Thiamine deficiency: Difference between revisions
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==Background== | ==Background== | ||
*Most common cause: chronic alcohol abuse | *Most common cause: chronic [[alcohol Abuse|alcohol abuse]] | ||
*Other causes: malabsorption, hemodialysis, chronic protein-calorie undernutrition | *Other causes: malabsorption, [[hemodialysis]], chronic [[malnutrition|protein-calorie undernutrition]] | ||
*IV dextrose can precipitate in patients with marginal thiamine stores | *IV [[dextrose]] can precipitate in patients with marginal thiamine stores | ||
==Clinical Features== | ==Clinical Features== | ||
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**Anorexia | **Anorexia | ||
**Muscle cramps | **Muscle cramps | ||
**Paresthesias | **[[Paresthesias]] | ||
**Irritability | **Irritability | ||
*Advanced/severe deficiency | *Advanced/severe deficiency | ||
**See [[beriberi | **See [[beriberi]] | ||
**See [[Wernicke-Korsakoff syndrome]] | **See [[Wernicke-Korsakoff syndrome]] | ||
| Line 23: | Line 23: | ||
==Management== | ==Management== | ||
*[[Thiamine]] 50–100 mg IV for first few days, followed by 5-10mg PO daily | *[[Thiamine]] 50–100 mg IV for first few days, followed by 5-10mg PO daily | ||
*Replete other vitamins/electrolytes that may also be depleted (e. | *Replete other vitamins/electrolytes that may also be depleted (i.e. [[banana bag]]) | ||
*Replete thiamine '''before''' giving IV dextrose! | *Replete thiamine '''before''' giving IV dextrose! | ||
==Disposition== | |||
==Prevention== | |||
{{Vitamin prophylaxis for ETOH}} | |||
==See Also== | ==See Also== | ||
{{Thiamine deficiency types}} | {{Thiamine deficiency types}} | ||
*[[Thiamine]] | *[[Thiamine]] | ||
==References== | |||
<references/> | |||
==Video== | |||
{{#widget:YouTube|id=nXK-kMdVk_0}} | |||
[[Category:FEN]] | |||
[[Category:Neurology]] | [[Category:Neurology]] | ||
Revision as of 16:54, 29 September 2019
Background
- Most common cause: chronic alcohol abuse
- Other causes: malabsorption, hemodialysis, chronic protein-calorie undernutrition
- IV dextrose can precipitate in patients with marginal thiamine stores
Clinical Features
- Early/mild features:
- Anorexia
- Muscle cramps
- Paresthesias
- Irritability
- Advanced/severe deficiency
- See beriberi
- See Wernicke-Korsakoff syndrome
Differential Diagnosis
- Ethanol toxicity
- Alcohol use disorder
- Alcohol withdrawal
- Electrolyte/acid-base disorder
Vitamin deficiencies
- Vitamin A deficiency
- Vitamin B deficiencies
- Vitamin B1 deficiency (Thiamine)
- Vitamin B3 deficiency (Pellagra)
- Vitamin B9 deficiency (Folate)
- Vitamin B7 deficiency (Biotin)
- Vitamin B12 deficiency
- Vitamin C deficiency (Scurvy)
- Vitamin D deficiency (Rickets)
- Vitamin E deficiency
- Vitamin K deficiency
- Zinc deficiency
Evaluation
- Clinical diagnosis
Management
- Thiamine 50–100 mg IV for first few days, followed by 5-10mg PO daily
- Replete other vitamins/electrolytes that may also be depleted (i.e. banana bag)
- Replete thiamine before giving IV dextrose!
Disposition
Prevention
Vitamin Prophylaxis for Chronic alcoholics
- At risk for thiamine deficiency, but no symptoms: thiamine 100mg PO q day
- Give multivitamin PO; patient at risk for other vitamin deficiencies
Banana bag
The majority of chronic alcoholics do NOT require a banana bag[1][2]
- Thiamine 100mg IV
- Folate 1mg IV (cheaper PO)
- Multivitamin 1 tab IV (cheaper PO)
- Magnesium sulfate 2mg IV
- Normal saline as needed for hydration
See Also
Thiamine deficiency types
References
Video
{{#widget:YouTube|id=nXK-kMdVk_0}}