First, WE is a recognized complication of IV D50 administration in malnourished or intoxicated persons. The national standard of care is that patients recieve Thiamine before administration of D50 if there is doubt as to the etiology of the hypoglycemic state. This is in Harrison's, the Washington Manual, the CMDT, and Cecil's Textbook of medicine. (Diamond)
Second, you will be found negligent in a court of law if you do not meet the standard of care as a "reasonable and prudent person." There have been many suits and many claims paid in regard to the negligence of a physician allowing a patient to suffer needlessly from WE. A recent case occured in FL. (Jacksonville Times Union)
Third, there are repeated and irrefutable case studies in widely read and peer reviewed journals that have documented WE in patients not recieving Thiamine prior to D50 administration.... the NEJM being one. There is also a known mechanism by which this occurs. (Kaineg)
Fourth, there is an exceedingly rare instance of case studied anaphylactic reaction to Thiamine. It has been documented in rather obscure journals, not widely recognized in the United States. This is somewhere along the line of 1:100,000 administrations and the case studies I read were in countries with less stringent guidlines for medication quality control than the US. Additionally, anaphylais is reversable in the healthcare setting where Thiamine would be administered. WE is not. (Leung)
Take from this what you will.
Diamond I: Nutritional disorders of the Nervous System. In: Cecil RL, Goldman L, Bennett JC, eds. Cecil Textbook of Medicine. 19th ed. Philadelphia, Pa: WB Saunders Co; 1992: 2125-2128.
Al-Sanouri I, Dikin M, Soubani AO: Critical care aspects of alcohol abuse. South Med J 2005 Mar; 98(3): 372-81
Kaineg, Brian. Wernicke's Encephalopathy. N Engl J Med. 2005 May 12;352(19):e18.
http://www.jacksonville.com/tu-online/stories/072407/met_186496616.shtml
Leung R, Puy R, Czarny D. Thiamine anaphylaxis. Med J Aust 1993;159(5):355.
