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Brothers TN, Furtado M, Al-Mamun MA. Thiamine utilization and the lack of prescribing standardization: A critical examination. Alcohol 2024; 117:11-19. [PMID: 37979843 DOI: 10.1016/j.alcohol.2023.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/31/2023] [Accepted: 10/31/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVES Thiamine is often prescribed for thiamine deficiency during hospitalization despite the lack of US-based clinical guidelines. This study aims to evaluate thiamine prescribing patterns and key characteristics associated with the deficiency to address gaps in care. METHODS Data were obtained from electronic health records of hospitalized patients between September 1, 2021, and March 30, 2022. Alcohol use disorder (AUD) was defined by a positive Clinical Institute Withdrawal Assessment score or a positive serum alcohol level upon admission. Geriatric patients were defined as age ≥65. Cohort 1 was defined as: AUD, albumin <4 g/L, INR >1.5, and total bilirubin >3 mg/dL. Cohort 2 was defined as: age >65, albumin <4 g/L, hemoglobin <15 g/dL, and folate <4 ng/mL. A multivariable LASSO regression model was used to identify characteristics associated with higher thiamine dosing (>100 mg/day). RESULTS Among 780 patients, 520 (66.7%) were identified as AUD, of which 265 (50.1%) were between the ages of 45-64 years. The AUD cohort was significantly different (p < 0.05) in the mean serum albumin 4.16 g/L (IQR: 3.8-4.5), AST 73.55 U/L (23.75-82.00), ALT 52.57 U/L (17.00-57.00), total bilirubin 0.98 (0.3-1.0), and INR 1.1 (0.99-1.12), compared to non-AUD patients with a mean serum albumin 3.75 g/L (3.3-4.2), AST 35.07 U/L (11.00-42.00), ALT 32.77 U/L (5.00-34.00), total bilirubin 0.89 (0.2-0.9), and INR 1.21 (1.0-1.22). In the geriatric cohort, 136 patients (17%) had a mean serum albumin 3.77 g/L (3.4-4.2), AST 38.66 U/L (14.0-41.0), ALT 29.36 U/L (9.0-37.0), total bilirubin 0.62 mg/dL (0.30-0.90), and direct bilirubin 0.12 mg/dL (0.00-0.20), compared to the non-geriatric cohort with a mean serum albumin 4.10 g/L (3.8-4.40), AST 66.44 U/L (21.0-75.0), ALT 50.03 U/L (16.00-53.75), total bilirubin 1.02 mg/dL (0.30-1.00), and direct bilirubin 0.31 mg/dL (0.00-0.20). In cohort 1, 40.6% patients were between 51 and 64 years old, (66.5%) male, and had a BMI <25 (36.4%). In cohort 2, 52.6% were between 65 and 70 years old, (57.9%) male, and had a BMI <25 (57.9%). Cohort 1 were prescribed a dose of 100 mg (47.7 %), oral (63.5%), intramuscular (18.2%), daily (58.9%), one-day duration (49.4%) most frequently. Cohort 2 were prescribed a dose of 100 mg (56.0%), oral (77.2%), daily (77.2%), one-day duration (29.8%) most frequently. The AUD was significantly associated with having a higher dosage (e.g., >100 mg) of thiamine prescribed per day OR 1.62 (1.11-2.37) (p < 0.01). CONCLUSIONS This study confirms that thiamine prescribing patterns vary during hospitalization and suggest specific laboratory findings may aid in identifying cohorts associated with the deficiency.
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Affiliation(s)
- Todd N Brothers
- College of Pharmacy, The University of Rhode Island, Kingston, RI, United States; Roger Williams Medical Center, Providence, RI, United States.
| | | | - Mohammad A Al-Mamun
- School of Pharmacy, University of West Virginia, Morgantown, WV, United States
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Vine J, Lee JH, Kravitz MS, Grossestreuer AV, Balaji L, Leland SB, Berlin N, Moskowitz A, Donnino MW. Thiamine administration in septic shock: a post hoc analysis of two randomized trials. Crit Care 2024; 28:41. [PMID: 38321529 PMCID: PMC10845751 DOI: 10.1186/s13054-024-04818-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/25/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND This is a post hoc analysis of combined cohorts from two previous Phase II clinical trials to assess the effect of thiamine administration on kidney protection and mortality in patients with septic shock. METHODS Patient-level data from the Thiamine in Septic Shock Trial (NCT01070810) and the Thiamine for Renal Protection in Septic Shock Trial (NCT03550794) were combined in this analysis. The primary outcome for the current study was survival without the receipt of renal replacement therapy (RRT). Analyses were performed on the overall cohort and the thiamine-deficient cohort (thiamine < 8 nmol/L). RESULTS Totally, 158 patients were included. Overall, thiamine administration was associated with higher odds of being alive and RRT-free (adjusted odds ratio [aOR]: 2.05 [95% confidence interval (CI) 1.08-3.90]) and not needing RRT (aOR: 2.59 [95% CI 1.01-6.62]). In the thiamine-deficient group, thiamine administration was associated with higher odds of being alive and RRT-free (aOR: 8.17 [95% CI 1.79-37.22]) and surviving to hospital discharge (aOR: 6.84 [95% CI 1.54-30.36]). There was a significant effect modification by baseline thiamine deficiency for alive and RRT-free (interaction, p = 0.016) and surviving to hospital discharge (p = 0.019). CONCLUSION In the combined analysis of two previous randomized trials, thiamine administration was associated with higher odds of being alive and RRT-free at hospital discharge in patients with septic shock. This signal was stronger in patients with thiamine deficiency.
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Affiliation(s)
- Jacob Vine
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - John H Lee
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Max S Kravitz
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Anne V Grossestreuer
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lakshman Balaji
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Shannon B Leland
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Noa Berlin
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
| | - Ari Moskowitz
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Critical Care Medicine, Montefiore Medical Center, The Bronx, NY, USA
- Bronx Center for Critical Care Outcomes and Resuscitation Research, The Bronx, NY, USA
| | - Michael W Donnino
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Berlin N, Pfaff A, Rozanski EA, Chalifoux NV, Hess RS, Donnino MW, Silverstein DC. Establishment of a reference interval for thiamine concentrations in healthy dogs and evaluation of the prevalence of absolute thiamine deficiency in critically ill dogs with and without sepsis using high-performance liquid chromatography. J Vet Emerg Crit Care (San Antonio) 2024; 34:49-56. [PMID: 37987121 PMCID: PMC11007751 DOI: 10.1111/vec.13341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/11/2022] [Accepted: 07/29/2022] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To determine the normal reference interval (RI) for thiamine concentrations in healthy dogs and investigate the prevalence of thiamine deficiency in critically ill dogs with and without sepsis. DESIGN Prospective, observational, multicenter study, conducted between 2019 and 2021. SETTING Two veterinary university teaching hospitals. ANIMALS A total of 109 dogs were enrolled into 3 groups: 40 healthy dogs, 33 dogs with suspected or confirmed sepsis and evidence of tissue hypoperfusion (Doppler blood pressure ≤90 mm Hg or plasma lactate ≥3 mmol/L), and 36 dogs with other critical illnesses and evidence of tissue hypoperfusion. INTERVENTIONS For each dog, CBC, serum biochemistry, plasma lactate concentration, whole-blood thiamine concentration, blood pressure, vital parameters, Acute Patient Physiologic and Laboratory Evaluation (APPLE)fast score, and clinical outcomes were recorded, alongside basic patient parameters and dietary history. Whole-blood thiamine pyrophosphate (TPP) concentrations were measured using high-performance liquid chromatography. MEASUREMENTS AND MAIN RESULTS The RI for whole-blood TPP in healthy dogs was 70.9-135.3 μg/L. Median TPP concentrations were significantly lower in septic dogs compared to healthy controls (P = 0.036). No significant difference in median TPP concentrations was found between septic dogs and nonseptic critically ill dogs, or between healthy dogs and nonseptic critically ill dogs. TPP concentrations were below the normal RI in 27.3% of septic dogs, compared to 19.4% of nonseptic critically ill dogs (P = 0.57). No correlations were found between TPP concentrations and lactate concentrations, age, body condition scores, time since last meal, RBC count, serum alanine aminotransferase, APPLEfast scores, or patient outcomes. CONCLUSIONS TPP concentrations were significantly lower in septic dogs compared to healthy controls, with an absolute thiamine deficiency found in 27.3% of septic dogs. The established TPP RI allows for further investigation of thiamine deficiency in critically ill dogs.
