Wet Brain (Wernicke-Korsakoff) Syndrome: Symptoms and Treatment

Last Updated: June 10, 2020

Authored by Nena Messina, Ph.D.

One might have seen them on the street. Walking unsteadily. Slurred speech. Eyeballs are moving unnaturally as if they have no control over them. Violent muscle twitches. Mental confusion. Mumbling about events that are figments of the imagination. This is not a person who has had one drink too many the night before. It is an alcoholic who is probably suffering from wet brain syndrome. Alcoholics present a sorry sight, but the reality is grimmer. If wet brain disease is not treated, it is possible to die from it.

What is Wet Brain Disease?

Wet brain, also known as Wernicke-Korsakoff syndrome, is the result of brain damage due to severe thiamine or vitamin B1 deficiency. This condition usually progresses in two stages if left untreated – the first stage is Wernicke encephalopathy, and the second stage is Korsakoff syndrome, AKA Korsakoff psychosis.
According to the National Institutes of Health, wet brain disease is a type of brain damage caused by a severe deficiency of thiamine or vitamin B1. It is also known as Wernicke-Korsakoff syndrome, named after Dr. Wernicke and Dr. Korsakoff, who identified the symptoms of the disease.
The first stage of wet brain disease, Wernicke encephalopathy, is acute and damages the lower parts of the brain, including the thalamus and hypothalamus. This damage is reversible if the patient receives prompt treatment.
The second stage of the disease, Korsakoff psychosis, is a chronic state of permanent brain damage that affects memory. The symptoms of this stage are triggered if Wernicke encephalopathy is not treated promptly or is left untreated.

What Causes Wet Brain Syndrome?

Though thiamine deficiency alcoholism is more common, other non-alcoholic conditions can cause this vitamin deficiency. Amongst non-alcoholics, thiamine deficiency can be caused by poor diets that lack this essential nutrient, a rare disease called genetic beriberi that impairs the body’s ability to absorb thiamine from food, anorexia nervosa, and bulimia. Sometimes pregnant women who have prolonged periods of morning sickness develop thiamine deficiency.
Thiamine deficiency can occur in persons who are unable to absorb sufficient nutrients from food. For instance, individuals suffering from chronic illnesses like cancer or AIDS or those who have undergone bariatric (gastric bypass) surgery often cannot absorb food leading to nutritional deficiency. Some therapies, when administered for prolonged periods, can cause thiamine deficiency. Long-term diuretic therapy for heart failure and dialysis cause the body to lose this vital vitamin.

Why is Thiamine Deficiency Alcoholism Common?

There are several reasons why alcoholic wet brain disease is common. Historically, thiamine deficiency is associated with alcoholism. According to a publication by the U.S. Department of Health and Human Services, alcoholism impairs the body’s ability to absorb thiamine from food sources. Those who drink heavily should make an effort to eat foods rich in thiamine or to take vitamin supplements to help prevent thiamine deficiency.
Thiamine deficiency alcoholism is also common because many alcoholics neglect to eat nutrient-rich diets, either because they are too intoxicated or lack motivation. So they are generally nutritionally deficient.
Though thiamine deficiency can occur in non-alcoholics, the risk of developing wet brain disease is higher in alcoholics. This is due to the peculiar way in which sugar acts on the thiamine-deficient brain. According to this research, prolonged glucose intake by someone who has thiamine deficiency increases his risk of developing Wernicke-Korsakoff syndrome. Sugar or glucose is a by-product of alcohol metabolism in the brain.

What are the Classic Wet Brain Symptoms?

Countless research studies, like this one, have established the importance of thiamine in maintaining brain functionality. Thiamine also facilitates the conduction of signals between nerves and maintains normal muscle contraction.
Droopy Eyelid is one of the symptoms of alcoholic wet brain syndrome.

Thiamine deficiency alcoholism affects the brain and the nervous system and triggers a cascade of symptoms.
The typical symptoms of Wernicke encephalopathy are:

  • mental confusion
  • loss of muscle coordination (Remember, the twitches?)
  • vision problems like unnatural eye movements
  • drooping of the eyelids
  • double vision
  • loss of psychic abilities that may be fatal.

