Thiamine absorption in alcoholic delirium patients.

Holzbach, Ernst

doi:10.15288/jsa.1996.57.581

Cited by 15 publications

(7 citation statements)

References 6 publications

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“…In one third of malnourished patients, ethanol can decrease thiamine absorption by 50%. Furthermore, here is evidence that patients experiencing DT present impaired thiamine absorption (90). Thiamine repletion in the critically iU should unequivocally be managed with parenteral thiamine.…”

Section: Clonidinementioning

confidence: 84%

“…When high-dose IV thiamine administered, serum levels rise rapidly, quick passive diffusion occurs, and the brain thiamine levels normalize rapidly. Oral thiamine repletion is limited by its intestinal absorption rate (82,90), as an oral dose of 30mg will permit absorption of about 4.5 mg. In chronic malnourished alcoholics, intestinal absorption of thiamine can be reduced by about 70% (91).…”

Section: Clonidinementioning

confidence: 99%

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Alcohol, Nicotine, and Iatrogenic Withdrawals in the ICU

Awissi

Lebrun

Fagnan

et al. 2013

Critical Care Medicine

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We recommend a pharmacologic regimen titrated to withdrawal symptoms in ICU patients with alcohol withdrawal syndrome. Benzodiazepines are a reasonable option; phenobarbital appears to confer some advantages in combination with benzodiazepines. Propofol and dexmedetomidine have not been rigorously tested in comparative studies of drug withdrawal treatment; their use as additional or alternative strategies for managing withdrawal syndromes in ICU patients should therefore be individualized to each patient. Insufficient data preclude recommendations as to nicotine replacement therapy and management of iatrogenic drug withdrawal in ICU patients.

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Section: Clonidinementioning

confidence: 84%

Section: Clonidinementioning

confidence: 99%

Alcohol, Nicotine, and Iatrogenic Withdrawals in the ICU

Awissi

Lebrun

Fagnan

et al. 2013

Critical Care Medicine

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“…Evidence suggests that, in the most vulnerable patients, the total absorption of thiamine from three oral doses of 100 mg each would be reduced to one-third or less of that in healthy subjects, that is ~5 mg in 24 h. The number of studies that have been carried out to establish the size of the malabsorbing group has been limited, but it could be more extensive than expected. Work by Holzbach (1996) indicates impaired thiamine absorption in patients experiencing delirium tremens. It is likely that patients will exhibit varying degrees of absorption depending on the degree of malnutrition and the amount of alcohol being consumed.…”

Section: How Adequate Is Treatment With Oral Thiamine?mentioning

confidence: 99%

The Royal College of Physicians Report on Alcohol: Guidelines for Managing Wernicke's Encephalopathy in the Accident and Emergency Department

Thomson¹

2002

Alcohol and Alcoholism

349

310

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The Royal College of Physicians (London) recently published its latest report on alcohol misuse entitled 'Alcohol - Can the NHS Afford It?'. Part of this document, encompassing our views, has made specific recommendations for the management of patients in the Accident and Emergency (A&E) Department who may possibly have, or are at risk of developing, Wernicke's encephalopathy. Patients showing evidence of chronic alcohol misuse and suspected of having a poor diet should be treated at the outset with B vitamins intravenously or intramuscularly, especially when the clinical signs are initially masked by drunkenness at presentation to the A&E Department. This commentary offers a review of the scientific foundations on which these recommendations have been made.

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“…Therefore, the threshold for starting therapy should be low. Oral administration is insufficient as the intestinal thiamine absorption may be severely impaired (Holzbach, 1996). In a recent Cochrane review, only one sufficiently large randomized double‐blind trial on the preventive effects of different doses of thiamine could be identified (Ambrose et al.…”

Section: Resultsmentioning

confidence: 99%

EFNS guideline on the diagnosis and management of alcohol‐related seizures: report of an EFNS task force

Bråthen

Ben‐Menachem

Brodtkorb

et al. 2005

Euro J of Neurology

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Despite being a considerable problem in neurological practice and responsible for onethird of seizure-related admissions, there is little consensus as to the optimal investigation and management of alcohol-related seizures. The final literature search was undertaken in September 2004. Consensus recommendations are given graded according to the EFNS guidance regulations. To support the history taking, use of a structured questionnaire is recommended. When the drinking history is inconclusive, elevated values of carbohydrate-deficient transferrin and/or gammaglutamyl transferase can support a clinical suspicion. A first epileptic seizure should prompt neuroimaging (CT or MRI). Before starting any carbohydrate containing fluids or food, patients presenting with suspected alcohol overuse should be given prophylactic thiamine parenterally. After an alcohol withdrawal seizure (AWS), the patient should be observed in hospital for at least 24 h and the severity of withdrawal symptoms needs to be followed. For patients with no history of withdrawal seizures and mild to moderate withdrawal symptoms, routine seizure preventive treatment is not necessary. Generally, benzodiazepines are efficacious and safe for primary and secondary seizure prevention; diazepam or, if available, lorazepam, is recommended. The efficacy of other drugs is insufficiently documented. Concerning long-term recommendations for non-alcohol dependant patients with partial epilepsy and controlled seizures, small amounts of alcohol may be safe. Alcohol-related seizures require particular attention both in the diagnostic work-up and treatment. Benzodiazepines should be chosen for the treatment and prevention of recurrent AWS.

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Thiamine absorption in alcoholic delirium patients.

Cited by 15 publications

References 6 publications

Alcohol, Nicotine, and Iatrogenic Withdrawals in the ICU

Alcohol, Nicotine, and Iatrogenic Withdrawals in the ICU

The Royal College of Physicians Report on Alcohol: Guidelines for Managing Wernicke's Encephalopathy in the Accident and Emergency Department

EFNS guideline on the diagnosis and management of alcohol‐related seizures: report of an EFNS task force

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