1
|
Zhou DJ, Kedar S. Authors' reply, re: A response to Zhou et al. regarding thiamine supplementation in altered mental status. Hosp Pract (1995) 2023; 51:1. [PMID: 36647904 DOI: 10.1080/21548331.2023.2170154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Daniel J Zhou
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sachin Kedar
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
2
|
Eghbali F, Bhahdoust M, Sarafraz H, Naghshbandi M, Eshkevari AV, Movahedi H. Dry beriberi after sleeve gastrectomy: An undiagnosed case report. Int J Surg Case Rep 2022; 96:107357. [PMID: 35779318 PMCID: PMC9284039 DOI: 10.1016/j.ijscr.2022.107357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Sleeve gastrectomy (SG) is a popular surgery for morbid obesity because of minimal complications, while somewhere uncommon micronutrient deficiencies occur that make problems. One of these rare complications is dry beriberi (BB). CASE PRESENTATION A 20-year-old girl with obesity that a few months after SG had non-specific symptoms like nausea, vomiting, debilitating weakness, burning, and tingling in her feet, which led to more tests and imaging and confused the physicians. During the next two months, she had a 40 kg weight loss. The critical test that helped diagnosis was Electromyography and Nerve Conduction Velocity (EMG/NCV), which showed subacute axonal sensory-motor polyneuropathy and decreased level of vitamin B1, proved the patient's diagnosis was dray BB. CLINICAL DISCUSSION SG may contribute to vitamin and trace elements deficiency development. One of the micronutrients that deficiencies can disturb the patient is vitamin B1 deficiency. Vitamin B1 deficiencies could be demonstrated with peripheral polyneuropathy, beriberi, or Wernicke-Korsakoff syndrome. Based on decreased vitamin B1 and EMG/NCV results, the diagnosis had been dry beriberi corrected with supplement therapy. CONCLUSION Thiamine deficiency should be suspected in all patients with vomiting, neurological symptoms, and rapid weight loss post-bariatric surgery (BS), even after restrictive surgery. Especially when a patient reports substantial weight loss and vomiting in short order. Hopefully, this case report will make any patient hospitalized with similar conditions evaluated for beriberi and again multivitamin supplementation therapy after SG is emphasized.
Collapse
Affiliation(s)
- Foolad Eghbali
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mansour Bhahdoust
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran,Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Corresponding author at: Minimally Invasive Surgery Research Center, Rasool-e-Akram Hospital, Niyayesh Ave, Sattarkhan St., Tehran, Iran.
| | - Hamid Sarafraz
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mobin Naghshbandi
- Student Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Hamidreza Movahedi
- Student Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Zhou DJ, Samson KK, Joseph N, Fahad I, Purbaugh MV, Villafuerte-Trisolini BJ, Kodali N, Guda P, Grogan W, Mukherjee U, Kedar S. Thiamine supplementation in hospitalized patients with altered mental status: does it help? Hosp Pract (1995) 2021; 50:27-36. [PMID: 34875959 DOI: 10.1080/21548331.2021.2014737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe thiamine-prescribing patterns and to study the association of thiamine supplementation with clinical outcomes in hospitalized patients with altered mental status (AMS). METHODS We conducted a retrospective cohort study of all adult hospitalized patients with AMS with index admission in calendar year 2017. We studied the association of a) supplemental thiamine and b) timing of thiamine relative to glucose, with hospital outcomes - length of stay (LOS), 90-day readmission rates, and mortality rates - using linear, logistic, and extended Cox models, respectively. We also modeled association of supplemental thiamine on time to resolution of AMS using extended Cox models in patients admitted with AMS. RESULTS Of 985 patients, 178 (18%) received thiamine, including 123 (12.5%) who received thiamine before, with, or without glucose (thiamine first). We identified 365 (37%) patients who received intravenous glucose before or without thiamine (glucose first). We found that patients who received glucose first had longer LOS and higher rate of in-hospital deaths compared to those who did not. Patients who received thiamine supplementation had longer LOS compared to those who did not. There were no significant differences in other hospital outcomes or AMS resolution by discharge compared to their respective reference groups. CONCLUSION Although thiamine supplementation was not associated with better hospital or cognitive outcomes, we do not have enough evidence to suggest a change in current practice. Thiamine must be administered prior to glucose in hospitalized patients with AMS.
