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Thiamine supplementation in the critically ill.
Curr Opin Clin Nutr Metab Care. 2011 Nov; 14(6):610-7.CO

Abstract

PURPOSE OF REVIEW

To summarize the properties of thiamine and evaluate current evidence on thiamine status and supplementation, for different populations of critically ill patients.

RECENT FINDINGS

Thiamine, in the form of thiamine pyrophosphate, is a critical co-factor in the glyocolysis and oxidative decarboxylation of carbohydrates for energy production. Different studies have shown that critical illness in adults and children is characterized by absolute or relative thiamine depletion, which is associated with an almost 50% increase in mortality. Thiamine deficiency should be suspected in different clinical scenarios such as severe sepsis, burns, unexplained heart failure or lactic acidosis, neurological disorder in patients with previous history of alcoholism, starvation, chronic malnutrition, long-term parenteral feeding, hyperemesis gravidarum, or bariatric surgery. Nonetheless, thiamine supplements are not routinely given to critically ill patients. Clinicians should be able to suspect and recognize risk factors for the occurrence of severe neurological disorders secondary to thiamine deficiency, as early treatment can prevent the appearance of permanent neurological damage.

SUMMARY

Symptoms and signs associated with thiamine deficiency lack sensitivity and specificity in critically ill patients. Consequently, depletion is frequently unrecognized and underdiagnosed by clinicians. Potentially deleterious consequences of thiamine depletion should be avoided by early and appropriate supplementation.

Authors+Show Affiliations

Department of Critical Care Medicine, Hospital de Clínicas, Dr Manuel Quintela, Faculty of Medicine, University Hospital, Universidad de la República, UDELAR, Montevideo, Uruguay. wmanzanares@adinet.com.uyNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

21912244

Citation

Manzanares, William, and Gil Hardy. "Thiamine Supplementation in the Critically Ill." Current Opinion in Clinical Nutrition and Metabolic Care, vol. 14, no. 6, 2011, pp. 610-7.
Manzanares W, Hardy G. Thiamine supplementation in the critically ill. Curr Opin Clin Nutr Metab Care. 2011;14(6):610-7.
Manzanares, W., & Hardy, G. (2011). Thiamine supplementation in the critically ill. Current Opinion in Clinical Nutrition and Metabolic Care, 14(6), 610-7. https://doi.org/10.1097/MCO.0b013e32834b8911
Manzanares W, Hardy G. Thiamine Supplementation in the Critically Ill. Curr Opin Clin Nutr Metab Care. 2011;14(6):610-7. PubMed PMID: 21912244.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thiamine supplementation in the critically ill. AU - Manzanares,William, AU - Hardy,Gil, PY - 2011/9/14/entrez PY - 2011/9/14/pubmed PY - 2012/2/15/medline SP - 610 EP - 7 JF - Current opinion in clinical nutrition and metabolic care JO - Curr Opin Clin Nutr Metab Care VL - 14 IS - 6 N2 - PURPOSE OF REVIEW: To summarize the properties of thiamine and evaluate current evidence on thiamine status and supplementation, for different populations of critically ill patients. RECENT FINDINGS: Thiamine, in the form of thiamine pyrophosphate, is a critical co-factor in the glyocolysis and oxidative decarboxylation of carbohydrates for energy production. Different studies have shown that critical illness in adults and children is characterized by absolute or relative thiamine depletion, which is associated with an almost 50% increase in mortality. Thiamine deficiency should be suspected in different clinical scenarios such as severe sepsis, burns, unexplained heart failure or lactic acidosis, neurological disorder in patients with previous history of alcoholism, starvation, chronic malnutrition, long-term parenteral feeding, hyperemesis gravidarum, or bariatric surgery. Nonetheless, thiamine supplements are not routinely given to critically ill patients. Clinicians should be able to suspect and recognize risk factors for the occurrence of severe neurological disorders secondary to thiamine deficiency, as early treatment can prevent the appearance of permanent neurological damage. SUMMARY: Symptoms and signs associated with thiamine deficiency lack sensitivity and specificity in critically ill patients. Consequently, depletion is frequently unrecognized and underdiagnosed by clinicians. Potentially deleterious consequences of thiamine depletion should be avoided by early and appropriate supplementation. SN - 1473-6519 UR - https://www.unboundmedicine.com/medline/citation/21912244/Thiamine_supplementation_in_the_critically_ill_ L2 - http://dx.doi.org/10.1097/MCO.0b013e32834b8911 DB - PRIME DP - Unbound Medicine ER -