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Affiliation(s)
- Noa Berlin
- Foster Hospital for Small Animals, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alexandra Pfaff
- Foster Hospital for Small Animals, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
| | - Elizabeth A Rozanski
- Foster Hospital for Small Animals, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
| | - Nolan V Chalifoux
- Matthew J Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecka S Hess
- Matthew J Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Michael W Donnino
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Deborah C Silverstein
- Matthew J Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Agedal KJ, Steidl KE, Burgess JL. An Overview of Type B Lactic Acidosis Due to Thiamine (B1) Deficiency. J Pediatr Pharmacol Ther 2023; 28:397-408. [PMID: 38130495 PMCID: PMC10731935 DOI: 10.5863/1551-6776-28.5.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/08/2022] [Indexed: 12/23/2023]
Abstract
Type B lactic acidosis can occur secondary to several factors, including thiamine deficiency, and is not as common as type A. Recognizing thiamine deficiency-associated lactic acidosis is challenging because serum thiamine concentrations are not routinely obtained, and a thorough and specific history is necessary for clinicians to suspect thiamine deficiency as a root cause. Furthermore, the appropriate dose and duration of thiamine treatment are not well defined. Untreated thiamine deficiency-associated lactic acidosis can lead to critical illness requiring lifesaving extracorporeal therapies. Additionally, if thiamine and glucose are not administered in an appropriate sequence, Wernicke encephalopathy or Korsakoff syndrome may occur. This review aims to summarize therapeutic treatment for thiamine deficiency-associated lactic acidosis, based on case reports/series and nutritional guidance. After a literature search of the PubMed database, 63 citations met inclusion criteria, of which 21 involved pediatric patients and are the focus of this review. -Citations describe dosing regimens ranging from 25 to 1000 mg of intravenous (IV) thiamine as a single dose, or multiple daily doses for several days. Specific guidance for critically ill adults recommends a thiamine range of 100 mg IV once daily to 400 mg IV twice daily. Although there are no specific recommendations for the pediatric population, given the relative safety of thiamine administration, its low cost, and our review of the literature, treatment with thiamine 100 to 200 mg IV at least once is supported, with ongoing daily doses based on clinical response of the patient, regardless of age.
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Affiliation(s)
- Kaitlyn J. Agedal
- Department of Pharmacy (KJA, KES, JLB), SUNY Upstate University Hospital, Syracuse, NY
| | - Kelly E. Steidl
- Department of Pharmacy (KJA, KES, JLB), SUNY Upstate University Hospital, Syracuse, NY
- Department of Pediatrics (KES), SUNY Upstate Medical University, Syracuse, NY
| | - Jeni L. Burgess
- Department of Pharmacy (KJA, KES, JLB), SUNY Upstate University Hospital, Syracuse, NY
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Sangla F, Verissimo T, Faivre A, Glauser T, Cheah SK, Assouline B, Sgardello S, Legouis D. Thiamine as a metabolic resuscitator in septic shock: a meta-analysis of randomized controlled trials with trial sequential analysis. Front Med (Lausanne) 2023; 10:1223862. [PMID: 37780556 PMCID: PMC10533915 DOI: 10.3389/fmed.2023.1223862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023] Open
Abstract
ObjectiveSeptic shock is one of the most common reasons for admission to the Intensive Care Unit (ICU) and is associated with high mortality. Fundamentally, its management rests on antibiotics, fluid therapy and vasopressor use while many adjunctive therapies have shown disappointing results. Thiamine has recently gained interest as a metabolic resuscitator, though recent trials have tempered this enthusiasm, more specifically when thiamine is associated with ascorbic acid. However, thiamine use alone has been poorly investigated.DesignWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) in septic shock patients to assess the effects of thiamine without ascorbic acid as an adjunctive therapy.SettingPubMed, Embase and the Cochrane library databases were searched from inception to April of 2023. Data were extracted independently by two authors. The main outcome was mortality.SubjectsWe included RCTs comparing standard care using thiamine alone, to standard care or placebo, in patients admitted to the ICU with sepsis or septic shock.Main resultsWe included 5 RCTs (n = 293 patients). In this analysis, use of thiamine alone did not significantly change mortality, RR 0.87 (95%CI 0.65; 1.16, I2 = 21%) p = 0.34.ConclusionCurrent RCTs did not show an improvement in mortality when using thiamine in septic shock patients as an adjunctive therapy. However, these trials are largely underpowered for a definitive conclusion to be drawn. Further studies are therefore needed to assess the effects of thiamine without ascorbic acid as an adjunctive therapy.