Dr. Wernicke discovered that alcoholism causes thiamine deficiency that, in turn, adversely affects the nervous system, brain, muscles, heart, and the gastrointestinal system.
If Wernicke encephalopathy is not treated promptly, Korsakoff psychosis develops and damages structures of the brain associated with global amnesia, which is the inability to remember new information. The classic symptoms of Korsakoff psychosis are severe loss of memory and inability to process new memories. Other notable symptoms are hallucinating and making up stories and believing in them.
Dr. Korsakoff identified these symptoms while exploring memory disturbance and loss in alcoholics.
Unfortunately, it takes days and weeks for the results of thiamine deficiency tests to be processed. Sometimes, the symptoms of thiamine deficiency may not even manifest for days and weeks.
It is imperative that physicians are not only familiar with the signs and symptoms of alcoholic wet brain disease but also able to extract the best clinical history from patients and their loved ones to make an accurate diagnosis. Family members of alcoholics should also be on the lookout for symptoms and be aware of the food habits of their loved ones.

Is there a treatment for the wet brain?

Fortunately, there is a treatment for the wet brain as long as it is diagnosed in the early stages. Prompt intravenous administration of 500 mg of thiamine hydrochloride in standard saline solution should be given to patients with acute Wernicke encephalopathy three times a day for at least three days.

How is Wet Brain Disease Treated?

The gold standard of treating Wernicke encephalopathy is prompt and sufficient thiamine replacement. The thiamine should be administered intravenously because the human body can use only 5 percent of the thiamine taken orally, whereas IV thiamine has 100 percent bioavailability.
According to the findings of this research study, 500 mg thiamine hydrochloride with normal saline should be given to patients with acute Wernicke encephalopathy thrice daily for at least three days. This is to be followed by 250 mg of thiamine hydrochloride in regular saline once daily for three more days. IV therapy should be accompanied by an oral thiamine course. Comatose, lethargic, or unconscious patients should be treated at a medical facility where their vitals can be continuously monitored.
But sometimes treating thiamine deficiency poses significant challenges. For instance, patients who have developed thiamine deficiency due to malnutrition or vomiting for prolonged periods may also have low blood sugar levels. Hypoglycemia or low blood sugar necessitates the administration of glucose. But administering glucose to thiamine-deficient individuals can increase their risks of developing Wernicke encephalopathy.
According to this research, hypoglycemic patients should be administered glucose urgently to prevent them from going into a coma. But thiamine MUST be delivered to them as soon as their blood sugar levels normalize.

What is the Wet Brain Prognosis?

Wet brain syndrome MUST be treated urgently, else the symptoms cannot be reversed, and worse, the individual usually dies.

Fortunately, most symptoms of Wernicke encephalopathy, like vision and speech problems, uncontrolled muscle movements, unsteady gait, and confusion, or delirium, can be slowed, stopped, or reversed if treated promptly with thiamine supplementation. Here is a case study that demonstrates how intensive thiamine replacement therapy can manage and improve the symptoms of Wernicke encephalopathy and help an individual regain most of his physical and cognitive functionalities.

The untreated alcoholic wet brain disease can trigger complications like permanent alcoholic neuropathy that causes a host of symptoms like problems in swallowing and talking, uncoordinated muscle movements, impotence, nausea and vomiting, urine incontinence, and constipation or diarrhea.

Untreated Wernicke encephalopathy progresses to Korsakoff psychosis.

Unfortunately, wet brain prognosis is grim for individuals who have developed Korsakoff psychosis. Symptoms like memory loss and loss of mental abilities are usually permanent. Wet brain death is not uncommon. The severe brain damage that has developed into Korsakoff psychosis leads to cognitive decline and dementia in thiamine deficiency alcoholism. The final stages of the wet brain are coma and, ultimately, premature death.

The Costs of Wet Brain Disease Treatment

At all stages, wet brain disease should ideally be treated at a medical facility where doctors can monitor symptoms and administer drugs accordingly. The cost of treatment depends on the length of stay in the hospital, which, in turn, depends on the severity of symptoms.

Sometimes patients with thiamine deficiency alcoholism and mild symptoms of Wernicke encephalopathy are discharged within a week after they have been administered IV thiamine. Patients who have developed Korsakoff psychosis require longer stays and extensive physical and cognitive rehabilitation to improve symptoms like uncoordinated muscle movement and mental confusion. The duration of the hospital stay also increases if patients have complications like malnutrition, liver damage, and cardiovascular disease.

After being treated for thiamine deficiency, some patients are discharged to be cared for in a nursing home. These are patients who may need help eating, walking, or bathing. At other times, patients who exhibit psychiatric disorders like alcoholic wet brain-related dementia are admitted to a specialty psychiatric treatment unit. This study presents the cases of two individuals diagnosed with wet brain disease, which help to understand how different symptoms and their severity determine the approach and duration of treatment.

Why is thiamine deficiency common in alcoholics?

