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Thiamine (Vitamin B1) Deficiency in Intensive Care: Physiology, Risk Factors, Diagnosis, and Treatment

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Diet and Nutrition in Critical Care

Abstract

Thiamine plays an essential role in cellular energy metabolism; its deficiency will result in severely compromised energy generation and may culminate in cellular dysfunction and death. Body stores of thiamine are small and deficiency can develop within 2–3 weeks of inadequate intake. Systemic inflammation, increased renal or gastrointestinal losses, increased water turnover, and insufficient supply are the most common risk factors for thiamine deficiency in critically ill patients.

Thiamine deficiency affects the central and peripheral nervous system and cardiovascular system in different combinations. Considering that early diagnosis and treatment are crucial to prevent sequelae and severe deficiency may be potentially fatal, treatment should be initiated at the very earliest suspicion of vitamin depletion – laboratory confirmation is not required to initiate supplementation in high-risk patients. Treatment is cheap, easy, and safe. The dose, route, and extent of treatment will depend on the clinical condition and severity of the deficiency.

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Abbreviations

α-KGDH:

α-ketoglutarate dehydrogenase

BCKDH:

Branched-chain keto acid dehydrogenase

CRRT:

Continuous renal replacement therapy

ETKA:

Erythrocyte transketolase activity

GABA:

Gamma-aminobutyric acid

HPLC:

High-performance liquid chromatography

PDH:

Pyruvate dehydrogenase

TD:

Thiamine deficiency

TDP:

Thiamine diphosphate

TPP:

Thiamine pyrophosphate

TTPE:

Thiamine pyrophosphate effect

WE:

Wernicke’s encephalopathy

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Authors and Affiliations

  1. Discipline of Nutrition and Metabolism, Department of Pediatrics, Federal University of Sao Paulo, Rua Loefgreen 1647, 04040-032, Sao Paulo, Brazil

    Heitor Pons Leite

  2. Pediatric Intensive Care Unit, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil

    Lúcio Flávio Peixoto de Lima

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  1. Heitor Pons Leite
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  2. Lúcio Flávio Peixoto de Lima
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Correspondence to Heitor Pons Leite .

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Editors and Affiliations

  1. Department of Nutrition, King's College London, London, United Kingdom

    Rajkumar Rajendram

  2. School of Medicine, King's College London, London, United Kingdom

    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

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Leite, H.P., de Lima, L.F.P. (2014). Thiamine (Vitamin B1) Deficiency in Intensive Care: Physiology, Risk Factors, Diagnosis, and Treatment. In: Rajendram, R., Preedy, V., Patel, V. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8503-2_6-1

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  • DOI: https://doi.org/10.1007/978-1-4614-8503-2_6-1

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