How do you treat thiamine (Vitamin B1) deficiency?

From the Guidelines

To treat low vitamin B1 (thiamine) levels, administer thiamine 100-300 mg/day IV for 3-4 days in patients admitted to emergency or intensive care, and consider oral or IV thiamine 100-300 mg/day in patients with suspicion of reduced food intake or high alcohol consumption. This recommendation is based on the most recent and highest quality study, which suggests that thiamine can be administered orally, enterally, or IV, but the IV route is the most efficient in acute deficiency symptoms 1. The dose and route of administration may vary depending on the clinical situation, such as mild deficiency, chronic diuretic therapy, or high suspicion of deficiency, as outlined in the espen micronutrient guideline 1.

Some key considerations for treatment include:

• For mild deficiency, 10 mg/day thiamin for a week, followed by 3-5 mg/daily for at least 6 weeks may be sufficient 1
• In cases of chronic diuretic therapy, 50 mg a day by mouth may be suggested 1
• For patients at risk for deficiency, 100 mg, 3 times a day, IV may be recommended 1
• The maintenance dose in proven deficiency is 50-100 mg/day, orally 1

It is essential to note that thiamine is crucial for energy metabolism and nervous system function, and deficiency can lead to severe conditions like beriberi or Wernicke-Korsakoff syndrome. Patients with alcohol use disorder, malabsorption conditions, or poor nutrition are at higher risk and may require ongoing supplementation 1. Consuming thiamine-rich foods like whole grains, legumes, pork, and fortified foods can help maintain adequate levels. Additionally, avoiding raw fish, tea, coffee, or alcohol during treatment is recommended as they can interfere with thiamine absorption.

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 mg 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 mg to 10 mg thiamine, administered daily for one month, is recommended to achieve body tissue saturation.

To treat low B1 levels, thiamine supplementation is recommended. The treatment approach depends on the severity of the condition and the patient's ability to take oral medications.

• For mild cases, an oral therapeutic multivitamin preparation containing 5 mg to 10 mg thiamine, administered daily for one month, may be sufficient to achieve body tissue saturation 2.
• For more severe cases, such as beriberi, 10 mg to 20 mg of thiamine hydrochloride may be given IM three times daily for as long as two weeks 2.
• In emergency situations, such as Wernicke’s encephalopathy or infantile beriberi with acute collapse, IV thiamine may be necessary 3.

From the Research

Treatment of Low B1 Levels

To treat low B1 levels, also known as thiamine deficiency, the following approaches can be considered:

• Early therapeutic thiamine administration is currently the best approach, as it can lead to rapid clinical improvement within hours or days, even in severe cases 4
• Identification of potential causes of vitamin B1 deficiency and knowledge of its metabolic properties are important for the implementation of early therapeutic response required for the reduction and prevention of symptoms related to this disorder 5
• Patients at risk for thiamin deficiency, such as those with malnutrition, alcoholism, or certain clinical conditions, should be aware of the signs and symptoms of thiamin deficiency, including lactic acidosis, peripheral neuropathy, and ocular changes 6
• Thiamine supplementation can be administered orally or parenterally, with oral administration of lipid-soluble allithiamines being a recommended option for prophylaxis and treatment of thiamine deficits due to their efficient utilization and lack of untoward effects 7

Thiamine Deficiency Disorders

Thiamine deficiency can lead to various disorders, including:

• Wernicke-Korsakoff syndrome, a condition characterized by confabulation, memory loss, and psychosis 4, 6, 8
• Beri-Beri, a disease caused by thiamine deficiency, which can lead to heart failure, neuropathy, and other complications 5, 8
• Optic neuropathy, a condition that can cause vision loss and other ocular symptoms 5
• Other disorders, such as lactic acidosis, peripheral neuropathy, and ataxia, which can be caused by thiamine deficiency 6, 8

Prevention and Management

Prevention and management of thiamine deficiency can be achieved through:

• Early diagnosis and treatment of thiamine deficiency disorders 4
• Identification of patients at risk for thiamin deficiency and implementation of preventive measures, such as thiamine supplementation 6
• Education and awareness of clinicians and patients about the importance of thiamine and the risks of thiamine deficiency 4, 5