To the Editor.
—We believe that the otherwise excellent protocol for treatment by the Working Group on Status Epilepticus1 perpetuates a common misconception. The authors recommend that if hypoglycemia is established or a blood glucose determination is unavailable, glucose should be administered; in adults, 100 mg of thiamine should be given first.The belief that thiamine needs to be given to any patient prior to glucose administration is based on the article by Watson et al.2 In that report, four patients acutely developed Wernicke's encephalopathy after receiving glucose. It is important to note that although each patient developed symptoms acutely, none developed them immediately after glucose administration. Patient 1 received 3 L of 5% dextrose in water over 24 hours, patient 2 received 2 L of 5% dextrose in water, patient 3 received hypertonic dialysis for 48 hours, and patient 4 received hypertonic glucose solution for 5 days.
Slovis CM, Wrenn KD. Treatment of Status Epilepticus. JAMA. 1994;271(13):980. doi:10.1001/jama.1994.03510370032015