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.
KeywordsLactate Selenium Neuropathy NADPH Leucine
List of Abbreviations
Branched-chain keto acid dehydrogenase
Continuous renal replacement therapy
Erythrocyte transketolase activity
High-performance liquid chromatography
Thiamine pyrophosphate effect
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