From the Guidelines
Thiamine deficiency should be treated promptly with thiamine supplementation, beginning with parenteral administration in severe cases, with a dose of 500 mg IV three times daily for high suspicion or proven deficiency, as recommended by the most recent guideline 1.
Treatment Approach
The treatment approach for thiamine deficiency varies based on the clinical situation and the severity of the deficiency.
- For patients with mild deficiency, oral thiamine supplementation at a dose of 10 mg/day for a week, followed by 3-5 mg/day for at least 6 weeks, is adequate 1.
- In cases of chronic diuretic therapy, a suggestion of 50 mg a day by mouth is recommended 1.
- For patients at risk for deficiency, 100 mg three times a day IV is suggested 1.
- High suspicion or proven deficiency requires 200 mg three times a day IV 1.
- In cases of encephalopathy of uncertain etiology, including Wernicke encephalopathy, 500 mg three times a day IV is recommended 1.
Administration Route
The route of administration depends on the clinical situation.
- In cases of suspicion of chronic deficiency without any acute disease, the oral route is adequate 1.
- In cases of acute disease or suspicion of inadequate intake, even short-term, the IV route is preferred 1.
Concurrent Administration
Concurrent administration of other B vitamins and magnesium may enhance thiamine utilization 1.
Monitoring
Monitor for clinical improvement, which often begins within days of treatment initiation 1.
Maintenance Therapy
Maintenance therapy should continue for at least several weeks, with lifelong supplementation for those with ongoing risk factors like alcoholism 1.
From the FDA Drug Label
Thiamine hydrochloride injection is effective for the treatment of thiamine deficiency or beriberi whether of the dry (major symptoms related to the nervous system) or wet (major symptoms related to the cardiovascular system) variety Thiamine hydrochloride injection should be used where rapid restoration of thiamine is necessary, as in Wernicke’s encephalopathy, infantile beriberi with acute collapse, cardiovascular disease due to thiamine deficiency, or neuritis of pregnancy if vomiting is severe. In the treatment of beriberi, 10 to 20 mg of thiamine hydrochloride are given IM three times daily for as long as two weeks. An oral therapeutic multivitamin preparation containing 5 to 10 mg thiamine, administered daily for one month, is recommended to achieve body tissue saturation. In the treatment of Wernicke-Korsakoff syndrome, thiamine hydrochloride has been administered IV in an initial dose of 100 mg, followed by IM doses of 50 to 100 mg daily until the patient is consuming a regular, balanced diet.
Thiamine Deficiency Management: The management of thiamine deficiency involves the administration of thiamine hydrochloride, either orally or parenterally, depending on the severity of the condition and the patient's ability to take oral medications.
- For mild cases, oral therapy with a multivitamin preparation containing 5 to 10 mg of thiamine daily for one month may be sufficient.
- For severe cases, such as Wernicke's encephalopathy or infantile beriberi with acute collapse, parenteral administration of thiamine hydrochloride is recommended, with doses ranging from 10 to 20 mg IM three times daily for up to two weeks, or an initial IV dose of 100 mg followed by IM doses of 50 to 100 mg daily.
- Prevention of thiamine deficiency is also important, particularly in patients with poor dietary habits or those receiving IV dextrose, and can be achieved by administering 100 mg of thiamine hydrochloride in each of the first few liters of IV fluid 2, 3.
From the Research
Thiamine Deficiency Management
- Thiamine deficiency is a primary cause of Wernicke-Korsakoff syndrome (WKS), with more than 90% of cases reported in alcohol-dependent patients 4
- The optimum thiamine dose to treat or prevent Wernicke's encephalopathy or Wernicke-Korsakoff syndrome is still unclear, with no significant differences observed between different dosage conditions in some studies 4
- Clinical judgment should be exercised in diagnosis and treatment (dosage, frequency, route of administration, and duration) in all cases of Wernicke's encephalopathy (WE) 5
Diagnosis and Treatment
- WE is a clinical diagnosis, with common findings including mental status changes, ocular dysfunction, and a gait apraxia, present in only 10% of cases 5
- Recognition of nutritional deficiency and any portion of the classic triad should prompt treatment, and hypothermia, hypotension, and coma should raise clinical suspicion for the disease 5
- Primary treatment includes timely administration of thiamine, with the route and dosage remaining controversial 5
Patient-Specific Treatment
- Patient-specific treatment is recommended, taking into account the potential impact of other biochemical factors (e.g., magnesium and other B vitamin deficiencies) 4
- The absence of conclusive evidence for the superiority of high-dose thiamine supports a recommendation for patient-specific treatment 4
Risk Factors and Prevention
- Risk factors for thiamine deficiency include malnutrition, alcoholism, starvation, hyperemesis gravidarum, and bariatric surgery 6, 7
- 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 7