A recent large US study* found that the vitamin thiamine was not given to 49 percent of Intensive Care patients who were at risk of thiamine malnutrition associated with Alcohol Use Disorder. This finding suggests disturbing and profound ignorance (despite published guidelines) in the treating teams’ understanding of the need to provide urgent thiamine supplementation when malnutrition is suspected. It could also suggest similar ignorance about the need to give thiamine to patients with malnutrition not associated with alcohol use disorder, particularly before giving significant amounts of simple carbohydrates – for instance via intravenous glucose solution. If large amounts of sugar are given to a person with thiamine deficiency this loads metabolic oxidative pathways which depend on Thiamine Pyrophosphate. This can precipitate serious brain pathology including damage to crucial memory systems – ‘Wernicke’s encephalopathy’ and the long-term irreversible damage of ‘Korsakoff syndrome’. This risk applies, not only when thiamine deficiency is associated with heavy alcohol use but also in a number of other potential malnutrition and subnutrition conditions: anorexia and bulimia nervosa; severe and persistent vomiting (as can occur in pregnancy); after a gastric banding operation; voluntary fasting (religious, hunger-strikes); cancer; severe depression; self-neglect. I raised this issue in a March 2019 post and discussed it in ‘Your Brain in Sickness and in Health’ on pages 94, 104, 353-354.
* Rahul D Pawar and many others. ‘Thiamine Supplementation in Patients With Alcohol Use Disorder Presenting With Acute Critical Illness: A Nationwide Retrospective Observational Study’ Ann Intern Med 2021 Dec 7 doi: 10.7326/M21-2103
The records were examined of 14,998 patients with Alcohol Use Disorder admitted to ICU with one of the following conditions: alcohol withdrawal, septic shock, traumatic brain injury, diabetic ketoacidosis. Overall only 51 percent received thiamine supplementation. Even only 59% of patients with alcohol withdrawal received thiamine supplementation. The figures for the other groups were: 26% for septic shock; 41% for Traumatic Brain Injury; and 24% for Diabetic Ketoacidosis.