We were veiy interested to read this letter in the recent issue of Alcohol Alcoholism written in response to the paper by Mancinelli and Ceccanti (2009). We agree with the authors that the use of biomarkers complements the taking of a comprehensive histoiy.The authors mentioned the measurement of erythrocyte transketolase activity, which has been used for many years as a measure of thiamine deficiency. However, this test is not usually routinely available in clinical practice or on an emergency basis in most UK hospitals, and there is debate about how best to interpret transketolase test results. The authors were correct to explain that any attempts to measure thiamine deficiency will only identify patients at risk of developing Wernicke's encephalopathy (WE) since there is no established threshold level of thiamine above which all patients will be safe from developing brain damage.
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