Uzma Alim1, Duane Bates2, Ashten Langevin3, Denise Werry4, Deonne Dersch-Mills5, Robert J Herman6, Marcy Mintz7, Sunita Ghosh8. 1. BScPharm, ACPR, PharmD, is a Clinical Pharmacist with St Joseph's Health Centre, Toronto, Ontario. 2. BScPharm, ACPR, is a Clinical Pharmacist with Calgary Zone, Alberta Health Services (Peter Lougheed Hospital), Calgary, Alberta. 3. BSc, BScPharm, is a Clinical Pharmacist with Calgary Zone, Alberta Health Services (Foothills Medical Center). Ashten Langevin is also a PharmD student with the University of Alberta. 4. BScPharm, ACPR, PharmD, is a Clinical Pharmacist-Infectious Diseases with Calgary Zone, Alberta Health Services (Foothills Medical Center), Calgary, Alberta. 5. BSc Pharm, ACPR, PharmD, is Clinical Practice Leader with Calgary Zone, Alberta Health Services (Alberta Children's Hospital), Calgary, Alberta. 6. MD, FRCPC, is a Professor in the Department of Medicine, University of Calgary, Calgary, Alberta. 7. MD, FRCPC, MHPE, is a Clinical Associate Professor in the Department of Medicine, University of Calgary, Calgary, Alberta. 8. PhD, PStat, is an Assistant Clinical Professor in the Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, Edmonton, Alberta.
Abstract
BACKGROUND: Thiamine (vitamin B1) is an essential cofactor responsible for the breakdown of glucose, and its deficiency is associated with Wernicke encephalopathy (WE). There is a lack of evidence from systematic studies on the optimal dosing of thiamine for WE. Objectives: The primary objective was to describe the prescribing patterns for IV thiamine in adult patients admitted to a large teaching hospital. The secondary objective was to evaluate the clinical resolution of WE symptoms (confusion, ataxia, and/or ocular motor abnormalities) in relation to the dose of IV thiamine prescribed. METHODS: A retrospective design was used to review data for adult patients admitted to an internal medicine service from June 1, 2014, to June 30, 2015. All patients included in the study received IV thiamine: low-dose therapy was defined as 100 mg IV daily and high-dose therapy was defined as dosage greater than 100 mg IV daily. RESULTS: A total of 141 patients were included; low-dose thiamine was prescribed for 115 (81.6%) and high-dose thiamine for 26 (18.4%). Patients for whom high-dose thiamine was prescribed were more likely to be those in whom a diagnosis of WE was being considered (12/26 [46.2%] versus 5/115 [4.3%], p < 0.001). Of the total 219 IV thiamine doses ordered, 180 (82.2%) were for 100 mg, and 143 (65.3%) were prescribed for once-daily administration. There was no statistically significant difference in the time to resolution of WE symptoms for patients receiving high-dose versus low-dose thiamine. CONCLUSIONS: A wide variety of thiamine prescribing patterns were noted. This study did not show a difference in time to resolution of WE symptoms in relation to the dose of IV thiamine. Additional large-scale studies are required to determine the optimal dosing of thiamine for WE.
BACKGROUND: Thiamine (vitamin B1) is an essential cofactor responsible for the breakdown of glucose, and its deficiency is associated with Wernicke encephalopathy (WE). There is a lack of evidence from systematic studies on the optimal dosing of thiamine for WE. Objectives: The primary objective was to describe the prescribing patterns for IV thiamine in adult patients admitted to a large teaching hospital. The secondary objective was to evaluate the clinical resolution of WE symptoms (confusion, ataxia, and/or ocular motor abnormalities) in relation to the dose of IV thiamine prescribed. METHODS: A retrospective design was used to review data for adult patients admitted to an internal medicine service from June 1, 2014, to June 30, 2015. All patients included in the study received IV thiamine: low-dose therapy was defined as 100 mg IV daily and high-dose therapy was defined as dosage greater than 100 mg IV daily. RESULTS: A total of 141 patients were included; low-dose thiamine was prescribed for 115 (81.6%) and high-dose thiamine for 26 (18.4%). Patients for whom high-dose thiamine was prescribed were more likely to be those in whom a diagnosis of WE was being considered (12/26 [46.2%] versus 5/115 [4.3%], p < 0.001). Of the total 219 IV thiamine doses ordered, 180 (82.2%) were for 100 mg, and 143 (65.3%) were prescribed for once-daily administration. There was no statistically significant difference in the time to resolution of WE symptoms for patients receiving high-dose versus low-dose thiamine. CONCLUSIONS: A wide variety of thiamine prescribing patterns were noted. This study did not show a difference in time to resolution of WE symptoms in relation to the dose of IV thiamine. Additional large-scale studies are required to determine the optimal dosing of thiamine for WE.
Entities:
Keywords:
Wernicke encephalopathy; affections liées à l’alcool; alcohol-related disorders; carence en thiamine; encéphalopathie de Wernicke; thiamine; thiamine deficiency; vitamin B1; vitamine B1
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