It is reasonable to prescribe thiamine 50 mg orally three times a day for 2 to 3 weeks, as thiamine stores may be depleted because of poor diet and alcohol-impaired gut absorption. Wernicke-Korsakoff syndrome is life-threatening and steps must be taken to avoid it developing. (8) The malnourished patient, or the patient who shows any sign of Wernicke's encephalopathy (confusion, ataxia, ophthalmoplegia, nystagmus—do not wait for the 'triad' of symptoms), must be given immediate parenteral B vitamins. Anaphylactic shock was a very rare complication of some older preparations. It is less likely with intramuscular than intravenous injection; infusion saline drip, when practicable, is probably preferable to slow bolus injection.
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