Clinical Use

Many of the clinical uses of thiamine supplements are conditions thought to arise from a marginal deficiency, but some indications are based on the concept of highdose supplements acting as therapeutic agents. In practice, vitamin B1 is usually recommended in combination with other B group vitamins.

DEFICIENCY: TREATMENT AND PREVENTION

Thiamine supplements are traditionally used to treat or prevent thiamine deficiency states in people at risk (see Secondary Deficiency).

Hyperemesis Although thiamine supplementation will not reduce the symptoms of hyperemesis, it may be necessary in cases of hyperemesis gravidarum and hyperemesis due to gastroplasty in order to avoid deficiency states and the development of Wernicke's encephalopathy, which has been reported in these situations, although noted to be a rare consequence. It may be precipitated in part by intravenous fluids containing dextrose, and is more commonly seen when the patient's liver transaminases are elevated, which may contribute to the encephalopathy (Gardian et al 1999, Seehra et al 1996, Spruill & Kuller 2002, Tan & Ho 2001, Togay-lsikay et al 2001, Toth & Voll 2001, Welsh 2005). Alcoholism In alcoholism, a state of decreased intake, absorption, utilisation and increased requirement for thiamine occurs, suggesting a need to increase intakes to avoid deficiency states (D'Amour et al 1991). In cases of Wernicke's encephalopathy, monitoring of thiamine status and prophylactic intravenous treatment will inhibit the progression to Korsakoff's psychosis (Thomson & Marshall 2005). Ongoing research has revealed that the cerebellar neurotoxicity associated with excess alcohol is more likely to be predominantly mediated by thiamine deficiency rather than direct ethanol cytotoxicity as previously believed (Mulholland et al 2005).

Total parenteral nutrition Several case reports show patients who have received TPN without proper replacement of thiamine are at risk of developing deficiency signs and Wernicke's encephalopathy (Hahn et al 1998, van Noort et al 1987, Vortmeyer et al 1992, Zak et al 1991).

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