THIAMINE-DEFICIENCY IN HEAD-INJURY - A MISSED INSULT

Practice regarding the use of thiamine in head-injured patients at ris k of Wemicke-Korsakoff syndrome in Scottish neurosurgical units was su rveyed by questionnaire and revealed no clear policy. A 2 year retrosp ective study of 218 admissions to one of these units of patients who h ad taken alcohol shortly before sustaining head injury is also describ ed. The minority (20.6%) of the total had been given thiamine, with ju st over half (56.1%) of those categorized as alcoholic receiving this treatment. Additional carbohydrate loads, in the form of i.v, dextrose or parenteral nutrition, had been given to 44.5% of patients and only 28.9% of this group had also been given thiamine. The dose and durati on of thiamine given was inadequate in most cases. It is suggested tha t failure to ensure that bead injury patients at risk of Wernicke-Kors akoff syndrome receive appropriate thiamine prophylaxis represents a m issed and treatable additional insult to the damaged brain.