Prolonged heavy alcohol use can result in thiamin deficiency due to reduced dietary intake, reduced absorption, and increased excretion of thiamin. This may result in Wernicke’s encephalopathy (WE) which is characterized by delirium and anterograde amnesia, ataxia, and ophthalmoplegia. WE should be rapidly treated since the lack of thiamin and replacement therapy can have a mortality rate of up to 20% with 75% developing a permanent severe amnestic syndrome (Korsadoff’s psychosis). Since thiamin has limited absorption following in oral dose, the treatment for suspected WE involves intravenous delivery of a high potency vitamin B- complex therapy containing thiamin. Patients with suspected WE should receive 500 mg of thiamin three times daily for three days or those at risk for WE can receive 250 mg three times daily for three–five days. In the outpatient detoxification setting, thiamin can be administered intramuscular ( 200 mg for five days). It is important that thiamin is administered prior to oral or parenteral carbohydrates since thiamin is a co-factor for enzymes required in glucose metabolism and WE may be precipitated if glucose is administered prior to thiamin.