Journal
AMERICAN JOURNAL OF THE MEDICAL SCIENCES
Volume 356, Issue 4, Pages 382-390Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.amjms.2018.06.015
Keywords
Thiamine; Heart failure; Delirium; Lactic acidosis; Gastrointestinal dysfunction
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Thiamine is an essential cofactor for 4 enzymes involved in the production of energy (ATP) and the synthesis of essential cellular molecules. The total body stores of thiamine are relatively small, and thiamine deficiency can develop in patients secondary to inadequate nutrition, alcohol use disorders, increased urinary excretion and acute metabolic stress. Patients with sepsis are frequently thiamine deficient, and patients undergoing surgical procedures can develop thiamine deficiency. This deficiency can cause congestive heart failure, peripheral neuropathy, Wernicke's encephalopathy, Korsakoff's syndrome and gastrointestinal beriberi. In addition, thiamine deficiency can contribute to the development of intensive care unit complications, such as heart failure, delirium, critical care neuropathy, gastrointestinal dysfunction and unexplained lactic acidosis. Consequently, clinicians need to consider thiamine deficiency in patients admitted to intensive care units and the development of thiamine deficiency during the management of critically ill patients. Intravenous thiamine can correct lactic acidosis, improve cardiac function and treat delirium.
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