From the Guidelines
Thiamine (Vitamin B1) should be administered to pediatric patients at a dose of 0.35-0.50 mg/kg/day for preterm and term infants up to 12 months of age on parenteral nutrition, and 1.2 mg/day for older children, as recommended by the most recent guidelines 1. The use of thiamine in pediatric patients is crucial, particularly in cases of malnutrition, malabsorption disorders, or metabolic diseases. Thiamine pyrophosphate is involved in carbohydrate and lipid metabolism, and its requirements depend on carbohydrate intake. Deficiency of thiamine may lead to severe lactic acidosis, Wernicke's encephalopathy, and even death within a period of days to weeks 1.
Key Considerations
- Thiamine is essential for pediatric patients on parenteral nutrition to prevent deficiency and related complications 1.
- The recommended dosage for preterm and term infants up to 12 months of age is 0.35-0.50 mg/kg/day, while older children should receive 1.2 mg/day 1.
- Thiamine can be administered orally, enterally, or intravenously, with the IV route being the most efficient in cases of acute deficiency symptoms 1.
- Regular supplementation is recommended for children with chronic malabsorption conditions or those on long-term parenteral nutrition.
Administration and Monitoring
- Thiamine should be administered before glucose in malnourished children to prevent precipitating Wernicke's encephalopathy or worsening of lactic acidosis.
- Treatment typically continues for 2-3 weeks, followed by maintenance doses until the underlying cause is addressed.
- Higher initial IV doses of 100 mg may be necessary for critically ill children with lactic acidosis or Wernicke's encephalopathy, as suggested by recent guidelines 1.
From the FDA Drug Label
Dosage and Administration “Wet” beriberi with myocardial failure must be treated as an emergency cardiac condition, and thiamine must be administered slowly by the IV route in this situation (see WARNINGS). In the treatment of beriberi, 10 to 20 mg of thiamine hydrochloride are given IM three times daily for as long as two weeks. Infantile beriberi that is mild may respond to oral therapy, but if collapse occurs, doses of 25 mg may cautiously be given IV.
The use of thiamine in pediatric patients is for the treatment of:
- Infantile beriberi: thiamine can be given orally for mild cases, but IV doses of 25 mg may be cautiously given if collapse occurs. No other information is provided for pediatric patients. 2
From the Research
Use of Thiamine in Pediatric Patients
- Thiamine is an essential cofactor for enzymes involved in energy production and synthesis of cellular molecules 3
- Thiamine deficiency can develop in pediatric patients due to inadequate nutrition, increased urinary excretion, and acute metabolic stress 3
- Thiamine deficiency has been associated with poorer clinical outcomes, including congestive heart failure, peripheral neuropathy, and Wernicke's encephalopathy 4, 3
Clinical Presentations of Thiamine Deficiency
- Infantile thiamine deficiency can present in distinct forms, including lactic acidosis, pulmonary arterial hypertension, and Wernicke's encephalopathy 5
- Lactic acidosis is a universal finding in the acidotic form of thiamine deficiency, while infants with pulmonary hypertension may present with aphonia 5
- Wernicke's encephalopathy can be clinically diagnosed by the presence of encephalopathy and ophthalmic signs, such as ptosis 5
Diagnosis and Treatment
- Thiamine deficiency can be challenging to diagnose due to the broad clinical spectrum and overlapping signs and symptoms with other disorders 6
- A low threshold of clinical suspicion and early therapeutic thiamine is currently the best approach, with rapid clinical improvement possible within hours or days 6
- Thiamine should be added to peripheral parenteral nutrition solutions in pediatric patients after abdominal surgery to prevent deficiency 7
Risk Factors and Prognosis
- Systemic inflammatory response, as measured by C-reactive protein serum concentrations, is an independent risk factor for low blood thiamine concentrations in pediatric patients 4
- The association between thiamine deficiency and prognosis requires further investigation, but early recognition and treatment may improve clinical outcomes 4, 3