All patients should be prescribed a high protein high calorie diet with late evening snack on admission. Target daily calorie intake of 35 kcal/kg and protein intake of 1.2 to 1.5 g/kg/day. Monitor intake. Initiate enteral supplementation within 72 hours of inadequate intake. Esophageal varices do not present a contraindication to enteral tube placement.
Patients are often thiamine and folate deficient and this should be replaced.
- If Wernicke's encephalopathy is suspected (oculomotor dysfunction, ataxia, encephalopathy), start thiamine 500mg IV q8 hourly x 3 days, then 300mg IV daily x 5 days then 100mg po daily until the patient is no longer considered at risk (often ~3 months).
- For Wernicke's prophylaxis dosing, start thiamine 300mg po/IV daily for 3 days then reassess
- Folic acid 5mg po/IV daily for 5 days then reassess
Multivitamin 1 tab po daily or multivitamin 10mL in 100mL of 0.9% NaCl daily if NPO
Provide magnesium, phosphorus, potassium, and zinc supplementation as needed.