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Affiliation(s)
- Frédéric Sangla
- Intensive Care Medicine Unit, Division of Intensive Care, Department of Acute Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Thomas Verissimo
- Laboratory of Nephrology, Department of Medicine and Cell Physiology, University Hospital and University of Geneva, Geneva, Switzerland
| | - Anna Faivre
- Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Térence Glauser
- Department of Anesthesiology, Centre Hospitalier de Bienne, Bienne, Switzerland
| | - Saw Kian Cheah
- Department of Anesthesiology and Intensive Care, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia
| | - Benjamin Assouline
- Intensive Care Medicine Unit, Division of Intensive Care, Department of Acute Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Sebastian Sgardello
- Department of Surgery, Centre Hospitalier du Valais Romand, Sion, Switzerland
| | - David Legouis
- Intensive Care Medicine Unit, Division of Intensive Care, Department of Acute Medicine, University Hospital of Geneva, Geneva, Switzerland
- Laboratory of Nephrology, Department of Medicine and Cell Physiology, University Hospital and University of Geneva, Geneva, Switzerland
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6
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Fujii T, Sevransky J. Thiamine for Septic Shock: Take Your Vitamins? Am J Respir Crit Care Med 2023; 208:513-515. [PMID: 37490623 PMCID: PMC10492244 DOI: 10.1164/rccm.202307-1140ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/25/2023] [Indexed: 07/27/2023] Open
Affiliation(s)
- Tomoko Fujii
- Intensive Care Unit Jikei University Hospital Tokyo, Japan
- Australian and New Zealand Intensive Care Research Centre Monash University School of Public Health and Preventive Medicine Melbourne, Victoria, Australia
| | - Jonathan Sevransky
- Division of Pulmonary, Allergy, Critical Care, and Sleep Emory University Atlanta, Georgia
- Emory Critical Care Center Emory Healthcare Atlanta, Georgia
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Yue S, Wang J, Zhao Y, Ye E, Niu D, Huang J, Li X, Hu Y, Hou X, Wu J. Thiamine administration may increase survival benefit in critically ill patients with myocardial infarction. Front Nutr 2023; 10:1227974. [PMID: 37706212 PMCID: PMC10497214 DOI: 10.3389/fnut.2023.1227974] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/16/2023] [Indexed: 09/15/2023] Open
Abstract
Background Myocardial infarction (MI) is a common cardiovascular disease (CVD) in critically ill patients, leading to 17% mortality in the intensive care unit (ICU) setting. Patients with CVD frequently suffer from thiamine insufficiency, thereby thiamine supplements may be helpful. Unfortunately, the relationship between thiamine treatment and survival outcomes in ICU patients with MI is still unknown. The purpose of the research is to demonstrate the survival advantage of thiamine application in these patients. Methods The Medical Information Mart of Intensive Care-IV database served as the foundation for this retrospective cohort analysis. Depending on whether patients were given thiamine therapy during the hospital stay, critically ill MI patients were split into the thiamine and non-thiamine groups. The Kaplan-Meier (KM) method and Cox proportional hazard models were used to evaluate the relationship between thiamine use and the risk of in-hospital, 30-day, and 90-day mortality. To validate the results, a 1:2 closest propensity-score matching (PSM) was also carried out. Results This study included 1782 patients for analysis with 170 and 1,612 individuals in the thiamine and non-thiamine groups, respectively. The KM survival analyses revealed that the risk of in-hospital, 30-day, and 90-day mortality was significantly lower in the thiamine group than the none-thiamine group. After modifying for a variety of confounding factors, the Cox regression models demonstrated substantial positive impacts of thiamine use on in-hospital, 30-d, and 90-d mortality risk among critically ill patients with MI with hazard ratio being 0.605 [95% confidence interval (CI): 0.397-0.921, p = 0.019], 0.618 (95% CI: 0.398-0.960, p = 0.032), and 0.626 (95% CI: 0.411-0.953, p = 0.028), respectively, in the completely modified model. PSM analyses also obtained consistent results. Conclusion Thiamine supplementation is related to a decreased risk of mortality risk in critically ill patients with MI who are admitted to the ICU. More multicenter, large-sample, and well-designed randomized controlled trials are needed to validate this finding.
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Affiliation(s)
- Suru Yue
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- Guangdong Engineering Research Center of Collaborative Innovation of Clinical Medical Big Data Cloud Service in Western Guangdong Medical Union, Affiliated Hospital of Guangdong Medical University, Zhanjian, Guangdong, China
| | - Jia Wang
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- Guangdong Engineering Research Center of Collaborative Innovation of Clinical Medical Big Data Cloud Service in Western Guangdong Medical Union, Affiliated Hospital of Guangdong Medical University, Zhanjian, Guangdong, China
| | - Yumei Zhao
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- Guangdong Engineering Research Center of Collaborative Innovation of Clinical Medical Big Data Cloud Service in Western Guangdong Medical Union, Affiliated Hospital of Guangdong Medical University, Zhanjian, Guangdong, China
| | - Enlin Ye
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Dongdong Niu
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Jiasheng Huang
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Xiaolin Li
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Yiling Hu
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Xuefei Hou
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- Guangdong Engineering Research Center of Collaborative Innovation of Clinical Medical Big Data Cloud Service in Western Guangdong Medical Union, Affiliated Hospital of Guangdong Medical University, Zhanjian, Guangdong, China
| | - Jiayuan Wu
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- Guangdong Engineering Research Center of Collaborative Innovation of Clinical Medical Big Data Cloud Service in Western Guangdong Medical Union, Affiliated Hospital of Guangdong Medical University, Zhanjian, Guangdong, China
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Yu D, Tang X, Xue H, Ao Y, Xie Y, Li X. Paraneoplastic syndrome in malignant lymphoma: A case report. Heliyon 2023; 9:e18968. [PMID: 37636455 PMCID: PMC10458334 DOI: 10.1016/j.heliyon.2023.e18968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 07/12/2023] [Accepted: 08/03/2023] [Indexed: 08/29/2023] Open
Abstract
Hypercalcaemia associated with malignancy is a complication of advanced tumors. Lactic acidosis is also an extremely rare paraneoplastic syndrome of malignancy, and the presence of both usually indicates an extremely poor prognosis for the tumour. Diffuse large B-cell lymphoma is the most common type of non-Hodgkin's lymphoma and is also a common aggressive lymphoma. It is extremely rare for patients with diffuse large B-cell lymphoma to develop both hypercalcaemia and severe lactic acidosis. In this article, we report a case of CD5 positive diffuse large B-cell lymphoma with hypercalcaemic crisis and persistent lactic acidosis, in which calcium was rapidly reduced to normal after rehydration, diuresis, calcitonin and zoledronate, and continuous renal replacement therapy (CRRT). After correction of acidosis with sodium bicarbonate, diuresis, vitamin B1 and CRRT, the patient's lactate remained at a high level. The aim of this article is to analyse the experience of the combination of hypercalcaemia and intractable lactic acidosis, which should be considered as a serious electrolyte disorder possibly associated with abnormal metabolism of malignant tumors, and to identify and treat the primary lesion as early as possible.
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Affiliation(s)
- Dian Yu
- Lianyungang Clinical College of Nanjing Medical University, China
- Department of Emergency and Critical Care Medicine, The First People's Hospital of Lianyungang, China
- Clinical College of Guizhou Medical University, China
| | - Xinyi Tang
- Lianyungang Clinical College of Nanjing Medical University, China
- Department of Emergency and Critical Care Medicine, The First People's Hospital of Lianyungang, China
| | - Haoyue Xue
- Department of Emergency and Critical Care Medicine, The First People's Hospital of Lianyungang, China
- Lianyungang Clinical College of Xuzhou Medical University, China
| | - Yongfeng Ao
- Clinical College of Guizhou Medical University, China
| | - Yongpeng Xie
- Lianyungang Clinical College of Nanjing Medical University, China
- Department of Emergency and Critical Care Medicine, The First People's Hospital of Lianyungang, China
- Lianyungang Clinical College of Xuzhou Medical University, China
| | - Xiaomin Li
- Lianyungang Clinical College of Nanjing Medical University, China
- Department of Emergency and Critical Care Medicine, The First People's Hospital of Lianyungang, China
- Lianyungang Clinical College of Xuzhou Medical University, China
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9
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Kshirsagar SJ, Kute S, Bhalerao PM. Anaesthesia and intensive care management of shoshin beriberi in perioperative period in young adult. Ann Card Anaesth 2023; 26:318-320. [PMID: 37470531 PMCID: PMC10451140 DOI: 10.4103/aca.aca_133_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/26/2022] [Accepted: 10/18/2022] [Indexed: 07/21/2023] Open
Abstract
Thiamine deficiency presents as dry and wet beriberi. Wet beriberi is a complication of the cardiovascular system. Acute form of wet beriberi known as Shoshin beriberi is an acute presentation of cardiogenic shock which is rapidly reversed with thiamine administration. Here we present successful management of intraoperative acute decompensated heart failure, probably due to thiamine deficiency.
