencing a tonic-clonic seizure in the emergency department, she developed a fluent aphasia. Aphasias are ordinarily attributed to structural changes in the brain parenchyma, often from stroke, neoplasm, or infection. Read More

Neurology 2018 Oct;91(17):790-796

From the Department of Neurology (J.C.K., A.S.T.), University of Illinois College of Medicine; Illinois Neurologic Institute (J.C.K., A.S.T.), Peoria; Departments of Otolaryngology-Head and Neck Surgery (S.d.L., D.E.N.-T., D.S.Z.), Neuroscience (S.d.L., D.E.N.-T., D.S.Z.), and Neurology (S.d.L., D.E.N.-T., D.S.Z.), and Division of Neuro-Visual & Vestibular Disorders (D.E.N.-T.), Johns Hopkins University, Baltimore, MD.

Objective: To explain (1) why an initial upbeat nystagmus (UBN) converts to a permanent downbeat nystagmus (DBN) in Wernicke encephalopathy (WE) and (2) why convergence and certain vestibular provocative maneuvers may transiently switch UBN to DBN.

Methods: Following a literature review and study of our 2 patients, we develop hypotheses for the unusual patterns of vertical nystagmus in WE.

Results: Our overarching hypothesis is that there is a selective vulnerability and a selective recovery from thiamine deficiency of neurons within brainstem gaze-holding networks. Read More

Lakartidningen 2017 09 12;114. Epub 2017 Sep 12.

Umea Universitet Medicinska fakulteten - Institutionen för klinisk vetenskap - psykiatri, Sunderby Forskningsenhet Umea, Sweden Umea Universitet Medicinska fakulteten - Institutionen för klinisk vetenskap - psykiatri, Sunderby Forskningsenhet Umea, Sweden.

J Basic Clin Physiol Pharmacol 2018 Oct 2. Epub 2018 Oct 2.

Clinical Research Unit, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.

Wernicke encephalopathy (WE) and Korsakoff psychosis (KP), together termed Wernicke-Korsakoff syndrome (WKS), are distinct yet overlapping neuropsychiatric disorders associated with thiamine deficiency. Thiamine pyrophosphate, the biologically active form of thiamine, is essential for multiple biochemical pathways involved in carbohydrate utilization. Both genetic susceptibilities and acquired deficiencies as a result of alcoholic and non-alcoholic factors are associated with thiamine deficiency or its impaired utilization. Read More

Cureus 2018 Jul 17;10(7):e2991. Epub 2018 Jul 17.

Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK.

Wernicke's encephalopathy (WE) is a life-threatening acute or sub-acute neurological emergency characterized by ataxia, confusion, nystagmus, and ophthalmoparesis caused by thiamine deficiency. It was first described in 1881 by Carl Wernicke with alcohol being the most common cause. We present a rare case of a 35-year-old pregnant female who presented to our emergency department with a history of vomiting and loose motions for two weeks. Read More

Palliat Support Care 2018 Aug 31:1-2. Epub 2018 Aug 31.

Department of Psychiatry and Cognitive-Behavioral Medicine,Nagoya City University Graduate School of Medical Sciences,Aichi,Japan.

Objective: Although thiamine deficiency (TD) and Wernicke encephalopathy (WE) are not rare in cancer patients, the cases reported to date developed TD and/or WE after treatment had started.

Method: From a series of cancer patients, we report a patient diagnosed with TD without the typical clinical symptoms of WE at the preoperative psychiatric examination.ResultA 43-year-old woman with ovarian cancer was referred by her oncologist to the psycho-oncology outpatient clinic for preoperative psychiatric evaluation. Read More

Pediatr Int 2018 Aug;60(8):757-758

Department of Pediatric Hematology/Oncology, Okayama University Hospital, Okayama, Japan.

BMJ Case Rep 2018 Aug 20;2018. Epub 2018 Aug 20.

Department of Neurology, Smt BK Shah Medical Institute and Research Centre, Vadodara, Gujarat, India.

Progressive supranuclear palsy (PSP) may be a risk factor for thiamine deficiency. The classic symptoms of PSP (postural instability, supranuclear vertical gaze palsy and dementia) overlap with the clinical triad of Wernicke's encephalopathy (cognitive impairment, gait problems and ocular abnormality). Therefore, superimposed thiamine deficiency in patients with PSP may aggravate the pre-existing symptoms of PSP. Read More

Am J Med 2018 Nov 11;131(11):1321-1323. Epub 2018 Aug 11.

Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee. Electronic address:

Nutr Neurosci 2018 Aug 9:1-3. Epub 2018 Aug 9.

b Department of Psychiatry & Behavioral Sciences, Faculty of Medicine , University of Crete , Voutes, Heraklion 71410 , Greece.

Background: Wernicke encephalopathy (WE) predominantly occurs in alcoholic patients. Few case reports have described this diagnosis as a result of dieting. The diagnosis is often missed or delayed resulting in permanent and severe neurologic sequelae and even death. Read More

Palliat Support Care 2018 Aug 3:1-3. Epub 2018 Aug 3.

Department of Psychiatry and Cognitive-Behavioral Medicine,Nagoya City University Graduate School of Medical Sciences,Aichi,Japan.

Objective: Wernicke encephalopathy (WE) is a neuropsychiatric disorder caused by thiamine deficiency. It is recognized in various stages of the cancer trajectory but has not previously been recognized during nivolumab treatment.

Method: From a series of WE patients with cancer, we report a lung cancer patient who developed WE during treatment with nivolumab. Read More

Cureus 2018 May 9;10(5):e2597. Epub 2018 May 9.

Department of Neurology, University of Missouri, Columbia, USA.

Wernicke's encephalopathy (WE) is a rare neurological syndrome that presents in the setting of thiamine deficiency. Though alcoholism is the most common cause of this condition, a few other etiologies include malnutrition from other causes, hemodialysis, and hyperemesis gravidarum. In this case report, we aim to report a case of a young woman who developed WE in the setting of hyperemesis gravidarum (HG) that improved with thiamine replacement. Read More

Int J Rehabil Res 2018 Dec;41(4):373-376

Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey.

Wernicke-Korsakoff syndrome is a type of brain disorder caused by the lack of thiamine, most commonly because of chronic alcohol misuse. It consists of two separate conditions including Wernicke's encephalopathy and Korsakoff syndrome. Various levels of cognitive impairments are associated with the severity of the syndrome. Read More

Psychiatry Clin Neurosci 2018 Oct 31;72(10):774-779. Epub 2018 Jul 31.

Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.

Anorexia nervosa (AN) is a common eating disorder that affects 2.9 million people worldwide. Not eating a balanced diet or fasting can cause neurological complications after severe vitamin B1 malnourishment, although the precise signs and symptoms of Wernicke's encephalopathy (WE) are not clear. Read More

BMJ Case Rep 2018 Jul 6;2018. Epub 2018 Jul 6.

Neurology, Smt B K Shah Medical Institute and Research Centre, Vadodara, Gujarat, India.

Gastrointestinal symptoms, such as anorexia, nausea, vomiting and abdominal pain, are very common in patients with Wernicke's encephalopathy (WE). Mild thiamine deficiency may have only gastrointestinal symptoms. We are reporting two patients with thiamine deficiency who predominantly had gastrointestinal symptoms. Read More

Zhongguo Shi Yan Xue Ye Xue Za Zhi 2018 Jun;26(3):880-885

Department of Hematology, Aerospace Center Hospital, Beijing 100049, China.

Objective: To make through introduction of Wernicke's encephalopathy (WE) following hematopoietic stem cell transplantation (HSCT) in terms of clinical characteristics, diagnostic process and treatment.

Methods: The clinical charactaristics, diagnostic and therapeutic process and prognostic follow-up in 4 patients diagnosed of WE following HSCT between January 2016 to January 2017 at Department of Hematology, Chinese Aerospace Center Hospital were retrospectively analyzed.

Results: Four patients included 2 ALL and 2 AML, and 3 males and 1 female, their age ranged from 8 to 20 years old. Read More

Front Psychiatry 2018 31;9:204. Epub 2018 May 31.

Department of Psychiatry, University of Turku, Turku, Finland.

