Thiamine Administration Protocol
For thiamine administration, the recommended protocol depends on the clinical situation, with intravenous administration of 100-300 mg/day recommended for acute deficiency and hospitalized patients, while oral administration of 10 mg/day for one week followed by 3-5 mg/day for at least 6 weeks is appropriate for mild deficiency. 1, 2
Route of Administration
- For suspected chronic deficiency without acute disease, the oral route is adequate 1, 2
- For acute disease or suspected inadequate intake, the IV route should be used 1, 2
- For patients with alcohol-related gastritis, the IV route is preferred due to poor absorption 2
- When administering IV thiamine, be aware that serious hypersensitivity/anaphylactic reactions can occur, especially after repeated administration 3
Dosage by Clinical Situation
Mild/Preventive Cases
- Mild deficiency (outpatients): 10 mg/day orally for one week, followed by 3-5 mg/daily for at least 6 weeks 1, 2
- Chronic diuretic therapy: 50 mg/day orally 1, 2
- Maintenance dose after proven deficiency: 50-100 mg/day orally 1, 2
Moderate Risk Cases
- At risk for deficiency: 100 mg, 3 times a day, IV 1
- Continuous renal replacement therapy: 100 mg/day 1, 2
High Risk/Acute Cases
- Hospitalized patients/critical illness: 100-300 mg/day IV 1, 2
- Emergency/intensive care patients: 100-300 mg/day IV for 3-4 days from admission 1, 2
- High suspicion or proven deficiency: 200 mg, 3 times a day, IV 1
- Prolonged vomiting or dysphagia: 200-300 mg thiamine daily plus vitamin B co strong 1-2 tablets three times daily 1
Severe Cases
- Encephalopathy of uncertain etiology (including Wernicke encephalopathy): 500 mg, 3 times a day, IV 1, 2, 4
- Refeeding syndrome: 300 mg IV before initiating nutrition therapy, then 200-300 mg IV daily for at least 3 more days 1, 2
Important Safety Considerations
- A skin test should be performed on patients suspected of drug allergies or previous reactions to thiamine 3
- If hypersensitivity is suspected, administer one-hundredth of the dose intradermally and observe for 30 minutes before giving full dose 3
- Be prepared to treat anaphylactic reactions with epinephrine, oxygen, vasopressors, steroids, and antihistamines 3
- Thiamine should be administered before glucose-containing IV fluids to avoid precipitating acute thiamine deficiency 2
- The product contains aluminum that may reach toxic levels with prolonged parenteral administration if kidney function is impaired 3
Duration of Treatment
- For mild deficiency: at least 6 weeks 2
- For Wernicke encephalopathy: high-dose IV thiamine (500 mg three times daily) for 3-5 days, followed by 250 mg IV daily for at least 3-5 additional days 5
- For alcoholic liver disease: 100-300 mg/day for 2-3 months 2
Monitoring
- Thiamine status should be determined by measuring RBC or whole blood thiamine diphosphate (ThDP) 1, 2
- Monitoring is recommended in patients with suspected deficiency and cardiomyopathy, prolonged diuretic treatment, prolonged medical nutrition, post-bariatric surgery, refeeding syndrome, or encephalopathy 1, 2