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Affiliation(s)
- Sujit J. Kshirsagar
- Department of Anaesthesiology, B. J. Government Medical College, Pune, Maharashtra, India
| | - Shivaji Kute
- Department of Anaesthesiology, B. J. Government Medical College, Pune, Maharashtra, India
| | - Pradnya M. Bhalerao
- Department of Anaesthesiology, B. J. Government Medical College, Pune, Maharashtra, India
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Gundogan K, Sahin GG, Ergul SS, Ozer NT, Temel S, Akbas T, Ercan T, Yildiz H, Dizdar OS, Simsek Z, Aydın K, Ulu R, Zerman A, Dal HC, Aydin E, Ozyilmaz E, Ateş N, Gonderen K, Yalcin N, Topeli A, Tok G, Edipoglu O, Ergan B, Aydemir FD, Akbudak IH, Ergun R, Yuksel RC, Sungur M, Griffith DP, Ziegler TR. Evaluation of whole blood thiamine pyrophosphate concentrations in critically ill patients receiving chronic diuretic therapy prior to admission to Turkish intensive care units: A pragmatic, multicenter, prospective study. J Crit Care 2023; 77:154326. [PMID: 37186999 DOI: 10.1016/j.jcrc.2023.154326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND/OBJECTIVES Thiamine plays a pivotal role in energy metabolism. The aim of the study was to determine serial whole blood TPP concentrations in critically ill patients receiving chronic diuretic treatment before ICU admission and to correlate TPP levels with clinically determined serum phosphorus concentrations. SUBJECTS/METHODS This observational study was performed in 15 medical ICUs. Serial whole blood TPP concentrations were measured by HPLC at baseline and at days 2, 5 and 10 after ICU admission. RESULTS A total of 221 participants were included. Of these, 18% demonstrated low TPP concentrations upon admission to the ICU, while 26% of participants demonstrated low levels at some point during the 10-day study period. Hypophosphatemia was detected in 30% of participants at some point during the 10-day period of observation. TPP levels were significantly and positively correlated with serum phosphorus levels at each time point (P < 0.05 for all). CONCLUSIONS Our results show that 18% of these critically ill patients exhibited low whole blood TPP concentrations on ICU admission and 26% had low levels during the initial 10 ICU days, respectively. The modest correlation between TPP and phosphorus concentrations suggests a possible association due to a refeeding effect in ICU patients requiring chronic diuretic therapy.
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Affiliation(s)
- Kursat Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye; Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye.
| | - Gulsah G Sahin
- Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Serap S Ergul
- Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Nurhayat T Ozer
- Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Sahin Temel
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye
| | - Turkay Akbas
- Division of Intensive Care Medicine, Department of Internal Medicine, Duzce University School of Medicine, Duzce, Turkiye
| | - Talha Ercan
- Division of Intensive Care Medicine, Department of Internal Medicine, Duzce University School of Medicine, Duzce, Turkiye
| | - Hamit Yildiz
- Department of Internal Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Turkiye
| | - Oguzhan S Dizdar
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkiye
| | - Zuhal Simsek
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkiye
| | - Kaniye Aydın
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkiye
| | - Ramazan Ulu
- Department of Nephrology, Firat Medical Faculty, Elazig, Turkiye
| | - Avsar Zerman
- Department of Intensive Care Unit, Kirsehir Ahi Evran University, Kirsehir, Turkiye
| | - Hayriye C Dal
- Department of Intensive Care Unit, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkiye
| | - Emre Aydin
- Department of Nephrology, School of Medicine, Dicle University, Diyarbakır, Turkiye
| | - Ezgi Ozyilmaz
- Division of Intensive Care Medicine, Department of Internal Medicine, Cukurova University School of Medicine, Adana, Turkiye
| | - Nazire Ateş
- Division of Intensive Care Medicine, Department of Internal Medicine, Cukurova University School of Medicine, Adana, Turkiye
| | - Kamil Gonderen
- Clinic of Intensive Care Unit, Kütahya Evliya Çelebi Training and Research Hospital, Kütahya, Turkiye
| | - Nazif Yalcin
- Clinic of Intensive Care Unit, Kütahya Evliya Çelebi Training and Research Hospital, Kütahya, Turkiye
| | - Arzu Topeli
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkiye
| | - Gulay Tok
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkiye
| | - Ozlem Edipoglu
- Department of Intensive Care Unit, Health Sciences University, İzmir Dr.Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkiye
| | - Begum Ergan
- Division of Intensive Care Medicine, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkiye
| | - Ferhan D Aydemir
- Division of Intensive Care Medicine, Canakkale Mehmet Akif Ersoy State Hospital, Canakkale, Turkiye
| | - Ismail H Akbudak
- Division of Intensive Care Medicine, Department of Internal Medicine, Pamukkale University School of Medicine, Denizli, Turkiye
| | - Recai Ergun
- Department of Chest Diseases, Selçuk University Faculty of Medicine, Konya, Turkiye
| | - Recep C Yuksel
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye
| | - Murat Sungur
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkiye; Department of Clinical Nutrition, Erciyes University Health Sciences Institute, Kayseri, Turkiye
| | - Daniel P Griffith
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, GA, USA
| | - Thomas R Ziegler
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, GA, USA; Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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11
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McGovern J, Wadsworth J, Catchpole A, Richards C, McMillan DC, Kelliher T, Goodall E, Murray E, Melaugh T, McPhillips S, Brice K, Barbour K, Robinson S, Moffitt P, Kemp O, Talwar D, Maguire D. The relationship between micronutrient status, frailty, systemic inflammation, and clinical outcomes in patients admitted to hospital with COVID-19. J Transl Med 2023; 21:284. [PMID: 37118813 PMCID: PMC10139911 DOI: 10.1186/s12967-023-04138-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/16/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Micronutrients have been associated with disease severity and poorer clinical outcomes in patients with COVID-19. However, there is a paucity of studies examining if the relationship with micronutrient status and clinical outcomes is independent of recognised prognostic factors, specifically frailty and the systemic inflammatory response (SIR). The aim of the present study was to examine the relationship between micronutrient status, frailty, systemic inflammation, and clinical outcomes in patients admitted with COVID-19. METHODS Retrospective analysis of prospectively collected data was performed on patients with confirmed COVID-19, admitted to hospital between the 1st April 2020-6th July 2020. Clinicopathological characteristics, frailty assessment, biochemical and micronutrient laboratory results were recorded. Frailty status was determined using the Clinical Frailty scale. SIR was determined using serum CRP. Clinical outcomes of interest were oxygen requirement, ITU admission and 30-day mortality. Categorical variables were analysed using chi-square test and binary logistics regression analysis. Continuous variables were analysed using the Mann-Whitney U or Kruskal Wallis tests. RESULTS 281 patients were included. 55% (n = 155) were aged ≥ 70 years and 39% (n = 109) were male. 49% (n = 138) of patients were frail (CFS > 3). 86% (n = 242) of patients had a serum CRP > 10 mg/L. On univariate analysis, frailty was significantly associated with thirty-day mortality (p < 0.001). On univariate analysis, serum CRP was found to be significantly associated with an oxygen requirement on admission in non-frail patients (p = 0.004). Over a third (36%) of non-frail patients had a low vitamin B1, despite having normal reference range values of red cell B2, B6 and selenium. Furthermore, serum CRP was found to be significantly associated with a lower median red cell vitamin B1 (p = 0.029). CONCLUSION Vitamin B1 stores may be depleted in COVID-19 patients experiencing a significant SIR and providing rationale for thiamine supplementation. Further longitudinal studies are warranted to delineate the trend in thiamine status following COVID-19.
