Thiamine deficiency in the critically ill

Abstract

There have been recent reports of hospitalised patients developing clinical thiamine deficiency, combined with much debate on the optimal supplementation of thiamine for the parenterally fed patient, particularly in the intensive therapy environment. We performed a retrospective study on 158 patients admitted to the Intensive Care Unit who required nutritional support. Patients who survived had significantly higher body thiamine status than those who died (p less than 0.01). There was no difference between serum albumin concentrations of the two groups. Twenty percent of the patients had biochemical evidence of thiamine deficiency and the mortality rate in these patients was 72% as compared with 50% mortality overall. Follow-up results suggest that current levels of thiamine supplementation are insufficient for critically ill intravenously fed patients. We suggest that patients be given a loading dose of 50-250 mg thiamine on admission to the Intensive Care Unit.

Thiamine deficiency in patients with B-chronic lymphocytic leukaemia: a pilot study

“…(2) Subclinical thiamine deficiency may increase the patient's vulnerability to develop overt signs of thiamine deficiency when confronted with disease and/or chemotherapy associated factors which may superimpose secondary thiamine deficiency, namely: malnutrition, malabsorption, malutilisation, hypophophataemia, hypomagnesaemia, major catabolic and physiological stress,21 and use of various concomitant drugs, for example omeprazole22 and frusemide (furosemide) 23…”

Vitamin B1 in critically ill patients: needs and challenges

“…Peripheral vasodilation, biventricular myocardial failure, volume overload, tachycardia, depression of left ventricular function with low ejection fraction, sudden onset cardiac failure and acute renal failure are just some of the signs of wet beriberi [6,63,64]. In contrast, signs of dry beriberi include ophthalmoplegia, ataxia, confusion, memory loss and confabulation in chronic settings [6,65,66].…”

“…The prevalence of TD in the ICU, hospitals and the elderly (>76 years of age) has also been examined [15,75,76]. A retrospective study by Cruickshank et al [63] observed a 20% prevalence of TD in intensive care patients requiring nutritional support. A mortality rate of 72% was seen in patients with TD compared to 50% in the non-TD group from 158 patients.…”

Low blood thiamine concentrations in children upon admission to the intensive care unit: risk factors and prognostic significance

“…In a retrospective study in critically ill adults in which laboratory biochemical values for thiamine and riboflavin were plotted against prognosis, patients who evolved to death had a higher incidence of low concentrations of these vitamins than did survivors. None of the patients studied presented any clinical signs of vitamin deficiency (4).…”