Collapse
Affiliation(s)
- Daniel J Zhou
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kaeli K Samson
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Navya Joseph
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ismail Fahad
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Matthew V Purbaugh
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Neeharica Kodali
- Electronic Health Record Data Access Core, University of Nebraska Medical Center, Omaha, NE, USA
| | - Purnima Guda
- Electronic Health Record Data Access Core, University of Nebraska Medical Center, Omaha, NE, USA
| | - Wendie Grogan
- Department of Pharmaceutical Services, Nebraska Medicine, Omaha, NE, USA
| | - Urmila Mukherjee
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sachin Kedar
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
4
|
DeFries T, Leyde S, Haber LA, Martin M. Things We Do for No Reason™: Prescribing Thiamine, Folate and Multivitamins on Discharge for Patients With Alcohol Use Disorder. J Hosp Med 2021; 16:751-753. [PMID: 34730500 DOI: 10.12788/jhm.3691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/23/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Triveni DeFries
- Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital and Trauma Center, University of California, San Francisco, California
| | - Sarah Leyde
- Division of General Internal Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Lawrence A Haber
- Division of Hospital Medicine, Department of Medicine, San Francisco General Hospital and Trauma Center, University of California, San Francisco, California
| | - Marlene Martin
- Division of Hospital Medicine, Department of Medicine, San Francisco General Hospital and Trauma Center, University of California, San Francisco, California
| |
Collapse
|
5
|
Tipton PW, Day GS, Graff-Radford N. A Neurologist's Practical Approach to Cognitive Impairment. Semin Neurol 2021; 41:686-698. [PMID: 34826872 DOI: 10.1055/s-0041-1726354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The global prevalence of dementia is expected to triple by the year 2050. This impending health care crisis has led to new heights of public awareness and general concern regarding cognitive impairment. Subsequently, clinicians are seeing more and more people presenting with cognitive concerns. It is important that clinicians meet these concerns with a strategy promoting accurate diagnoses. We have diagramed and described a practical approach to cognitive impairment. Through an algorithmic approach, we determine the presence and severity of cognitive impairment, systematically evaluate domains of function, and use this information to determine the next steps in evaluation. We also discuss how to proceed when cognitive impairment is associated with motor abnormalities or rapid progression.
Collapse
Affiliation(s)
| | - Gregory S Day
- Department of Neurology, Mayo Clinic, Jacksonville, Florida
| | | |
Collapse
|
6
|
Heirene RM, John B, O’Hanrahan M, Angelakis I, Roderique-Davies G. Professional Perspectives on Supporting Those with Alcohol-Related Neurocognitive Disorders: Challenges & Effective Treatment. ALCOHOLISM TREATMENT QUARTERLY 2021. [DOI: 10.1080/07347324.2021.1898294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Robert M. Heirene
- Brain & Mind Centre, School of Psychology, University of Sydney, Sydney, Australia
- Addictions Research Group, University of South Wales, School of Psychology & Therapeutic Studies, Pontypridd, UK
| | - Bev John
- Addictions Research Group, University of South Wales, School of Psychology & Therapeutic Studies, Pontypridd, UK
| | - Marie O’Hanrahan
- Addictions Research Group, University of South Wales, School of Psychology & Therapeutic Studies, Pontypridd, UK
| | - Ioannis Angelakis
- Addictions Research Group, University of South Wales, School of Psychology & Therapeutic Studies, Pontypridd, UK
| | - Gareth Roderique-Davies
- Addictions Research Group, University of South Wales, School of Psychology & Therapeutic Studies, Pontypridd, UK
| |
Collapse
|
7
|
Day GS, Ladak S, Del Campo CM. Improving thiamine prescribing at an academic hospital network using the computerized provider order entry system: a cohort study. CMAJ Open 2020; 8:E383-E390. [PMID: 32414885 PMCID: PMC7239638 DOI: 10.9778/cmajo.20200029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Oral thiamine therapy is frequently prescribed to patients at risk for thiamine deficiency despite recommendations emphasizing the need for high doses of parenteral thiamine to reverse brain thiamine deficits. We evaluated the effect of changes to the computerized provider order entry system on the proportion of prescriptions for parenteral thiamine treatment (primary outcome) and dosages prescribed (secondary outcome) within our academic hospital network. METHODS We obtained data from the pharmacy information system recording thiamine prescribed to inpatients at University Health Network hospitals (Toronto, Ontario) before (Jan. 1, 2010, to Dec. 31, 2011) and after (Nov. 21, 2013, to Apr. 30, 2017) changes to the computerized provider order entry system promoting the use of higher dosages (≥ 200 mg) of parenterally administered thiamine. Patients receiving thiamine as part of total parenteral nutrition were excluded from analyses, as thiamine prescribing was automated and unlikely to be affected by the intervention. RESULTS A total of 6105 thiamine prescriptions were written for 2907 patients before the intervention and 12 787 thiamine prescriptions for 8032 patients after the intervention. The proportion of prescriptions for parenteral treatment increased from 55.5% (3386/6105) to 92.5% (11 829/12 787) after the intervention (p < 0.001). Increases in prescribing of parenteral thiamine treatment were sustained or enhanced across the 3.4-year observation period and were realized across all hospital services. Prescriptions for higher dosages of thiamine increased from 1.1% (65/6105) to 61.4% (7845/12 787) after the intervention (p < 0.001). INTERPRETATION Changes to the computerized provider order entry system were associated with sustained increases in the proportion of prescriptions for high-dose parenteral thiamine therapy. Similar approaches may be leveraged to align prescriber behaviour with well-accepted practice parameters in other areas of medicine.