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Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
| | - John Wadsworth
- Clinical Biochemistry Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Anthony Catchpole
- Clinical Biochemistry Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Conor Richards
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Level 2, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
| | - Tadhg Kelliher
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Emma Goodall
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Ellie Murray
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Terry Melaugh
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | | | - Kathryn Brice
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Katie Barbour
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Sophie Robinson
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Peter Moffitt
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Olivia Kemp
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Dinesh Talwar
- Clinical Biochemistry Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Donogh Maguire
- Emergency Department, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
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12
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Abdelaziz TA, Atfy M, Elalawi SM, Baz EG. Thiamine status during treatment of diabetic ketoacidosis in children - tertiary care centre experience. J Pediatr Endocrinol Metab 2023; 36:179-184. [PMID: 36440592 DOI: 10.1515/jpem-2022-0387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES There is a lack of information regarding thiamine status in children with diabetic ketoacidosis (DKA). This study was designed to assess the thiamine status upon admission and 24 h after treatment initiation of DKA, whether newly diagnosed children or with established T1DM diagnosis, who presented with DKA. METHODS We enrolled 90 children (mean age, 9.8 ± 2.6 years; 58 females and 32 males) with type 1 diabetes mellitus (T1DM), whether newly diagnosed or with an established T1DM diagnosis (from 1 to 5.2 years ago), who presented with DKA. We observed the initial Glasgow Coma Scale (GCS) and recovery time. The whole blood thiamine diphosphate levels were measured upon admission (baseline point) and 24 h after initiation of the DKA treatment (second-time point). RESULTS The mean blood thiamine levels at the second-time point (90.11 ± 15.76 nmol/L) significantly decreased compared with their levels at baseline (108.8 ± 17.6 nmol/L) (p<0.001). We compared thiamine levels with the initial GCS, patient's age, and recovery time. Thiamine levels at the second-time point were positively correlated with baseline thiamine levels (r=0.86, p=0.0001) and the initial GCS (r=0.68, p=0.001) but were negatively correlated with patient's age (r=-0.61, p=0.001) and recovery time (r=-0.724, p=0.001). Based on multiple regression analysis, thiamine levels at the second-time point were directly related to the initial GCS and inversely related to the patient's age. CONCLUSIONS The current study indicates that blood thiamine diphosphate levels significantly decreased after 24 h of DKA treatment initiation compared to pre-treatment levels. After 24 h of treatment initiation, blood thiamine levels are directly related to the initial GCS and inversely related to the patient's age.
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Affiliation(s)
- Tarek A Abdelaziz
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mervat Atfy
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Saffaa M Elalawi
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Eman Gamal Baz
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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13
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Thiamine pharmaconutrition in sepsis: Monotherapy, combined therapy, or neither? Current evidence on safety and efficacy. Nutrition 2023; 109:112000. [PMID: 36913862 DOI: 10.1016/j.nut.2023.112000] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/30/2023] [Accepted: 02/04/2023] [Indexed: 02/25/2023]
Abstract
Sepsis is a life-threatening condition characterized by multiorgan dysfunction due to an exaggerated host response to infection associated with a homeostatic failure. In sepsis, different interventions, aimed at improving clinical outcomes, have been tested over the past decades. Among these most recent strategies, intravenous high-dose micronutrients (vitamins and/or trace elements) have been investigated. According to current knowledge, sepsis is characterized by low thiamine levels, which are associated with illness severity, hyperlactatemia, and poor clinical outcomes. However, caution is needed about the clinical interpretation of thiamine blood concentration in critically ill patients, and the inflammatory status, based on C-reactive protein levels, should always be measured. In sepsis, parenteral thiamine has been administered as monotherapy or in combination with vitamin C and corticosteroids. Nevertheless, most of those trials failed to report clinical benefits with high-dose thiamine. The purpose of this review is to summarize the biological properties of thiamine and to examine current knowledge regarding the safety and efficacy of high-dose thiamine as pharmaconutrition strategy when administering singly or in combination with other micronutrients in critically ill adult patients with sepsis or septic shock. Our examination of the most up-to-date evidence concludes that Recommended Daily Allowance supplementation is relatively safe for thiamine-deficient patients. However, current evidence does not support pharmaconutrition with high-dose thiamine as a single therapy or as combination therapy aimed at improving clinical outcomes in critically ill septic patients. The best nutrient combination still needs to be determined, based on the antioxidant micronutrient network and the multiple interactions among different vitamins and trace elements. In addition, a better understanding of the pharmacokinetic and pharmacodynamic profiles of intravenous thiamine is needed. Future well-designed and powered clinical trials are urgently warranted before any specific recommendations can be made regarding supplementation in the critical care setting.
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14
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Blakeslee PA, Hyrkäs K. Impact of supplemental thiamin on lactate levels in adults with septic shock. Nutr Clin Pract 2023; 38:580-601. [PMID: 36633131 DOI: 10.1002/ncp.10930] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/09/2022] [Accepted: 10/09/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Elevated lactate levels at 24 h are highly predictive of in-hospital mortality in adults with septic shock. Thiamin is closely involved in carbohydrate metabolism, and in thiamin-deficient states, increased lactic acid levels can be found, exacerbated by critical illness. This integrative literature review focused on the relationship between supplemental thiamin, lactate clearance, and impact on mortality in sepsis. METHODS A search in PubMed, Embase, and CINAHL was conducted for literature published between January 2016 and January 2021. We included observational studies and clinical trials with ≥10 participants. We excluded studies involving pediatric (<18 years old) populations, animal studies, case studies, dropout rate of >20%, nonhospitalized patients, or patients receiving comfort measures only. RESULTS A total of 48 full-text articles were assessed for eligibility, with 15 evaluated for this integrative review. Included were five retrospective, two prospective observational, and eight randomized controlled trials. In almost all retrospective studies, thiamin administration was associated with decreased mortality, and in observational studies, with decreased lactate and improved clinical outcomes. In clinical trials, thiamin with or without vitamin C/hydrocortisone did not impact clinical outcomes or mortality. However, four trials testing intravenous thiamin 200-500 mg two to three times daily for up to 3 days reported improved lactate clearance. CONCLUSIONS Thiamin supplementation may improve lactate clearance when administered in the first 24 h. Those deficient in thiamin may benefit more from supplementation. The combination of thiamin, vitamin C, and/or hydrocortisone may not be advantageous. Lactate reduction in response to thiamin needs further rigorous research.
