Thiamine deficiency

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

Differential Diagnosis

Ethanol related disease processes

Vitamin deficiencies

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]

See Also

Thiamine deficiency

References

  1. Krishel, S, et al. Intravenous Vitamins for Alcoholics in the Emergency Department: A Review. The Journal of Emergency Medicine. 1998; 16(3):419–424.
  2. Li, SF, et al. Vitamin deficiencies in acutely intoxicated patients in the ED. The American Journal of Emergency Medicine. 2008; 26(7):792–795.