Thiamine Deficiency Treatment and Dosage Recommendations
For thiamine deficiency, the recommended treatment is 500 mg IV thiamine three times daily for suspected or confirmed cases of Wernicke's encephalopathy, followed by oral maintenance therapy of 50-100 mg/day. 1
Dosage Recommendations Based on Clinical Presentation
Severe Thiamine Deficiency (Wernicke's Encephalopathy)
- Initial treatment: 100-500 mg IV thiamine three times daily for 3-5 days 1, 2
- Maintenance therapy: Oral thiamine 50-100 mg daily 1
High Suspicion or Proven Thiamine Deficiency
- Initial treatment: 200 mg IV thiamine three times daily 1
- Maintenance therapy: Oral thiamine 50-100 mg daily 1
Patients at Risk of Deficiency
- Preventive therapy: 100 mg IV thiamine three times daily 1
- Maintenance therapy: Oral thiamine 50-100 mg daily 1
Beriberi Treatment
- "Wet" beriberi with myocardial failure: Emergency treatment with slow IV administration 2
- General beriberi: 10-20 mg IM thiamine three times daily for up to two weeks 2
- Maintenance: Oral therapeutic multivitamin containing 5-10 mg thiamine daily for one month 2
High-Risk Populations Requiring Thiamine Supplementation
- Alcohol use disorder patients: Parenteral thiamine 250-500 mg/day for 3-5 days, followed by oral thiamine 250-300 mg/day 3
- Post-bariatric surgery patients: 15 mg oral thiamine daily, with increased dosage to 200-300 mg daily if symptomatic 4
- Patients with prolonged vomiting or poor dietary intake: Oral thiamine 200-300 mg daily 4
- ICU patients: Consider 100-300 mg/day IV thiamine 1, 5
- Patients receiving dextrose infusions: 100 mg thiamine in each of the first few liters of IV fluid 2
Important Clinical Considerations
- Thiamine deficiency can develop rapidly in conditions of oxidative stress and systemic inflammation due to limited body stores (25-30 mg) 1
- Critically ill patients with alcohol use disorder are frequently undertreated, with studies showing only 51% receive thiamine supplementation 6
- Early administration is crucial as thiamine deficiency can lead to:
Safety Considerations
- No established upper limit for thiamine toxicity has been determined 1
- Excess thiamine is excreted in urine 1
- Doses exceeding 400 mg may cause nausea, anorexia, and mild ataxia 1
- Rare anaphylactic reactions with high IV doses have been reported 1
Patient Education and Monitoring
- Educate patients about risks of thiamine deficiency and importance of seeking early advice if experiencing prolonged vomiting or poor dietary intake 4
- Clinicians should be educated about factors predisposing to thiamine deficiency and importance of immediate treatment 4
- Monitor response to treatment, as clinical improvement confirms diagnosis 8
Thiamine supplementation is safe, inexpensive, and potentially life-saving when administered promptly to patients with suspected deficiency or those at high risk.