What is the treatment for Vitamin B1 (Thiamine) deficiency?

From the Guidelines

The treatment for vitamin B1 (thiamine) deficiency involves immediate thiamine supplementation, typically starting with high-dose parenteral (injectable) thiamine followed by oral maintenance therapy, with a recommended dose of 100-300 mg/day IV for 3-4 days in patients admitted to emergency or intensive care, as stated in the espen micronutrient guideline 1.

Key Considerations

• The administration of thiamine should be prescribed without hesitation from admission for 3-4 days in patients admitted to emergency or intensive care, with a dose of 100-300 mg/day IV 1.
• In patients admitted on the ward with any suspicion of reduced food intake during the previous days or high alcohol consumption, thiamine 100-300 mg/day should be administered by either oral or IV route 1.
• Thiamine can be administered orally, enterally, or IV, but the IV route is the most efficient, providing 3 x 100-300 mg per day 1.
• Treatment should begin before administering glucose in malnourished patients, as glucose can precipitate or worsen Wernicke's encephalopathy by depleting remaining thiamine stores.
• Concurrent correction of other vitamin deficiencies and addressing underlying causes such as alcoholism, malabsorption, or malnutrition is essential for complete recovery.

Important Details

• Thiamine is water-soluble and generally safe even at high doses, with excess being excreted in urine.
• Early treatment is crucial as neurological damage from thiamine deficiency can become permanent if treatment is delayed.
• The espen micronutrient guideline recommends a grade of recommendation B with a strong consensus of 92% for the administration of thiamine in patients with suspicion of reduced food intake or high alcohol consumption 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. The treatment for Vitamin B1 (Thiamine) deficiency is thiamine hydrochloride injection, which is indicated for:

• Rapid restoration of thiamine
• Wernicke’s encephalopathy
• Infantile beriberi with acute collapse
• Cardiovascular disease due to thiamine deficiency
• Neuritis of pregnancy with severe vomiting
• Patients with established thiamine deficiency who cannot take thiamine orally due to coexisting severe anorexia, nausea, vomiting, or malabsorption 2

From the Research

Treatment for Vitamin B1 (Thiamine) Deficiency

• The treatment for thiamine deficiency varies depending on the severity of the condition and the patient's overall health, with parenteral thiamine administration recommended for patients with established Wernicke's encephalopathy 3
• For patients with suspected Wernicke's encephalopathy, parenteral thiamine 250-300mg should be given two times a day for 3-5 days, followed by oral thiamine 250-300mg/day 3
• In patients at high risk of thiamine deficiency, parenteral thiamine 250-500mg/day should be given for 3-5 days, followed by oral thiamine 250-300mg/day 3
• Oral thiamine 250-500mg/day can be given for 3-5 days, followed by oral thiamine 100-250mg/day for patients at low risk (with uncomplicated alcohol dependence) 3
• Thiamine supplementation has been shown to have a putative beneficial effect in autism spectrum disorder (ASD) and other neurological conditions 4

Thiamine Deficiency Risk Factors

• Alcohol abuse is a common risk factor for thiamine deficiency, with patients with alcohol dependence being at high risk of developing thiamine deficiency 3, 5
• Malnutrition, increased urinary excretion, and acute metabolic stress can also contribute to thiamine deficiency 6, 7
• Patients with sepsis, those undergoing surgical procedures, and critically ill patients are also at risk of developing thiamine deficiency 7

Consequences of Untreated Thiamine Deficiency

• Untreated thiamine deficiency can lead to severe neurological and cardiovascular complications, including heart failure, neuropathy, ataxia, paralysis, confusion, and delirium 4, 5
• Thiamine deficiency can also contribute to the development of intensive care unit complications, such as heart failure, delirium, critical care neuropathy, gastrointestinal dysfunction, and unexplained lactic acidosis 7