Collapse
Affiliation(s)
- Gregory S Day
- Department of Neurology (Day), Mayo Clinic Florida, Jacksonville, Fla.; Krembil Neuroscience Centre (Ladak), University Health Network; Department of Pharmacy (Ladak, del Campo), University Health Network; Division of Neurology (del Campo), University of Toronto, Toronto, Ont.
| | - Safiya Ladak
- Department of Neurology (Day), Mayo Clinic Florida, Jacksonville, Fla.; Krembil Neuroscience Centre (Ladak), University Health Network; Department of Pharmacy (Ladak, del Campo), University Health Network; Division of Neurology (del Campo), University of Toronto, Toronto, Ont
| | - C Martin Del Campo
- Department of Neurology (Day), Mayo Clinic Florida, Jacksonville, Fla.; Krembil Neuroscience Centre (Ladak), University Health Network; Department of Pharmacy (Ladak, del Campo), University Health Network; Division of Neurology (del Campo), University of Toronto, Toronto, Ont
| |
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW This article describes the clinical features that suggest a reversible cause of dementia. RECENT FINDINGS Substantial variability exists in the presenting features and clinical course of patients with common neurodegenerative causes of dementia, but the response to available therapies and eventual outcomes are often poor. This realization has influenced the evaluation of patients with dementia, with diagnostic approaches emphasizing routine screening for a short list of potentially modifiable disorders that may exacerbate dementia symptoms or severity but rarely influence long-term outcomes. Although a standard approach to the assessment of dementia is appropriate in the vast majority of cases, neurologists involved in the assessment of patients with dementia must recognize those rare patients with reversible causes of dementia, coordinate additional investigations when required, and ensure expedited access to treatments that may reverse decline and optimize long-term outcomes. SUMMARY The potential to improve the outcome of patients with reversible dementias exemplifies the need to recognize these patients in clinical practice. Dedicated efforts to screen for symptoms and signs associated with reversible causes of dementia may improve management and outcomes of these rare patients when encountered in busy clinical practices.
Collapse
|
9
|
Thomson A, Guerrini I, Marshall EJ. Incidence of Adverse Reactions to Parenteral Thiamine in the Treatment of Wernicke's Encephalopathy, and Recommendations. Alcohol Alcohol 2019; 54:609-614. [PMID: 31565743 DOI: 10.1093/alcalc/agy091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 10/07/2018] [Accepted: 01/24/2019] [Indexed: 11/12/2022] Open
Abstract
AIM To offer an estimate of the incidence of anaphylactic reactions to parenteral products containing thiamine used in the treatment of Wernicke's encephalopathy (WE) and make recommendations. METHOD Review of previously released data on some older products and parenteral thiamine use in some other countries; analysis of sales and adverse incident data on anaphylaxis for a contemporary parenteral product used in the UK, Pabrinex. RESULTS It was difficult to estimate the incidence of related anaphylactic reactions to Pabrinex in the UK because the number of doses given is unknown. Sales data are only an approximation to doses given because for products with a limited shelf life not all product sold is administered. However, available data indicate that there have been 10 anaphylactic reactions to Pabrinex from between 5,431,235-6,651,947 patient-days (14,880-16,080 years) of treatment. CONCLUSION It is reasonable to assume that the risk of anaphylaxis is low, and lower than for many other drugs. The risk-benefit ratio for administration is favourable given the potential severity of brain damage in Wernicke-Korsakoff (WK) syndrome. There is a need for international agreement on the reporting of anaphylaxis and on the optimum thiamine therapy for the treatment of WK syndrome. We make recommendations on how this might be achieved.