Non-alcoholic Wernicke's encephalopathy and Korsakoff syndrome are greatly underdiagnosed. There are very few reported cases of neuropsychologically documented non-alcoholic Korsakoff syndrome, and diffusion tensor imaging (DTI) data are scarce. We report clinical characteristics and neuropsychological as well as radiological findings from three psychiatric patients (one woman and two men) with a history of probable undiagnosed non-alcoholic Wernicke's encephalopathy and subsequent chronic memory problems. Read More

Handb Clin Neurol 2018 ;155:333-352

Neurology Service, Hôpital Erasme, Brussels, Belgium.

The cerebellum is a brain region which is particularly susceptible to intoxication. Clinical presentation is heterogeneous. It is often considered that elderly patients and patients presenting pre-existing structural lesions of the posterior fossa are particularly at risk of developing a toxic-induced cerebellar syndrome (TOICS). Read More

Handb Clin Neurol 2018 ;155:117-127

Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD, United States. Electronic address:

The nervous system is vulnerable to intrinsic and extrinsic metabolic perturbations. In particular, the cerebellum, with its large Purkinje cells and its high density of neurons and glial cells, has high metabolic demand and is highly vulnerable to metabolic derangements. As a result, many disorders of intermediary metabolism will preferentially and sometimes selectively target the cerebellum. Read More

Oxf Med Case Reports 2018 May 22;2018(5):omy013. Epub 2018 May 22.

Department of Medicine, Changi General Hospital, Singapore.

A 61-year-old gentleman, with a long-standing history of alcohol abuse presented with altered sensorium and unsteady gait for 2 weeks. A diagnosis of Wernicke encephalopathy (WE) was considered. The magnetic resonance imaging brain showed features consistent with the WE, thus supporting the diagnosis. Read More

Surg Obes Relat Dis 2018 07 26;14(7):943-950. Epub 2018 Mar 26.

Department of Surgery, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Background: As the vertical sleeve gastrectomy (VSG) becomes increasingly popular, its effect on postoperative micronutrient levels, such as thiamine, becomes more important. We previously found a 1.8% prevalence of thiamine deficiency in bariatric patients before surgery. Read More

Psychosomatics 2018 Jul - Aug;59(4):311-317. Epub 2018 Mar 27.

Durham VA Medical Center, Durham, NC.

Background: Wernicke's encephalopathy is a condition whose treatment many consultation-liaison psychiatrists know quite well. Less clear, however, is the treatment of its dementia disorder descendent, the Korsakoff's syndrome (KS).

Objective: This article seeks to review treatment options and provide recommendations for consultation-liaison psychiatrists treating cognitive impairment in KS. Read More

Palliat Support Care 2018 12 11;16(6):800-802. Epub 2018 May 11.

Department of Psychiatry and Cognitive-Behavioral Medicine,Nagoya City University Graduate School of Medical Sciences,Nagoya,Japan.

Objective: Wernicke encephalopathy (WE) is a neuropsychiatric disorder caused by thiamine deficiency, and is sometimes overlooked because of the diversity of clinical symptoms.

Method: From a series of WE patients with cancer, we report a lung cancer patient who developed WE, the main symptom of which was agitation.ResultA 50-year-old woman with lung cancer was referred to our psycho-oncology clinic because of agitation lasting for three days. Read More

Front Neurol 2018 24;9:264. Epub 2018 Apr 24.

Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

Bilateral vestibulopathy (BVP), which is due to peripheral lesions, may selectively involve certain semicircular canal (SCC). Recent eye movement recordings with search coil and video head impulse test (HIT) have provided insight in central lesions that can cause bilateral and selective SCC deficit mimicking BVP. Since neurological signs or ocular motor deficits maybe subtle or absent, it is critical to recognize central lesions correctly since there is prognostic and treatment implication. Read More

Nutr Clin Pract 2018 Aug 14;33(4):510-514. Epub 2017 Dec 14.

Department of Anesthesiology, Graduate School of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee, USA.

Background: We report a case of a patient who was 3 months post-sleeve gastrectomy and presented with acute stroke symptoms ultimately due to Wernicke's encephalopathy (WE) after bariatric surgery. A 20-year-old white female presented to an outside hospital 3 months after sleeve gastrectomy complaining of nausea and vomiting. She initially underwent a cholecystectomy and later became less responsive and required intubation. Read More

Curr Drug Abuse Rev 2017 ;10(1):44-51

Italian Liver Foundation, Centro Studi Fegato, SS14, Km 163.5, Trieste, 34149, Italy.

