- Most common cause: chronic alcohol abuse
- Other causes: malabsorption, hemodialysis, chronic protein-calorie undernutrition
- IV dextrose can precipitate in patients with marginal thiamine stores
- Early/mild features:
- Muscle cramps
- Advanced/severe deficiency
- 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!
- At risk for thiamine deficiency, but no symptoms: thiamine 100mg PO q day
- Give multivitamin PO; patient at risk for other vitamin deficiencies
The majority of chronic alcoholics do NOT require a banana bag
- ↑ Krishel, S, et al. Intravenous Vitamins for Alcoholics in the Emergency Department: A Review. The Journal of Emergency Medicine. 1998; 16(3):419–424.
- ↑ Li, SF, et al. Vitamin deficiencies in acutely intoxicated patients in the ED. The American Journal of Emergency Medicine. 2008; 26(7):792–795.