Where can I get a thiamine injection immediately, considering my history of Small Intestine Bacterial Overgrowth (SIBO) and potential malabsorption, as well as my worsening neuropathy symptoms, which I believe is life-threatening due to a suspected thiamine deficiency?

Where to Get Immediate Thiamine Treatment for Life-Threatening Deficiency

You need to go to the nearest emergency department immediately for intravenous thiamine administration—this is a medical emergency that requires IV thiamine 500 mg three times daily, which cannot be obtained outside of a hospital or urgent care setting. 1, 2

Why This Is Urgent

Your combination of SIBO with malabsorption and worsening neuropathy creates a high-risk scenario for severe thiamine deficiency that can cause permanent neurological damage or death if untreated. 1, 2

• Thiamine stores deplete within just 20 days of inadequate intake—faster than any other B vitamin—making isolated thiamine deficiency the first to manifest clinically in malabsorption conditions 1, 3
• SIBO specifically consumes thiamine as bacteria preferentially utilize it for their own metabolism, creating selective thiamine deficiency even when other nutrients remain adequate 3
• Neuropathy from thiamine deficiency can become irreversible if treatment is delayed, but responds rapidly (within days to weeks) when treated appropriately 1, 2, 4

Where to Go Right Now

Emergency Department (First Choice)

Go to your nearest hospital emergency department immediately where they can:

• Administer IV thiamine 500 mg three times daily (1,500 mg total daily) for severe deficiency with neurological symptoms 1, 2
• Provide immediate treatment without waiting for laboratory confirmation, as testing should never delay therapy 1, 2
• Monitor for other complications and correct magnesium deficiency (necessary for thiamine to work properly) 2

Bariatric Surgery Center (If You've Had Bariatric Surgery)

Contact your bariatric surgery center immediately if you've had gastric bypass or other bariatric procedures, as they have established protocols for this exact scenario and can arrange urgent IV thiamine 1

Urgent Care (Second Choice)

An urgent care facility may be able to administer IV thiamine, though they may refer you to the ED for the high doses needed for severe deficiency 1

Why Oral Thiamine Is Inadequate for You

Oral thiamine cannot achieve sufficient blood concentrations to reverse accumulated neurological damage in patients with:

• Active malabsorption from SIBO 2, 3
• Severe or worsening neurological symptoms 2
• Gastric involvement affecting absorption 2

The IV route bypasses your compromised gastrointestinal absorption entirely 2, 5

What Treatment You Need

Initial Phase (First 3-5 Days)

• 500 mg IV thiamine three times daily (total 1,500 mg/day) for severe neurological manifestations 1, 2
• This is the FDA-approved dose for Wernicke's encephalopathy and severe thiamine deficiency with neurological symptoms 5

Transition Phase (After 3-5 Days)

• 200-300 mg IV daily until symptoms improve and oral intake becomes reliable 2
• Then transition to oral thiamine 100-300 mg daily 2

Long-Term Maintenance

• Lifelong supplementation at 50-100 mg daily will likely be necessary given your chronic malabsorption from SIBO 2

Critical Safety Point

If you receive any IV fluids containing glucose or dextrose, thiamine MUST be given first to prevent acute worsening of Wernicke's encephalopathy, which can cause irreversible brain damage 1, 2, 5

Why You Cannot Wait

• Thiamine deficiency can cause permanent neurological deficits or death if treatment is delayed 4
• Your worsening neuropathy suggests progressive deficiency that requires immediate intervention 4, 6
• Treatment is safe with no toxicity risk—excess thiamine is simply excreted in urine—making the benefit-risk ratio overwhelmingly favorable for immediate empiric treatment 1, 2
• Clinical improvement typically begins within 24-48 hours of IV thiamine administration, with continued improvement over weeks 1, 6

What to Tell the Emergency Department

State clearly:

1. "I have SIBO with malabsorption and worsening neuropathy"
2. "I'm concerned about severe thiamine deficiency"
3. "I need IV thiamine 500 mg three times daily"
4. "Please do not give me glucose-containing IV fluids before thiamine"

The ED physician should not wait for thiamine levels before starting treatment—empiric therapy is standard of care in your situation 1, 2