Thiamine deficiency: Difference between revisions
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==Background== | |||
*Most common cause: chronic [[alcohol Abuse|alcohol abuse]] | |||
*Other causes: malabsorption, [[hemodialysis]], chronic [[malnutrition|protein-calorie undernutrition]] | |||
*IV [[dextrose]] can precipitate in patients with marginal thiamine stores | |||
{{Thiamine deficiency types}} | |||
==Clinical Features== | |||
*Early/mild features: | |||
**Anorexia | |||
**Muscle cramps | |||
**[[Paresthesias]] | |||
**Irritability | |||
*Advanced/severe deficiency | |||
**See [[beriberi]] | |||
**See [[Wernicke-Korsakoff syndrome]] | |||
==Differential Diagnosis== | |||
{{Ethanol DDX}} | |||
{{Vitamin deficiencies DDX}} | |||
==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 ETOH}} | |||
==See Also== | ==See Also== | ||
*[[Thiamine]] | *[[Thiamine]] | ||
==References== | |||
<references/> | |||
==Video== | |||
{{#widget:YouTube|id=nXK-kMdVk_0}} | |||
[[Category:FEN]] | |||
[[Category:Neurology]] | [[Category:Neurology]] | ||
Revision as of 21:11, 27 October 2020
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
Thiamine deficiency types
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
References
Video
{{#widget:YouTube|id=nXK-kMdVk_0}}