Safety of intravenous push thiamine administration at a tertiary academic medical center

McLaughlin, Kevin; Joyal, Kayla; Lee, Seung-Joo; Corrado, Michael; Marquis, Kathleen A.; Anger, Kevin E.; Szumita, Paul M.

doi:10.1016/j.japh.2019.12.005

Cited by 10 publications

(10 citation statements)

References 9 publications

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“…In critically ill patients, prophylaxis or treatment for TD typically consists of parenteral administration of thiamine (25,26). The intravenous route is most frequently used due to rapidly achieving high plasma concentrations, flexible rate of dosing, and better site tolerance as compared to intramuscular injection (28). Also, thiamine replacement by oral or enteral route is possible in situations of nonemergent deficiency, though it is important to note that the gastrointestinal microenvironment is often perturbed during sepsis, resulting in gut dysfunction and nutrient malabsorption (24,29).…”

Section: Thiamine: Functions and Mechanisms Of Actionmentioning

confidence: 99%

“…Although thiamine is considered to have a very good safety profile, the tolerable upper intake level (UL) is not established (30). Studies have shown that parenteral doses >500 mg have occasionally led to anaphylaxis and minimal adverse effects such as nausea, anorexia, lethargy, mild ataxia, and a diminution of gut tone (26,28,31).…”

Section: Thiamine: Functions and Mechanisms Of Actionmentioning

confidence: 99%

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Insights Into Thiamine Supplementation in Patients With Septic Shock

et al. 2022

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Septic shock is associated with unacceptably high mortality rates, mainly in developing countries. New adjunctive therapies have been explored to reduce global mortality related to sepsis. Considering that metabolic changes, mitochondrial dysfunction and increased oxidative stress are specific disorders within the path of septic shock, several micronutrients that could act in cellular homeostasis have been studied in recent decades. Thiamine, also known as vitamin B1, plays critical roles in several biological processes, including the metabolism of glucose, synthesis of nucleic acids and reduction of oxidative stress. Thiamine deficiency could affect up to 70% of critically ill patients, and thiamine supplementation appears to increase lactate clearance and decrease the vasopressor dose. However, there is no evident improvement in the survival of septic patients. Other micronutrients such as vitamin C and D, selenium and zinc have been tested in the same context but have not been shown to improve the outcomes of these patients. Some problems related to the neutrality of these clinical trials are the study design, doses, route, timing, length of intervention and the choice of endpoints. Recently, the concept that multi-micronutrient administration may be better than single-micronutrient administration has gained strength. In general, clinical trials consider the administration of a single micronutrient as a drug. However, the antioxidant defense is a complex system of endogenous agents in which micronutrients act as cofactors, and the physiological interactions between micronutrients are little discussed. In this context, the association of thiamine, vitamin C and corticoids was tested as an adjunctive therapy in septic shock resulting in a significant decrease in mortality. However, after these initial results, no other study conducted with this combination could reproduce those benefits. In addition, the use of low-dose corticosteroids is recommended in patients with septic shock who do not respond to vasopressors, which can affect the action of thiamine. Therefore, given the excellent safety profile, good biologic rationale and promising clinical studies, this review aims to discuss the mechanisms behind and the evidence for single or combined thiamine supplementation improving the prognosis of patients with septic shock.

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Section: Thiamine: Functions and Mechanisms Of Actionmentioning

confidence: 99%

Section: Thiamine: Functions and Mechanisms Of Actionmentioning

confidence: 99%

Insights Into Thiamine Supplementation in Patients With Septic Shock

et al. 2022

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“…25 In contrast to the oral route, parenteral use has been associated with phlebitis and very rarely with hypersensitivity reactions such as pruritus, respiratory distress, nausea, abdominal pain, and even anaphylactic shock, which are mainly associated with the administration route (<2%). [35][36][37] Vitamin B6 and Neurotoxicity…”

Section: Vitamin B1 and Adverse Reactionsmentioning

confidence: 99%

Update on Safety Profiles of Vitamins B1, B6, and B12: A Narrative Review

Calderón-Ospina¹,

Nava-Mesa²,

Paez-Hurtado³

2020

TCRM

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The neurotropic B vitamins B1 (thiamine), B6 (pyridoxine), and B12 (cobalamin) are essential for proper functioning of the nervous system. Deficiencies may induce neurological disorders like peripheral neuropathy (PN) and mainly occur in vulnerable populations (eg, elderly, diabetics, alcoholics). As epidemiologic cohort studies raised safety concerns about vitamin B6/B12 intake being potentially associated with increased risks of hip fracture (HF) and lung cancer (LC), we explored these aspects and performed comprehensive literature searches. However, we suggest not to neglect actual high-risk factors (eg, smoking in LC, higher age in HF) by focusing on individual nutrients, but to examine the complex interaction of numerous factors involved in disease development. Because it warrants continued consideration, we also provide an update on neurotoxicity associated with vitamin B6. We consider that neurological side effects due to vitamin B6 intake are rare and only occur with high daily doses and/or longer treatment duration. The benefit-risk ratio of high-dose treatment with neurotropic B vitamins in indications like PN is therefore considered advantageous, particularly if dosing recommendations are followed and serum levels monitored.

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“…3,4 Giving empiric IV multivitamins also comes with several concerns that may include potential vitamin toxicities or allergic reactions, additional costs, unnecessary IV access, and risk of infection at the IV site. [3][4][5][6] To implement evidence-based medicine in the ED regarding the utilization of vitamin therapies in an alcoholrelated diagnosis, a group of researchers employed an intervention at our institution in 2009 to change practice. 7 This intervention consisted of changes to the default order entry settings in our hospital's electronic medical record (EMR) as well as education to the emergency providers.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Impacts of a Targeted Intervention in the Emergency Department on Inpatient Prescribing Practices

Negaard

Vakkalanka

Nugent

et al. 2022

Journal of Pharmacy Practice

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Background: In 2009, researchers successfully implemented an intervention to decrease the inappropriate prescribing of multivitamin infusions (MVIs) in the emergency department (ED) for patients presenting with alcohol-related illnesses. Objective: The purposes of our study were to determine the impact of the 2009 intervention on hospital-wide prescribing practices of vitamin therapies for alcohol-related illnesses, and to evaluate its long-term sustainability. Methods: A retrospective observational cohort study was conducted at a 60,000-visit ED, 811-bed academically-affiliated tertiary referral hospital with an average census of 515 and 714 patients in 2009 and 2019, respectively. Patients were included if they presented to the ED from 2009 to 2019 with an alcohol-related illness as defined by ICD-9 and ICD-10 codes. The primary outcome was the change in the monthly average of MVIs ordered inpatient within the first four months compared to the last four months of the study period. Secondary outcomes included changes in the mean distribution (MD) per month of thiamine administrations in the ED and inpatient setting, and MVIs ordered in the ED. Results: The MD of MVIs ordered per month decreased by 3.5% (95% CI −5.3, −1.7) in the inpatient setting and decreased by 1.4% (95% CI −2.5, −.3) in the ED from the beginning to the end of our study period. Conclusions: This study suggests the effects of an intervention made in the ED sustained impact over a 10-year timeframe, and decreased the use of MVIs in both the ED and hospital-wide.

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Safety of intravenous push thiamine administration at a tertiary academic medical center

Cited by 10 publications

References 9 publications

Insights Into Thiamine Supplementation in Patients With Septic Shock

Insights Into Thiamine Supplementation in Patients With Septic Shock

Update on Safety Profiles of Vitamins B1, B6, and B12: A Narrative Review

Long-Term Impacts of a Targeted Intervention in the Emergency Department on Inpatient Prescribing Practices

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