Background: Drinking more than the recommended limits is a worldwide emerging problem, difficult to circumscribe, and alcohol-related brain damages are an under-recognized health problem. Alcohol-cognitive disruption can be considered as transient and recoverable if the alcohol consumption is limited and occasional; if not, it can progress to the so-called Alcohol-Related Dementia (ARD), or to the Wernicke encephalopathy, or it can even induce the Korsakoff syndrome, an irreversible and long-lasting medical condition. ARD still remains poorly diagnosed and addressed, despite having increased research interest being a frustrating condition, a relatively non-progressive, or even partially reversible condition in abstinent ex-drinkers. Read More

G Chir 2018 Mar-Apr;39(2):92-96

Aim: In the last years with the increase of bariatric surgery, first of all as a result of new indications, a rise in the incidence of nutrient-related complications has been observed. Currently little is known about the impact of post-bariatric malnutrition and neurological complications. Wernicke's encephalopathy is a severe neurological syndrome which occurs as a result of thiamine deficiency. Read More

Obes Surg 2018 Jul;28(7):2060-2068

Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands.

Half a million bariatric procedures are performed annually worldwide. Our aim was to review the signs and symptoms of Wernicke's encephalopathy (WE) after bariatric surgery. We included 118 WE cases. Read More

Asian Cardiovasc Thorac Ann 2018 May 18;26(4):302-304. Epub 2018 Apr 18.

Department of Cardiovascular Surgery, Mie Heart Center, Mie, Japan.

A 76-year-old woman who had been on hemodialysis for 3 years developed ischemic mitral valve insufficiency, tricuspid insufficiency, and chronic atrial fibrillation, and underwent cardiac surgery. On the 4th postoperative day, she experienced a sudden disturbance of consciousness, aphasia, and limb ataxia. Brain computed tomography and magnetic resonance imaging showed no abnormalities. Read More

Tijdschr Psychiatr 2018;60(4):250-257

Background: The new draft Law on care and coercion focuses on the care of people with a psychogeriatric disorder or intellectual disability. Perhaps this law can be applied to people suffering from chronic alcoholism, associated with an increased risk of Korsakoff's syndrome.

Aim: To explore whether the new draft law on care and coercion can be applied to people suffering from chronic alcoholism who still live at home. Read More

Pediatr Emerg Care 2018 Dec;34(12):e223-e225

From the Departments of Pediatric Neurology.

Wernicke encephalopathy is an acute neurological problem resulting from thiamine deficiency and manifesting with mental confusion, oculomotor dysfunction, and ataxia. It is associated with alcohol dependence in adults. Preparatory factors include hyperemesis gravidarum, prolonged diarrhea, prolonged parental nutrition without vitamin support, absorption disorders, anorexia, cancer, and chemotherapy. Read More

Front Neurol 2018 12;9:141. Epub 2018 Mar 12.

Department of Neurology, University Hospital Zurich, Zurich, Switzerland.

Background: Wernicke's encephalopathy (WE), a metabolic disorder due to thiamine deficiency, manifests with various neurological symptoms and signs. It has been known as a cause of vestibular dysfunction. Preliminary reports have proposed predominant involvement of the horizontal semicircular canals (HSCs). Read More

Oman J Ophthalmol 2018 Jan-Apr;11(1):85-87

Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman.

Wernicke's Encephalopathy (WE) is a potentially devastating disorder, which if not diagnosed and treated at the earliest, could lead to dangerous neurological and ophthalmological complications. We report the ocular manifestations of WE in a pregnant woman with hyperemesis gravidarum. Read More

Psychosomatics 2018 Jul - Aug;59(4):379-387. Epub 2018 Jan 11.

Department of Psychiatry, University of North Carolina, Chapel Hill, NC; Department of Medicine, University of North Carolina, Chapel Hill, NC.

Background: Wernicke encephalopathy is a common neuropsychiatric syndrome due to thiamine deficiency. There is no consensus regarding thiamine dosing when Wernicke encephalopathy is suspected. A longstanding dosing strategy for Wernicke encephalopathy is 100mg daily, yet updated clinical guidelines suggest using high-dose intravenous (HDIV) thiamine. Read More