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Comment & Response
September 8, 2020

Challenges in Prediction and Diagnosis of Alcohol Withdrawal Syndrome and Wernicke Encephalopathy—Reply

Author Affiliations
  • 1Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
  • 2Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  • 3British Columbia Centre on Substance Use, St Paul’s Hospital, Vancouver, British Columbia, Canada
JAMA Intern Med. Published online September 8, 2020. doi:10.1001/jamainternmed.2020.3561

In Reply We thank Sechi and Sechi for their interest in our recent article describing challenges in the diagnosis and management of alcohol withdrawal in medically ill hospitalized patients.1 We certainly agree that Wernicke encephalopathy (WE) should always be included in the differential diagnosis for delirium in patients with a history of heavy alcohol use, and parenteral thiamine should be provided empirically without delay. Urgent treatment with parenteral thiamine can reverse WE, whereas untreated patients may progress to permanent cognitive impairment and Korsakoff syndrome, coma, or death.2

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