Indications

• Thiamine Deficiency (see Thiamine Deficiency)
  • Infantile Beriberi
  • Dry Beriberi
  • Wet Beriberi
  • Wernicke-Korsakoff Syndrome

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Pharmacology

Normal Thiamine Physiology

• Thiamine is a Water-Soluble Vitamin: therefore, thiamine is not stored
  • Thiamine Toxicity is Not Observed, Since Kidneys are Capable of Clearance of Almost All Excess Thiamine
  • Biologic Half-Life: 10-20 days

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Administration

Recommended Daily Thiamine Intake

• PO
  • Female ≥19 y/o: 1.1 mg
  • Pregnancy/Lactation: 1.4 mg
  • Male ≥19 y/o: 1.2 mg

Ethanol Withdrawal (see Ethanol, Ethanol)

• Standard Prophylaxis Regimen
  • Administer 100 mg/day IV (Usually in a “Banana Bag” Which Includes Folate and Multivitamin) x Several Days, Followed by 50-100 mg PO day
• Royal College of Physicians High-Dose Thiamine Prophylaxis Regimen for Wernicke’s Encephalopathy (Administered in Addition to Other B Vitamins, Ascorbic Acid, Potassium, Magnesium, and Phosphate) (Alcohol Alcohol, 2002) [MEDLINE]
  • Administer 250 mg IV qday x 3-5 Days

Thiamine Deficiency (Beriberi and/or Wernicke’s Encephalopathy) (see Thiamine Deficiency, Thiamine Deficiency)

• Standard Regimen
  • Administer 100 mg IV qday (Usually in a “Banana Bag” Which Includes Folate and Multivitamin) Until Patient is Tolerating a Balanced Oral Diet
  • However, Higher Thiamine Doses May Be Required in Patients Who Do Not Clinically Improve on the Standard Regimen
• Royal College of Physicians High-Dose Thiamine Regimen for the Treatment of Wernicke’s Encephalopathy (Administered in Addition to Other B Vitamins, Ascorbic Acid, Potassium, Magnesium, and Phosphate) (Alcohol Alcohol, 2002) [MEDLINE]
  • Administer 500 mg IV TID x 3 Days, Followed by 250 mg IV qday x 5 Days (or Until Clinical Improvement is Observed)

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References

• The Royal College of Physicians report on alcohol: guidelines for managing Wernicke’s encephalopathy in the accident and Emergency Department. Alcohol Alcohol. 2002 Nov-Dec;37(6):513-21 [MEDLINE]