Purpose of review
To summarize the properties of thiamine
and evaluate current evidence on thiamine
status and supplementation, for different populations of critically ill patients
Recent findings Thiamine
, in the form of thiamine
pyrophosphate, is a critical co-factor in the glyocolysis and oxidative decarboxylation of carbohydrates for energy production. Different studies have shown that critical illness in adults and children is characterized by absolute or relative thiamine
depletion, which is associated with an almost 50% increase in mortality. Thiamine
deficiency should be suspected in different clinical scenarios such as severe sepsis, burns, unexplained heart failure or lactic acidosis, neurological disorder in patients with previous history of alcoholism, starvation, chronic malnutrition, long-term parenteral feeding, hyperemesis gravidarum, or bariatric surgery. Nonetheless, thiamine
supplements are not routinely given to critically ill patients
. Clinicians should be able to suspect and recognize risk factors for the occurrence of severe neurological disorders secondary to thiamine
deficiency, as early treatment can prevent the appearance of permanent neurological damage.
Symptoms and signs associated with thiamine
deficiency lack sensitivity and specificity in critically ill patients
. Consequently, depletion is frequently unrecognized and underdiagnosed by clinicians. Potentially deleterious consequences of thiamine
depletion should be avoided by early and appropriate supplementation.