Thiamine deficiency

Background

• Most common cause: chronic alcohol abuse
• Other causes: malabsorption, hemodialysis, chronic protein-calorie undernutrition
• IV dextrose can precipitate in patients with marginal thiamine stores

Clinical Features

• Early/mild features:
  • Anorexia
  • Muscle cramps
  • Paresthesias
  • Irritability
• Advanced/severe deficiency
  • See beriberi
  • See Wernicke-Korsakoff syndrome

Differential Diagnosis

Ethanol related disease processes

• Ethanol toxicity
• Alcohol use disorder
• Alcohol withdrawal
  • Alcohol withdrawal seizures
  • Delerium tremens
• Electrolyte/acid-base disorder
  • Alcoholic ketoacidosis
  • Beer potomania syndrome
  • Beriberi
  • Thiamine deficiency
  • Wernicke-Korsakoff syndrome

Vitamin deficiencies

• Vitamin A deficiency
• Vitamin B deficiencies
  • Vitamin B1 deficiency (Thiamine)
    • Beriberi
    • Wernicke-Korsakoff syndrome
  • Vitamin B3 deficiency (Pellagra)
  • Vitamin B9 deficiency (Folate)
  • Vitamin B7 deficiency (Biotin)
  • Vitamin B12 deficiency
• Vitamin C deficiency (Scurvy)
• Vitamin D deficiency (Rickets)
• Vitamin E deficiency
• Vitamin K deficiency
• Zinc deficiency
  • Acrodermatitis enteropathica

Evaluation

• Clinical diagnosis

Management

• Thiamine 50–100 mg IV for first few days, followed by 5-10mg PO daily
• Replete other vitamins/electrolytes that may also be depleted (e.g. banana bag, magnesium, folate, multivitamin)
• Replete thiamine before giving IV dextrose!

See Also

Thiamine deficiency types

• Wernicke-Korsakoff syndrome
• Beriberi
• Thiamine