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Affiliation(s)
- Paul A Blakeslee
- Clinical Nutrition Program, Maine Medical Center, Portland, Maine, USA
| | - Kristiina Hyrkäs
- Center for Nursing Research and Quality Outcomes, Maine Medical Center, Portland, Maine, USA
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15
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Yang R, Huang J, Zhao Y, Wang J, Niu D, Ye E, Yue S, Hou X, Cui L, Wu J. Association of thiamine administration and prognosis in critically ill patients with heart failure. Front Pharmacol 2023; 14:1162797. [PMID: 37033650 PMCID: PMC10076601 DOI: 10.3389/fphar.2023.1162797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/15/2023] [Indexed: 04/11/2023] Open
Abstract
Background: Thiamine deficiency is common in patients with heart failure, and thiamine supplement can benefit these patients. However, the association between thiamine administration and prognosis among critically ill patients with heart failure remains unclear. Thus, this study aims to prove the survival benefit of thiamine use in critically ill patients with heart failure. Methods: A retrospective cohort analysis was performed on the basis of the Medical Information Mart of Intensive Care-Ⅳ database. Critically ill patients with heart failure were divided into the thiamine and non-thiamine groups depending on whether they had received thiamine therapy or not during hospitalization. The association between thiamine supplement and in-hospital mortality was assessed by using the Kaplan-Meier (KM) method and Cox proportional hazard models. A 1:1 nearest propensity-score matching (PSM) and propensity score-based inverse probability of treatment weighting (IPW) were also performed to ensure the robustness of the findings. Results: A total of 7,021 patients were included in this study, with 685 and 6,336 in the thiamine and non-thiamine groups, respectively. The kaplan-meier survival curves indicated that the thiamine group had a lower in-hospital mortality than the none-thiamine group. After adjusting for various confounders, the Cox regression models showed significant beneficial effects of thiamine administration on in-hospital mortality among critically ill patients with heart failure with a hazard ratio of 0.78 (95% confidence interval: 0.67-0.89) in the fully adjusted model. propensity-score matching and probability of treatment weighting analyses also achieved consistent results. Conclusion: Thiamine supplement is associated with a decreased risk of in-hospital mortality in critically ill patients with heart failure who are admitted to the ICU. Further multicenter and well-designed randomized controlled trials with large sample sizes are necessary to validate this finding.
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Affiliation(s)
- Rui Yang
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jiasheng Huang
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Engineering Research Center of Collaborative Innovation Technology of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong Province, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yumei Zhao
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Engineering Research Center of Collaborative Innovation Technology of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong Province, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jia Wang
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Dongdong Niu
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Enlin Ye
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Suru Yue
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Engineering Research Center of Collaborative Innovation Technology of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong Province, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xuefei Hou
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Engineering Research Center of Collaborative Innovation Technology of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong Province, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Lili Cui
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Institute of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- *Correspondence: Jiayuan Wu, ; Lili Cui,
| | - Jiayuan Wu
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Engineering Research Center of Collaborative Innovation Technology of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong Province, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- *Correspondence: Jiayuan Wu, ; Lili Cui,
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16
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Lane SL, Dowgos NM, Brainard BM. Evaluation of blood thiamine concentration in hospitalized dogs with and without critical illness. J Vet Emerg Crit Care (San Antonio) 2022; 32:723-732. [PMID: 36082426 DOI: 10.1111/vec.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate blood thiamine concentration in healthy and critically ill hospitalized dogs over 72 hours of hospitalization and to identify any association of thiamine concentration with patient morbidity and mortality. DESIGN Prospective, observational, clinical study. SETTING University veterinary teaching hospital. ANIMALS Thirty-one hospitalized healthy dogs and 37 dogs with critical illness. Dogs with critical illness had nonseptic (n = 24) or septic (n = 13) etiologies. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Whole blood EDTA samples were collected within 24 hours of admission and 72 hours later. Samples were stored at -80°C and batch analyzed. Total thiamine (tB1) and thiamine diphosphate (TDP) concentrations were measured using high-performance liquid chromatography, and free thiamine concentration was determined using liquid chromatography with tandem mass spectrometry. Collected patient data included CBC, biochemistry profile, plasma lactate concentration, shock index, Acute Patient Physiologic and Laboratory Evaluation Score (APPLEfast ) score, comorbid conditions, and patient outcome. Approximately 92% of tB1 present in whole blood is measured as TDP. TDP concentration was strongly correlated with tB1 (R = 0.97, P < 0.0001). Thiamine concentration, represented by TDP, was not different at admission or at 72 hours in all dogs. TDP concentration was lower in septic dogs requiring surgery at admission (P = 0.044) and 72 hours later (P = 0.008), compared to dogs not requiring surgery. TDP concentration was not different between dogs with and without stable chronic diseases at any time point. Older dogs had lower TDP concentration. Positive correlations were seen between TDP and body weight, APPLEfast score, and WBC count. Critically ill dogs with lower admission plasma lactate concentration were more likely to have an increase in thiamine over time (P = 0.0142). CONCLUSIONS Differences in thiamine concentration were not identified in hospitalized healthy or critically ill dogs. Further investigation into the clinical relevance of thiamine deficiency is indicated in septic dogs undergoing surgery.
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Affiliation(s)
- Selena L Lane
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Nicole M Dowgos
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
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Li K, Tong HHY, Chen Y, Sun Y, Wang J. The emerging roles of next-generation metabolomics in critical care nutrition. Crit Rev Food Sci Nutr 2022; 64:1213-1224. [PMID: 36004623 DOI: 10.1080/10408398.2022.2113761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Critical illness leads to millions of deaths worldwide each year, with a significant surge due to the COVID-19 pandemic. Patients with critical illness are frequently associated with systemic metabolic disorders and malnutrition. The idea of intervention for critically ill patients through enteral and parenteral nutrition has been paid more and more attention gradually. However, current nutritional therapies focus on evidence-based practice, and there have been lacking holistic approaches for nutritional support assessment. Metabolomics is a well-established omics technique in system biology that enables comprehensive profiling of metabolites in a biological system and thus provides the underlying information expressed and modulated by all other omics layers. In recent years, with the development of high-resolution and accurate mass spectrometry, metabolomics entered a new "generation", promoting its broader applications in critical care nutrition. In this review, we first described the technological development and milestones of next-generation metabolomics in the past 20 years. We then discussed the emerging roles of next-generation metabolomics in advancing our understanding of critical care nutrition, such as nutritional deficiency risk evaluation, metabolic mechanisms of nutritional therapies, and novel nutrition target identification.
