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Wernicke's encephalopathy

Quality statement

People with suspected, or at high risk of developing, Wernicke's encephalopathy are offered thiamine in accordance with NICE guidance.

Quality measure

Structure

Evidence of local arrangements to ensure that people with suspected, or at high risk of developing, Wernicke's encephalopathy are offered thiamine in accordance with NICE clinical guideline 115 and NICE clinical guideline 100.

Process

a) Proportion of people misusing alcohol, meeting NICE guidance criteria for prophylactic oral thiamine, who receive oral thiamine.

Numerator - the number of people in the denominator receiving prophylactic oral thiamine.

Denominator - the number of people misusing alcohol, meeting NICE guidance criteria for prophylactic oral thiamine.

b) Proportion of people misusing alcohol, meeting NICE guidance criteria for parenteral thiamine followed by oral thiamine, who receive parenteral thiamine followed by oral thiamine.

Numerator - the number of people in the denominator receiving parenteral thiamine followed by oral thiamine.

Denominator - the number of people misusing alcohol, meeting NICE guidance criteria for parenteral thiamine followed by oral thiamine.

Outcome

Proportion of people misusing alcohol who have Wernicke's encephalopathy or Wernicke-Korsakoff syndrome.

Numerator - the number of people in the denominator with Wernicke's encephalopathy or Wernicke-Korsakoff syndrome.

Denominator - the number of people misusing alcohol.

Description of what the quality statement means for each audience

Service providers ensure that systems are in place to provide thiamine in accordance with NICE guidance to people with suspected, or at high risk of developing, Wernicke's encephalopathy.

Healthcare professionals ensure they offer thiamine in accordance with NICE guidance to people with suspected, or at high risk of developing, Wernicke's encephalopathy.

Commissioners ensure they commission services that provide thiamine in accordance with NICE guidance for people with suspected, or at high risk of developing, Wernicke's encephalopathy.

People with suspected, or at high risk of developing, Wernicke's encephalopathy, which is a condition that affects the brain and nervous system, and is caused by a lack of thiamine (also called vitamin B1) in the body, are offered thiamine (either as tablets or as an injection followed by tablets, depending on the situation) to help prevent the condition developing or getting worse.

Source clinical guideline references

NICE clinical guideline 115 recommendation 1.3.8.5 and NICE clinical guideline 100 recommendations 1.2.1.1, 1.2.1.2, 1.2.1.3 and 1.2.1.4.

Data source

Structure

Local data collection.

Process

a) Local data collection.

b) Local data collection. The International statistical classification of diseases and related health problems (ICD-10) code for Wernicke's encephalopathy is E51.2 and alcohol amnesic syndrome is F10.6.

Outcome

See process b) data source for information relevant to the numerator. Data on the prevalence of alcohol misuse in adults is available by region from the NHS Adult Psychiatric Morbidity Survey in England.

Definitions

NICE clinical guideline 100 recommends that thiamine is offered to people at high risk of developing, or with suspected, Wernicke's encephalopathy. Thiamine should be given in doses toward the upper end of the ‘British national formulary' (BNF) range.

Prophylactic oral thiamine should be offered to harmful or dependent drinkers:

  • if they are malnourished or at risk of malnourishment or
  • if they have decompensated liver disease or
  • if they are in acute withdrawal or
  • before and during a planned medically assisted alcohol withdrawal.

Parenteral thiamine followed by oral thiamine should be offered to people with suspected Wernicke's encephalopathy and harmful or dependent drinkers if they:

  • aremalnourished or at risk of malnourishment or
  • havedecompensated liver disease and in addition
    • attend an emergency department or
    • are admitted to hospital with an acute illness or injury.

In addition, NICE clinical guideline 115 recommends offering parenteral thiamine followed by oral thiamine to people entering planned assisted alcohol withdrawal in specialist inpatient alcohol services or prison settings who are malnourished, at risk of malnourishment or have decompensated liver disease.

Equality and diversity considerations

This statement applies only to groups at high risk of developing Wernicke's encephalopathy. People with alcohol dependence who are homeless are likely to be included in this group.

This page was last updated: 25 August 2011

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.