Thiamine (Vitamin B1) Deficiency in Intensive Care: Physiology, Risk Factors, Diagnosis, and Treatment
Thiamine plays an essential role in cellular energy metabolism; its deficiency will result in severely compromised energy generation and may culminate in cellular dysfunction and death. Body stores of thiamine are small and deficiency can develop within 2–3 weeks of inadequate intake. Systemic inflammation, increased renal or gastrointestinal losses, increased water turnover, and insufficient supply are the most common risk factors for thiamine deficiency in critically ill patients.
Thiamine deficiency affects the central and peripheral nervous system and cardiovascular system in different combinations. Considering that early diagnosis and treatment are crucial to prevent sequelae and severe deficiency may be potentially fatal, treatment should be initiated at the very earliest suspicion of vitamin depletion – laboratory confirmation is not required to initiate supplementation in high-risk patients. Treatment is cheap, easy, and safe. The dose, route, and extent of treatment will depend on the clinical condition and severity of the deficiency.
KeywordsLactic Acidosis CRRTContinuous Renal Replacement Therapy Thiamine Deficiency Thiamine Pyrophosphate Thiamine Concentration
List of Abbreviations
Branched-chain keto acid dehydrogenase
Continuous renal replacement therapy
Erythrocyte transketolase activity
High-performance liquid chromatography
Thiamine pyrophosphate effect
- Centers for Disease Control and Prevention (CDC). Lactic acidosis traced to thiamine deficiency related to nationwide shortage of multivitamins for total parenteral nutrition – United States, 1997. MMWR Morb Mortal Wkly Rep. 1997;46:523–8.Google Scholar
- Costa NA, Gut AL, de Souza Dorna et al. Serum thiamine concentration and oxidative stress as predictors of mortality in patients with septic shock. J Crit Care 2014;29:249–52.Google Scholar
- Day E, Benthan P, Callaghan R, Kuruvilla T, George S, et al. Thiamine for Wernicke-Korsakoff syndrome in people at risk from alcohol abuse. Cochrane Database Syst Rev. 2004;1, CD004003.Google Scholar
- Gready R, Simpson JA, Cho T, et al. Postpartum thiamine deficiency in a Karen displaced population. Am J Clin Nutr. 2001;74:808–13.Google Scholar
- Institute of Medicine (IOM). Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. 1998; p. 58–85. http://www.nap.edu/openbook.php?record_id=6015%26page. Accessed 2 May 2013.
- Khounnorath S, Chamberlain K, Taylor A, et al. Clinically unapparent infantile thiamin deficiency in Vientiane, Laos. PLoS. 2011;5:e969.Google Scholar
- Koletzko B, Goulet O, Hunt J, Parenteral Nutrition Guidelines Working Group, European Society for Clinical Nutrition and Metabolism, European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), European Society of Paediatric Research (ESPR), et al. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr. 2005;41 Suppl 2:S47–53.Google Scholar
- Körner RW, Vierzig A, Roth B, Müller C, et al. Determination of thiamin diphosphate in whole blood samples by high-performance liquid chromatography – a method suitable for pediatric diagnostics. J Chromatogr. 2009;877:1882–6.Google Scholar
- Körner RW, Müller C, Roth B, Vierzig A, et al. Thiamin status of premature infants assessed by measurement of thiamin diphosphate in whole blood. Br J Nutr. 2012;1:1–8.Google Scholar
- Shenkin A, Alwood MC. Trace elements in adult intravenous nutrition. In: Rombeau JL, Rolandelli RH, editors. Clinical nutrition, Parenteral nutrition, vol. 2. 3rd ed. Philadelphia: WB Saunders; 2000.Google Scholar
- Shenkin A, Baines M, Fell GS, Lyon TD, et al. Vitamins and trace elements. In: Burtis CA, Ashwood ER, Bruns DE, editors. Tietz textbook of clinical chemistry and molecular diagnostics. 4th ed. St Louis: Elsevier Saunders; 2006. p. 1075–164.Google Scholar
- WHO/NHD/99.13. Thiamine deficiency and its prevention and control in major emergencies. Micronutrient series. Geneva: WHO; 1999. p. 277. http://whqlibdoc.who.int/hq/1999/WHO_NHD_99.13.pdf