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To the Editor.—In his letter, Dr Marinella¹ claims, "Thiamine should be administered prior to a glucose load because cases of Wernicke encephalopathy have been reported after glucose administration in thiamine-deficient patients." The reference that supports this statement describes only 4 patients.² The first was a 27-year-old woman with weight loss for more than 6 months, gastrointestinal symptoms for 3 days, and the onset of dizziness and blurring of her vision. She had tachycardia, confusion, ataxia, absent deep tendon reflexes, and horizontal nystagmus. After treatment with 3 L of 5% dextrose for more than 24 hours, her symptoms worsened. The second patient was a 79-year-old woman with schizophrenia, anorexia, weight loss, horizontal nystagmus, absent deep tendon reflexes, and a temperature of 33°C; the diagnosis was septicemia. After 2 L of dextrose, she developed bilateral sixth nerve palsies, disorientation, and coma. The third patient was a 45-year-old woman with end-stage renal . . . [Full Text of this Article]

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RELATED LETTER

Pharmacologic Treatment of Alcohol Withdrawal
Mark A. Marinella
JAMA. 1997;278(16):1317.
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