Thiamine iv
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Intravenous Thiamine: Efficacy, Safety, and Clinical Applications
Prevention of Delirium in Hematopoietic Stem Cell Transplantation
High-Dose IV Thiamine and Delirium Prevention
A randomized double-blind placebo-controlled trial investigated whether high-dose intravenous (IV) thiamine could prevent delirium in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). The study found no significant difference in the incidence, onset, duration, or severity of delirium between the thiamine and placebo groups, despite higher thiamine levels in the treatment group. This suggests that while thiamine deficiency is a known cause of delirium in chronic alcoholism, its role in preventing delirium in non-alcoholic populations, such as cancer patients undergoing HSCT, may be limited.
Safety of Intravenous Thiamine Administration
Incidence of Adverse Reactions
The safety profile of IV thiamine, particularly when administered as an IV push, has been evaluated in several studies. A large retrospective review at a tertiary academic medical center found no cases of anaphylaxis among 8,606 administrations of undiluted IV push thiamine. The incidence of injection site reactions was low, with only 0.30% of doses resulting in phlebitis or infiltration. Another study supported the safety of administering thiamine doses of 200 mg or less as an IV push, with no significant difference in adverse reaction rates compared to IV infusion.
Clinical Applications of High-Dose IV Thiamine
Treatment of Wernicke Encephalopathy
Wernicke encephalopathy (WE), a severe neuropsychiatric syndrome due to thiamine deficiency, requires prompt treatment with high-dose IV thiamine. Guidelines recommend administering 500 mg IV three times daily for 3 to 5 days, followed by 250 mg IV daily for an additional 3 to 5 days. This regimen is crucial for reversing the symptoms and preventing the progression to Korsakoff syndrome.
Rapid Reversal of Lactic Acidosis
Thiamine plays a critical role in energy metabolism, and its deficiency can lead to severe lactic acidosis. Case reports have demonstrated that IV thiamine administration can rapidly reverse lactic acidosis, stabilize hemodynamics, and resolve neurological disturbances in critically ill patients. This highlights the importance of recognizing and treating thiamine deficiency in patients with unexplained lactic acidosis.
Neuroprotective Effects in Neonatal Encephalopathy
Thiamine may also have potential neuroprotective effects in neonatal hypoxic-ischemic encephalopathy (HIE). High-dose IV thiamine, due to its antioxidant properties, could counteract oxidative stress and support mitochondrial function, potentially improving outcomes in neonates with HIE. Combining thiamine with therapeutic hypothermia may offer synergistic benefits.
Conclusion
Intravenous thiamine is a safe and effective treatment for conditions associated with thiamine deficiency, such as Wernicke encephalopathy and lactic acidosis. While its role in preventing delirium in non-alcoholic populations remains uncertain, its neuroprotective potential in neonatal encephalopathy warrants further investigation. The administration of IV thiamine, particularly in high doses, should be guided by clinical indications and safety considerations.
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