Collapse
Affiliation(s)
- Allan Thomson
- King's College London, Institute of Psychiatry, Psychology and Neuroscience London SE5 8AF, UK.,Division of Psychiatry, University College London, Rockefeller Building, Gower Street, London WC1E 6BT, UK
| | - Irene Guerrini
- King's College London, Institute of Psychiatry, Psychology and Neuroscience London SE5 8AF, UK.,Bexley Substance Misuse Service, South London and Maudsley NHS Trust, London, UK
| | - Elizabeth Jane Marshall
- King's College London, Institute of Psychiatry, Psychology and Neuroscience London SE5 8AF, UK.,Addictions Clinical Academic Group, South London and Maudsley NHS Foundation Trust, Marina House, 63-65 Denmark Hill, London SE58RS
| |
Collapse
|
10
|
Lin S, Leppla IE, Yan H, Probert JM, Randhawa PA, Leoutsakos JMS, Probasco JC, Neufeld KJ. Prevalence and Improvement of Caine-Positive Wernicke-Korsakoff Syndrome in Psychiatric Inpatient Admissions. PSYCHOSOMATICS 2019; 61:31-38. [PMID: 31607504 DOI: 10.1016/j.psym.2019.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Wernicke-Korsakoff Syndrome (WKS) resulting from thiamine deficiency is classically defined as including encephalopathy, ataxia, and ophthalmoplegia. Only 16% of autopsy-confirmed patients with WKS exhibit all three signs. Caine-positive WKS criteria include two or more of the following: nutritional deficiency, delirium or mild memory impairment, cerebellar dysfunction/ataxia, and oculomotor abnormalities. OBJECTIVE We describe Caine-positive WKS prevalence among psychiatric inpatients and compare pretreatment-versus-posttreatment neurocognitive improvement to an unaffected group. METHODS This 6-month quality-improvement evaluation included two-stage screening for Caine-positive WKS, administering high-dose intravenous thiamine (day 1: 1200 mg; days 2-4: 200 mg) with reexamination on day 5. We used descriptive statistics and fitted random effects models to examine rate-of-change differences in pre-/posttreatment Montreal Cognitive Assessment (MoCA), delayed 5-item recall, and gait/coordination scores between treated Caine-positive patients with WKS and untreated Caine-negative patients. RESULTS Of 262 patients, 32 (12%) had Caine-positive WKS; 17 (53%) used alcohol currently. Treated Caine-positive WKS (n = 26) versus Caine-negative comparison (n = 34) before and after treatment observed a mean change (standard deviation) in the MoCA score of 3.6 (2.5) versus 1.8 (2.5) (P < 0.01); 5-item recall: 1.8 (1.4) versus 0.5 (1.4) (P < 0.001); gait/coordination scores: -0.6 (1.2) versus -0.1 (0.6) (P < 0.001). Oculomotor abnormalities were infrequent (n = 4 in Caine-positive WKS, n = 2 in Caine-negative comparison groups). CONCLUSIONS Caine-positive WKS prevalence among psychiatric inpatients was 12%; only half used alcohol. Patients treated with high-dose thiamine demonstrated clinically significant neurocognitive improvement.
Collapse
Affiliation(s)
- Shihong Lin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Clinical Mental Health Counseling, Johns Hopkins University School of Education, Baltimore, MD.