Thiamine deficiency is common to alcoholics because they usually choose to drink rather than eating nutritious foods. Even when alcoholics don’t avoid eating, consuming large amounts of alcohol regularly can cause the body to have difficulty absorbing thiamine.

The treatment for Wernicke-Korsakoff syndrome to improve wet brain prognosis can be lengthy and costly because thiamine deficiency alcoholism manifests as a clutch of co-occurring symptoms. Therefore, it is imperative that physicians, along with those who drink heavily and their loved ones, learn to identify the signs of wet brain syndrome and seek treatment immediately.

People who drink alcohol regularly should make sure that they take regular thiamine supplements. The best way to prevent wet brain syndrome is to abstain from alcohol and maintain a balanced diet. A person who continues to drink should keep in mind that an alcoholic wet brain can lead to permanent brain damage, coma, and death.

Page Sources

  1. https://medlineplus.gov/ency/article/000339.htm
  2. http://www.ncbi.nlm.nih.gov/pubmed/19087395
  3. http://www.ncbi.nlm.nih.gov/pubmed/22104258
  4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805404/
  5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551444/

Published on: March 9th, 2018

Updated on: June 10th, 2020

About Author

Nena Messina, Ph.D.

Nena Messina is a specialist in drug-related domestic violence. She devoted her life to the study of the connection between crime, mental health, and substance abuse. Apart from her work as management at addiction center, Nena regularly takes part in the educational program as a lecturer.


Leave a comment

  • Ann
    I have been sober for six months and am still having walking difficulties. The only treatment I have received is from oral medication. Would it be too late to try the Thiamine IV therapy? Doctors in my location do not seem to take this very seriously and it doesn’t seem to be the protocol for treating my deficiency.
  • Irene
    Dear Ann, I am praying that you can get the help you need and will continue to stay sober. I am living this nightmare right now with my son who has all the classic signs of this terrible disease.
  • Shelley Jordan
    What type of specialist treats this disorder. I know my husband is in need of medical care but i don’t know whom to call. Sad tired wife
  • Barbara
    Thank you for making this information available. It has helped me to understand what my brother is going through.
  • Cat
    I believe it is a neurologist who handles this condition. Best of luck to you Shelley!
  • Pauline
    I believe my brother in law may have wet brain syndrome, he is a heavy drinker, drinks every day, he also suffers with copd , he is verbally abusive towards my sister, but then cannot remember saying anything, he is extremely thin and often goes all day without eating anything, his walking and coordination is terrible and he frequently falls over and injures himself, he also is starting to have bladder and bowel accidents, he just lays on sofa day after day and then says he can’t sleep, he is always repeating himself in conversations,but he will not admit that he has a drink problem.
  • Patty
    Sadly my husband lost his battle with alcoholism due to Wet Brain….. We noticed his short term memory loss with one of his long detoxing hospital stays along with a few other physical problems as well. He was in and out of treatment centers for several years and when the symptoms became very apparent he lasted about 3 weeks and spent 9 of those days in Critical care and went into cardiac arrest and passed away. I personally feel the doctors could have diagnosed it earlier, but due to his mental illness and him being an alcoholic he was treated as if “This is what happens when you drink” attitude. (regular floor hospital doctors) The critical care physicians were a little better. He did believe in AA and had much faith in the program. (In and out of treatment centers(26) for 14 years) He just couldn’t seem to get it right. I miss him so very much, just wish we had more time together and maybe just maybe he could have got it right.
    • Devin
      Patty, My heart goes out to you and I am really feeling like my family will be experiencing something similar in the days to come. My father, 67, has been an alcoholic for my entire life and has exhibited worsening symptoms over the last 5 years or so. I am 31 years old and expecting my first child in the next two weeks. There is so much I want him to experience as a grandfather with the burning knowledge that he nor, I will be able to experience these things. Unless he decides to choose recovery of some sort. I constantly ponder when he will die from this disease… Again, my heart goes out to you and your family. Here’s to beating this disease for ourselves and future generations!
    • Lori
      My heart is breaking as I read your story. My husband of 40 years is in hospital on life support as I write this . He has had a drinking problem since high school and it cost him his relationship with our children his friends his job and now possibly his life. As for me I feel like a soldier who as fought a war and lost and reading about your journey made me feel like I haven’t been the only one on the battlefield of addiction. May God bless you iand hope you find peace and happiness in the future.
  • elisa
    I’m scared . I am alone. This is my Dad! …Lord, please don’t let him die this way. please pray for all who suffer this. … there is no peace in our family and no resolution, what can i do????!!! I see the soul w/in minus this disease that has controlled his entire life and *what if the thiamine treatment might help if not crossed point yet? I can’t stop crying …terrified for him