How should I initiate thiamine replacement therapy in a patient suspected of having Wernicke's encephalopathy?

Initiate thiamine replacement therapy in suspected Wernicke's encephalopathy by offering parenteral thiamine immediately. This should be given at doses toward the upper end of the British National Formulary range to ensure adequate treatment.

Administer parenteral thiamine for a minimum of 5 days unless Wernicke's encephalopathy is excluded. Following parenteral therapy, continue with oral thiamine treatment to maintain adequate thiamine levels.

Maintain a high level of clinical suspicion for Wernicke's encephalopathy, especially in intoxicated patients or those at high risk.