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Affiliation(s)
- Kefeng Li
- Department of Critical Care Medicine, Yantai Yuhuangding Hospital Affiliated with Medical College of Qingdao University, Yantai, Shandong, China
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao SAR, China
- School of Medicine, University of California, San Diego, California, USA
| | - Henry Hoi Yee Tong
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao SAR, China
| | - Yuwei Chen
- The Second Clinical Medical College, Binzhou Medical University, Binzhou, Shandong, China
| | - Yizhu Sun
- Department of Critical Care Medicine, Yantai Yuhuangding Hospital Affiliated with Medical College of Qingdao University, Yantai, Shandong, China
| | - Jing Wang
- Department of Critical Care Medicine, Yantai Yuhuangding Hospital Affiliated with Medical College of Qingdao University, Yantai, Shandong, China
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18
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Associations between early thiamine administration and clinical outcomes in critically ill patients with acute kidney injury. Br J Nutr 2022; 128:183-191. [PMID: 34392848 DOI: 10.1017/s0007114521003111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The effects of early thiamine use on clinical outcomes in critically ill patients with acute kidney injury (AKI) are unclear. The purpose of this study was to investigate the associations between early thiamine administration and clinical outcomes in critically ill patients with AKI. The data of critically ill patients with AKI within 48 h after ICU admission were extracted from the Medical Information Mart for Intensive Care III (MIMIC III) database. PSM was used to match patients early receiving thiamine treatment to those not early receiving thiamine treatment. The association between early thiamine use and in-hospital mortality due to AKI was determined using a logistic regression model. A total of 15 066 AKI patients were eligible for study inclusion. After propensity score matching (PSM), 734 pairs of patients who did and did not receive thiamine treatment in the early stage were established. Early thiamine use was associated with lower in-hospital mortality (OR 0·65; 95 % CI 0·49, 0·87; P < 0·001) and 90-d mortality (OR 0·58; 95 % CI 0·45, 0·74; P < 0·001), and it was also associated with the recovery of renal function (OR 1·26; 95 % CI 1·17, 1·36; P < 0·001). In the subgroup analysis, early thiamine administration was associated with lower in-hospital mortality in patients with stages 1 to 2 AKI. Early thiamine use was associated with improved short-term survival in critically ill patients with AKI. It was possible beneficial role in patients with stages 1 to 2 AKI according to the Kidney Disease: Improving Global Outcomes criteria.
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19
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Thiamine pretreatment improves endotoxemia-related liver injury and cholestatic complications by regulating galactose metabolism and inhibiting macrophage activation. Int Immunopharmacol 2022; 108:108892. [DOI: 10.1016/j.intimp.2022.108892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/19/2022] [Accepted: 05/21/2022] [Indexed: 11/05/2022]
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20
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Zhang L, Li S, Lu X, Liu Y, Ren Y, Huang T, Lyu J, Yin H. Thiamine May Be Beneficial for Patients With Ventilator-Associated Pneumonia in the Intensive Care Unit: A Retrospective Study Based on the MIMIC-IV Database. Front Pharmacol 2022; 13:898566. [PMID: 35814219 PMCID: PMC9259950 DOI: 10.3389/fphar.2022.898566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Ventilator-associated pneumonia (VAP) is a common infection complication in intensive care units (ICU). It not only prolongs mechanical ventilation and ICU and hospital stays, but also increases medical costs and increases the mortality risk of patients. Although many studies have found that thiamine supplementation in critically ill patients may improve prognoses, there is still no research or evidence that thiamine supplementation is beneficial for patients with VAP. The purpose of this study was to determine the association between thiamine and the prognoses of patients with VAP. Methods: This study retrospectively collected all patients with VAP in the ICU from the Medical Information Mart for Intensive Care-IV database. The outcomes were ICU and in-hospital mortality. Patients were divided into the no-thiamine and thiamine groups depending upon whether or not they had received supplementation. Associations between thiamine and the outcomes were tested using Kaplan-Meier (KM) survival curves and Cox proportional-hazards regression models. The statistical methods of propensity-score matching (PSM) and inverse probability weighting (IPW) based on the XGBoost model were also applied to ensure the robustness of our findings. Results: The study finally included 1,654 patients with VAP, comprising 1,151 and 503 in the no-thiamine and thiamine groups, respectively. The KM survival curves indicated that the survival probability differed significantly between the two groups. After multivariate COX regression adjusted for confounding factors, the hazard ratio (95% confidence interval) values for ICU and in-hospital mortality in the thiamine group were 0.57 (0.37, 0.88) and 0.64 (0.45, 0.92), respectively. Moreover, the results of the PSM and IPW analyses were consistent with the original population. Conclusion: Thiamine supplementation may reduce ICU and in-hospital mortality in patients with VAP in the ICU. Thiamine is an inexpensive and safe drug, and so further clinical trials should be conducted to provide more-solid evidence on whether it improves the prognosis of patients with VAP.
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Affiliation(s)
- Luming Zhang
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shaojin Li
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xuehao Lu
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yu Liu
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yinlong Ren
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Tao Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China
- *Correspondence: Haiyan Yin, ; Jun Lyu,
| | - Haiyan Yin
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
- *Correspondence: Haiyan Yin, ; Jun Lyu,
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21
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Akkuzu E, Yavuz S, Ozcan S, Sincar S, Bayrakci B, Kendirli T, Pasaoglu H, Kalkan G. Prevalence and Time Course of Thiamine Deficiency in Critically Ill Children: A Multicenter, Prospective Cohort Study in Turkey. Pediatr Crit Care Med 2022; 23:399-404. [PMID: 35583619 DOI: 10.1097/pcc.0000000000002931] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the prevalence and time course of thiamine deficiency (TD) in PICU patients. DESIGN Multicenter, prospective, cohort study between May 2019 and November 2019. SETTING Three university-based tertiary care, mixed medical-surgical PICUs in Ankara, Turkey. PATIENTS PICU patients 1 month to 18 years old. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We studied 476 patients and grouped them by TD status on days 1 and 3 of the PICU admission. There might be a risk of unintended bias since we excluded 386 patients because of the absence of consent, inadequate blood samples, loss of identifier information, and recent vitamin supplementation. On day 1, TD was present in 53 of 476 patients (11.1%) and median (minimum-maximum) thiamine levels were 65.5 ng/mL (5-431 ng/mL). On day 3, TD was present in 27 of 199 patients (13.6%) with repeated measurement. The median (minimum-maximum) thiamine levels were 63 ng/mL (13-357 ng/mL). The time course of TD from day 1 to day 3 in these 199 patients was as follows. In 21 of 199 patients (10.6%) with TD on day 1, 11 of 21 (52%) continued to have TD on day 3 and the other 10 of 21 patients (48%) improved to no longer having TD. In 178 of 199 patients (89.4%) without TD on day 1, 16 of 178 (9%) went on to develop TD by day 3, and the other 162 of 178 (91%) continued to have normal thiamine status. CONCLUSIONS In the PICU population in three centers in Turkey, the prevalence of TD in the sample of patients was 11.1%. In those TD patients who had serial studies, we also identified that by day 3 some continued to be TD, and some patients improved to normal thiamine status. Of concern, however, is the population who develop TD over the course of PICU stay.