| | - Idris E Leppla
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Haijuan Yan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Privia A Randhawa
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jeannie-Marie S Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - John C Probasco
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Karin J Neufeld
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
11
|
Wai JM, Aloezos C, Mowrey WB, Baron SW, Cregin R, Forman HL. Using clinical decision support through the electronic medical record to increase prescribing of high-dose parenteral thiamine in hospitalized patients with alcohol use disorder. J Subst Abuse Treat 2019; 99:117-123. [PMID: 30797383 DOI: 10.1016/j.jsat.2019.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/20/2019] [Accepted: 01/23/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with alcohol use disorder (AUD) are at an increased risk of developing Wernicke's encephalopathy (WE), a devastating and difficult diagnosis caused by thiamine deficiency. Even as AUD is present in up to 25% of hospitalized patients on medical floors, appropriate thiamine supplementation in the hospital setting remains inadequate. These patients are particularly susceptible to thiamine deficiency and subsequent WE due to both their alcohol use and active medical illnesses. The electronic medical record (EMR) has become ubiquitous in health care systems and can be used as a tool to improve the care of hospitalized patients. METHODS As a quality improvement initiative, we implemented a medication order panel in the EMR with autopopulated orders for thiamine dosing to increase the appropriate use of high-dose parenteral thiamine (HPT) for hospitalized patients with AUD. We conducted a retrospective cohort study of all inpatients with AUD who received an Addiction Psychiatry Consult Service consult three months before and after the EMR change. We compared the proportion of patients receiving HPT prior to consultation (primary outcome) and the length of stay (secondary outcome) between the historical control group and the EMR intervention group. RESULTS Patients in the EMR intervention group were significantly more likely to receive HPT than the historical control group (20.2% vs. 2.7%, p < 0.0001). This difference remained statistically significant when adjusted for potential confounders (OR: 9.89, 95% CI: [2.77, 35.34], p = 0.0004). There was a trend towards statistical significance that the intervention group had a higher likelihood of being prescribed any thiamine (76.6% vs. 64.6%, p = 0.06) and had a shorter length of stay (median (IQR): 3.8 (2.4, 7.0) vs. 4.6 (2.9, 7.8) days, p = 0.06). CONCLUSION These results indicate that providing autopopulated thiamine order panels for patients with AUD can be an effective method for specialty services to increase appropriate care practices without additional education or training for providers. Further research should consider the clinical outcomes of increasing HPT for patients with AUD.
Collapse
Affiliation(s)
- Jonathan M Wai
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 66, Office 3705, New York, NY 10032, USA; Division on Substance Use Disorders, New York State Psychiatric Institute, Unit 66, Office 3705, New York, NY 10032, USA; Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Christopher Aloezos
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA; Department of Psychiatry, NYU School of Medicine, One Park Avenue, New York, NY 10016, USA
| | - Wenzhu B Mowrey
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Sarah W Baron
- Department of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA
| | - Regina Cregin
- Department of Pharmacy, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA
| | - Howard L Forman
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA
| |
Collapse
|
12
|
Thiamine Prescribing and Wernicke's Encephalopathy Risk Factors in Patients With Alcohol Use Disorders at a Psychiatric Hospital. J Psychiatr Pract 2018; 24:317-322. [PMID: 30427818 DOI: 10.1097/pra.0000000000000326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) is the leading cause of thiamine deficiency and can lead to Wernicke's encephalopathy (WE). WE has a higher prevalence of development in patients with AUD, and current recommendations emphasize parenteral administration of thiamine. Our objective was to characterize thiamine utilization in patients with AUD who were prescribed thiamine and evaluate if those who received oral thiamine had risk factors for the development of WE. METHODS This retrospective chart review enrolled adults admitted to a psychiatric hospital from October 2014 through September 2015 diagnosed with AUD as per the International Classification of Diseases, Ninth Edition (ICD-9). The cohort was divided on the basis of route of thiamine administration (nonparenteral vs. parenteral) and was then screened retrospectively for risk factors for WE. Descriptive data and measures of central tendency were utilized to assess the objectives. RESULTS The majority of patients were white male individuals, with a mean age of 48 years. Of the 226 patients, 201 (89%) were prescribed oral thiamine. Of the first 100 patients who received oral thiamine, 36% had risk factors for WE, with the most common risk factor being malnutrition. A χ analysis revealed that WE risk factors did not influence route of thiamine administration (χ=2.148, df=1, P=0.143). No patients were diagnosed with WE during their admission; however, 8 patients received parenteral thiamine at a treatment dose indicated for WE. CONCLUSIONS Parenteral thiamine is underutilized in patients with AUD and risk factors for WE. Education is needed to enhance thiamine prescribing and evaluation of risk factors for WE in this population. A thiamine prescribing protocol has been developed for further thiamine optimization.
