In which clinical scenarios should I consider referring a patient with suspected Wernicke's encephalopathy to a specialist?

Consider referring a patient with suspected Wernicke's encephalopathy to a specialist in the following clinical scenarios:

• If the patient is at high risk of developing or has suspected Wernicke's encephalopathy and requires parenteral thiamine treatment, especially if they are malnourished or have decompensated liver disease, as specialist input may be needed for management and monitoring.
• If the patient is admitted to hospital or attends an emergency department with acute illness or injury and has risk factors such as malnourishment or decompensated liver disease, referral to a specialist experienced in managing these complications is advised.
• If the diagnosis is uncertain or if the patient has complex comorbidities, including alcohol-related liver disease or mental health disorders, referral to specialists in hepatology, neurology, or psychiatry may be appropriate to ensure comprehensive assessment and management.
• For patients with Wernicke-Korsakoff syndrome requiring long-term care or cognitive support, referral to specialist services for supported living or 24-hour care is recommended.

In all cases, maintain a high index of suspicion for Wernicke's encephalopathy and initiate prompt parenteral thiamine treatment while arranging specialist referral as needed.

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