A prospective evaluation of thiamine and magnesium status in relation to clinicopathological characteristics and 1-year mortality in patients with alcohol withdrawal syndrome

Abstract

BackgroundAlcohol withdrawal syndrome (AWS) is routinely treated with B-vitamins. However, the relationship between thiamine status and outcome is rarely examined. The aim of the present study was to examine the relationship between thiamine and magnesium status in patients with AWS.MethodsPatients (n = 127) presenting to the Emergency Department with AWS were recruited to a prospective observational study. Blood samples were drawn to measure whole blood thiamine diphosphate (TDP) and serum magnesium concentrations. Routine biochemistry and haematology assays were also conducted. The Glasgow Modified Alcohol Withdrawal Score (GMAWS) measured severity of AWS. Seizure history and current medications were also recorded.ResultsThe majority of patients (99%) had whole blood TDP concentration within/above the reference interval (275–675 ng/gHb) and had been prescribed thiamine (70%). In contrast, the majority of patients (60%) had low serum magnesium concentrations (< 0.75 mmol/L) and had not been prescribed magnesium (93%). The majority of patients (66%) had plasma lactate concentrations above 2.0 mmol/L. At 1 year, 13 patients with AWS had died giving a mortality rate of 11%. Male gender (p < 0.05), BMI < 20 kg/m2 (p < 0.01), GMAWS max ≥ 4 (p < 0.05), elevated plasma lactate (p < 0.01), low albumin (p < 0.05) and elevated serum CRP (p < 0.05) were associated with greater 1-year mortality. Also, low serum magnesium at time of recruitment to study and low serum magnesium at next admission were associated with higher 1-year mortality rates, (84% and 100% respectively; both p < 0.05).ConclusionThe prevalence of low circulating thiamine concentrations were rare and it was regularly prescribed in patients with AWS. In contrast, low serum magnesium concentrations were common and not prescribed. Low serum magnesium was associated more severe AWS and increased 1-year mortality.

Magnesium Metabolism in Chronic Alcohol-Use Disorder: Meta-Analysis and Systematic Review

“…We urge that patients with chronic alcohol-use disorder have frequently blood magnesium measured. This suggestion is supported by recent data that implicate magnesium depletion in high mortality in this condition [45,46].…”

Microbiota dysbiosis influences immune system and muscle pathophysiology of dystrophin‐deficient mice

“…Since muscle calcium dysfunctions are common in DMD (Walther et al , 2000; Sparks et al , 2007; Maguire et al , 2019), we investigated the muscle amount of calcium channel proteins as transient receptor potential canonical 1 ( TRPC1 ) and vanilloid receptor 1 (VR‐1). Compared with WT, the TRPC1 expression was similarly upregulated in mdx, mdx+ABX and GFmdx, whereas VR‐1 was comparable among animal groups.…”

Intra-erythrocytes magnesium deficiency could reflect cognitive impairment status due to vascular disease: a pilot study

“…Further studies are needed to demonstrate whether magnesium deficiency is a consequence of inadequate dietary intake, a result of comorbidities in patients with cognitive impairment or a primary pathogenic factor. Little is known about prevalence of magnesium deficiency, ranging from 14.5% in general population to 35%-50% in older adult patients depending on study and compartment considered (plasma or intracellular measurement) [24,25] till 60% of subjects with alcohol dependence (Alcohol withdrawal syndrome) [26]. In this sense, elderly people tend to reduce food and green vegetables intake-which could account for magnesium deficiency-however comorbidities such as gastrointestinal dysfunction and disease could represent an important cause of magnesium malabsorption.…”