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
Brothers TD, Bach P. Challenges in Prediction and Diagnosis of Alcohol Withdrawal Syndrome and Wernicke Encephalopathy—Reply. JAMA Intern Med. Published online September 08, 2020. doi:10.1001/jamainternmed.2020.3561
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