This was from the GI Nutrition Support weekend conference administered by Carol Parrish, RD, who chose Kelly O'Donnell RD to present. One of Kelly's favorite micronutrient deficiencies is Thiamine... second only to Copper ;) That being said- she is my ultimate guru on the very best evidence based information on thiamine deficiency as well as treatment. Anyone that gets this excited and passionate about micronutrient deficiencies is worth listening to! So much of what we "do" as clinicians for thiamine deficiency has not been based on much data. As she said during this particular talk, the traditional dosing of 100mg mg/day for 3-5 days is more of an arbitrary recommendation, with not much data to support it!
Remember that due to the short half life of thiamine (9-18 days), thiamine deficiency is no longer only for those with a history of alcohol abuse. ANYONE with minimal po or increased n/v for 2-3 weeks is at risk!
For a quick and dirty reference, here are symptoms you look for if you are concerned for thiamine deficiency:
Mental status change: Confusion, Amnesia, Obtunded, Confabulation (the replacement of a gap in a person's memory by a falsification that he or she believes to be true)
Ocular changes: Nystagmus (rapid involuntary movements of the eyes), impaired visual acuity, ptosis (drooping of the upper eyelid), gaze palsy
Gait/balance changes: Ataxia (loss of coordination of the muscles, especially of the extremities), unsteady balance, unable to bear weight, weakness, paresthesias especially in lower extremities (numbness, tingling, "pins and needles")
Other: hypothermia, lactic acidosis
"Wet" beriberi- heart failure, peripheral edema
ASMBS Guidelines for Thiamine Deficiency 2019 (Still poor data, grade D recommendations):
Oral: 100mg 2-3x /day until sx resolve
IV: 200mg 3x/day (or 500mg 1-2x/day,) followed by 250mg/day x 3-5 days until symptoms resolve, possibly followed by 100mg/day indefinitely or until risk factors resolve
European Guidelines:
200mg IV 3x/day until symptoms resolve
Here are some articles going over the best data on thiamine deficiency as well as treatment.
Lactic Acidosis: A Lesser Known Side Effect of Thiamine Deficiency . https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2014/06/Parrish-March-17.pdf
Wernicke’s Encephalopathy: Under Our Radar More Than it Should Be?
Beyond the Banana Bag: Treating Nutritional Deficiencies of Alcohol Withdrawal Syndrome
Severe Micronutrient Deficiencies in RYGB Patients: Rare but Potentially Devastating
Thiamine deficiency in nutrition therapy. NCP, 2012.
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