Collapse
|
13
|
Nakamura ZM, Tatreau JR, Rosenstein DL, Park EM. Clinical Characteristics and Outcomes Associated With High-Dose Intravenous Thiamine Administration in Patients With Encephalopathy. PSYCHOSOMATICS 2018; 59:379-387. [PMID: 29482863 DOI: 10.1016/j.psym.2018.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Wernicke encephalopathy is a common neuropsychiatric syndrome due to thiamine deficiency. There is no consensus regarding thiamine dosing when Wernicke encephalopathy is suspected. A longstanding dosing strategy for Wernicke encephalopathy is 100mg daily, yet updated clinical guidelines suggest using high-dose intravenous (HDIV) thiamine. OBJECTIVE To describe thiamine prescribing practices at a large, public academic hospital and investigate clinical characteristics and outcomes associated with HDIV thiamine in patients with encephalopathy who received IV thiamine. METHODS Electronic medical records of hospitalized patients who received thiamine between 4/4/2014 and 11/1/2015 were reviewed. Chi-square tests, Wilcoxon Rank Sum tests, and logistic regression were used to compare clinical variables in patients with encephalopathy who received HDIV thiamine (≥ 200mg twice daily) vs lower doses of IV thiamine. RESULTS Among the total of 5236 thiamine orders, 29% (n = 1531) were IV; 10% (n = 150) of IV orders met HDIV criteria. In patients with encephalopathy who received IV thiamine (n = 432), HDIV thiamine was administered to 20% (n = 86) and only 2.1% (n = 9) received dosing consistent with Royal College of Physicians guidelines. In bivariable analyses, HDIV thiamine was associated with surgical services (p = 0.001), psychiatric consultation (p < 0.001), and decreased mortality (p = 0.004). In multivariable models, the association between HDIV thiamine and decreased in-hospital mortality did not meet statistical significance (p = 0.061). CONCLUSIONS In a large, public academic hospital, guideline-concordant thiamine supplementation is rare and HDIV thiamine is infrequently prescribed to patients with encephalopathy. Further studies are needed to confirm the possible benefits of HDIV thiamine for patients with suspected thiamine-deficient encephalopathy.
Collapse
Affiliation(s)
- Zev M Nakamura
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC.
| | - Jason R Tatreau
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Donald L Rosenstein
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC; Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Eliza M Park
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC; Department of Medicine, University of North Carolina, Chapel Hill, NC
| |
Collapse
|
14
|
Alim U, Bates D, Langevin A, Werry D, Dersch-Mills D, Herman RJ, Mintz M, Ghosh S. Thiamine Prescribing Practices for Adult Patients Admitted to an Internal Medicine Service. Can J Hosp Pharm 2017; 70:179-187. [PMID: 28680171 DOI: 10.4212/cjhp.v70i3.1657] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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.
Collapse
Affiliation(s)
- Uzma Alim
- BScPharm, ACPR, PharmD, is a Clinical Pharmacist with St Joseph's Health Centre, Toronto, Ontario
| | - Duane Bates
- BScPharm, ACPR, is a Clinical Pharmacist with Calgary Zone, Alberta Health Services (Peter Lougheed Hospital), Calgary, Alberta
| | - Ashten Langevin
- 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
| | - Denise Werry
- BScPharm, ACPR, PharmD, is a Clinical Pharmacist-Infectious Diseases with Calgary Zone, Alberta Health Services (Foothills Medical Center), Calgary, Alberta
| | - Deonne Dersch-Mills
- BSc Pharm, ACPR, PharmD, is Clinical Practice Leader with Calgary Zone, Alberta Health Services (Alberta Children's Hospital), Calgary, Alberta
| | - Robert J Herman
- MD, FRCPC, is a Professor in the Department of Medicine, University of Calgary, Calgary, Alberta
| | - Marcy Mintz
- MD, FRCPC, MHPE, is a Clinical Associate Professor in the Department of Medicine, University of Calgary, Calgary, Alberta
| | - Sunita Ghosh
- PhD, PStat, is an Assistant Clinical Professor in the Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, Edmonton, Alberta
| |
Collapse
|
15
|
Beriberi: an uncommon complication of sleeve gastrectomy. Surg Obes Relat Dis 2015; 11:e53-5. [DOI: 10.1016/j.soard.2015.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/09/2015] [Accepted: 07/13/2015] [Indexed: 11/21/2022]
|