Thiamine in ETOH overdose

Q: Thiamine protects against delirium tremens (DTs) in alcohol toxicity.

A) True

B) False

Answer: False

Thiamine is recommended in alcoholic patients as it helps prevent Wernicke encephalopathy (a triad of confusion, ataxia, ophthalmoplegia) and Korsakoff syndrome (consisting of anterograde and retrograde amnesia, confabulation, lack of insight and apathy). However, thiamine has no effect on the symptoms of alcohol withdrawal or on the prevention of seizures or DTs.

Moreover, orally administered thiamine may have poor enteral absorption in alcoholic patients, so in the initial phase or in high-risk patients, parenteral thiamine (100-250 mg once daily) should be prescribed.

#toxicity

#neurology

References:

1. Dervaux A, Laqueille X. Le traitement par thiamine (vitamine B1) dans l’alcoolodépendance [Thiamine (vitamin B1) treatment in patients with alcohol dependence]. Presse Med. 2017 Mar;46(2 Pt 1):165-171. French. doi: 10.1016/j.lpm.2016.07.025. Epub 2016 Nov 3. PMID: 27818067.

2. Shakory S. Thiamine in the management of alcohol use disorders. Can Fam Physician. 2020 Mar;66(3):165-166. PMID: 32165459; PMCID: PMC8302359.

3. Pawar RD, Balaji L, Grossestreuer AV, Thompson G, Holmberg MJ, Issa MS, Patel PV, Kronen R, Berg KM, Moskowitz A, Donnino MW. Thiamine Supplementation in Patients With Alcohol Use Disorder Presenting With Acute Critical Illness : A Nationwide Retrospective Observational Study. Ann Intern Med. 2022 Feb;175(2):191-197. doi: 10.7326/M21-2103. Epub 2021 Dec 7. PMID: 34871057; PMCID: PMC9169677.