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Affiliation(s)
- Emine Akkuzu
- Department of Pediatrics, Division of Critical Care Medicine, Gazi University Hospital, Ankara, Turkey
| | - Sinan Yavuz
- Department of Pediatrics, Division of Critical Care Medicine, Life Support Center, Hacettepe University Hospital, Ankara, Turkey
| | - Serhan Ozcan
- Department of Pediatrics, Division of Critical Care Medicine, Ankara University Hospital, Ankara, Turkey
| | - Sahin Sincar
- Department of Pediatrics, Division of Critical Care Medicine, Gazi University Hospital, Ankara, Turkey
| | - Benan Bayrakci
- Department of Pediatrics, Division of Critical Care Medicine, Life Support Center, Hacettepe University Hospital, Ankara, Turkey
| | - Tanil Kendirli
- Department of Pediatrics, Division of Critical Care Medicine, Ankara University Hospital, Ankara, Turkey
| | - Hatice Pasaoglu
- Department of Biochemistry, Gazi University Hospital, Ankara, Turkey
| | - Gokhan Kalkan
- Department of Pediatrics, Division of Critical Care Medicine, Gazi University Hospital, Ankara, Turkey
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
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22
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The epidemiology, impact, and diagnosis of micronutrient nutritional dermatoses. Part 2: B-complex vitamins. J Am Acad Dermatol 2022; 86:281-292. [DOI: 10.1016/j.jaad.2021.06.900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/20/2021] [Accepted: 06/08/2021] [Indexed: 12/15/2022]
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23
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Costa NA, Pereira AG, Sugizaki CSA, Vieira NM, Garcia LR, de Paiva SAR, Zornoff LAM, Azevedo PS, Polegato BF, Minicucci MF. Insights Into Thiamine Supplementation in Patients With Septic Shock. Front Med (Lausanne) 2022; 8:805199. [PMID: 35155482 PMCID: PMC8832096 DOI: 10.3389/fmed.2021.805199] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
Septic shock is associated with unacceptably high mortality rates, mainly in developing countries. New adjunctive therapies have been explored to reduce global mortality related to sepsis. Considering that metabolic changes, mitochondrial dysfunction and increased oxidative stress are specific disorders within the path of septic shock, several micronutrients that could act in cellular homeostasis have been studied in recent decades. Thiamine, also known as vitamin B1, plays critical roles in several biological processes, including the metabolism of glucose, synthesis of nucleic acids and reduction of oxidative stress. Thiamine deficiency could affect up to 70% of critically ill patients, and thiamine supplementation appears to increase lactate clearance and decrease the vasopressor dose. However, there is no evident improvement in the survival of septic patients. Other micronutrients such as vitamin C and D, selenium and zinc have been tested in the same context but have not been shown to improve the outcomes of these patients. Some problems related to the neutrality of these clinical trials are the study design, doses, route, timing, length of intervention and the choice of endpoints. Recently, the concept that multi-micronutrient administration may be better than single-micronutrient administration has gained strength. In general, clinical trials consider the administration of a single micronutrient as a drug. However, the antioxidant defense is a complex system of endogenous agents in which micronutrients act as cofactors, and the physiological interactions between micronutrients are little discussed. In this context, the association of thiamine, vitamin C and corticoids was tested as an adjunctive therapy in septic shock resulting in a significant decrease in mortality. However, after these initial results, no other study conducted with this combination could reproduce those benefits. In addition, the use of low-dose corticosteroids is recommended in patients with septic shock who do not respond to vasopressors, which can affect the action of thiamine. Therefore, given the excellent safety profile, good biologic rationale and promising clinical studies, this review aims to discuss the mechanisms behind and the evidence for single or combined thiamine supplementation improving the prognosis of patients with septic shock.
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Affiliation(s)
- Nara Aline Costa
- Faculty of Nutrition, Universidade Federal de Goiás (UFG), Goiânia, Brazil
| | - Amanda Gomes Pereira
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil
| | | | - Nayane Maria Vieira
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil
| | - Leonardo Rufino Garcia
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil
| | | | | | - Paula Schmidt Azevedo
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil
| | - Bertha Furlan Polegato
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil
| | - Marcos Ferreira Minicucci
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil
- *Correspondence: Marcos Ferreira Minicucci
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24
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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.
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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
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25
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Yao R, Zhu Y, Yu Y, Li Z, Wang L, Zheng L, Li J, Huang H, Wu G, Zhu F, Xia Z, Ren C, Yao Y. Combination therapy of thiamine, vitamin C and hydrocortisone in treating patients with sepsis and septic shock: a meta-analysis and trial sequential analysis. BURNS & TRAUMA 2021; 9:tkab040. [PMID: 34901285 PMCID: PMC8660008 DOI: 10.1093/burnst/tkab040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/12/2021] [Indexed: 12/29/2022]
Abstract
Background The objective of this study was to evaluate the clinical efficacy of thiamine and vitamin C with or without hydrocortisone coadministration on the treatment of sepsis and septic shock. Methods MEDLINE, EMBASE and CENTRAL databases were searched for randomized controlled trials (RCTs) that made a comparative study between the combination therapy of vitamin C and thiamine with or without hydrocortisone and the administration of placebo in patients with sepsis or septic shock. Two reviewers independently performed study selection, data extraction and quality assessment. Both short-term mortality and change in the sequential organ failure assessment (SOFA) score from baseline (delta SOFA) were set as the primary outcomes. Secondary endpoints included intensive care unit (ICU) mortality, new onset of acute kidney injury, total adverse events, ICU and hospital length of stay, duration of vasopressor usage and ventilator-free days. Meanwhile, trial sequential analysis was conducted for primary outcomes. Results Eight RCTs with 1428 patients were included in the current study. The results showed no significant reduction of short-term mortality in sepsis and septic shock patients who received combination therapy of vitamin C and thiamine with or without hydrocortisone compared to those with placebo {risk ratio (RR), 1.02 [95% confidence interval (CI), 0.87 to 1.20], p = 0.81, I2 = 0%; risk difference (RD), 0 [95% CI, −0.04 to 0.05]}. Nevertheless, the combination therapy was associated with significant reduction in SOFA score [mean difference (MD), −0.63, (95% CI, −0.96 to −0.29, p < 0.001, I2 = 0%] and vasopressors duration (MD, −22.11 [95% CI, −30.46 to −13.77], p < 0.001, I2 = 6%). Additionally, there were no statistical differences in the pooled estimate for other outcomes. Conclusions In the current meta-analysis, the combination therapy of vitamin C and thiamine, with or without hydrocortisone had no impact on short-term mortality when compared with placebo, but was associated with significant reduction in SOFA score among patients with sepsis and septic shock.
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Affiliation(s)
- Renqi Yao
- Translational Medicine Research Center, Fourth Medical Center and Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing 100048, China
| | - Yibing Zhu
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yue Yu
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai 200003, China
| | - Zhixuan Li
- International Cooperation Laboratory on Signal Transduction, Eastern Hepatobiliary Surgery Institute, Second Military Medical University, Shanghai 200082, China
| | - Lixue Wang
- Translational Medicine Research Center, Fourth Medical Center and Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing 100048, China
| | - Liyu Zheng
- Translational Medicine Research Center, Fourth Medical Center and Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing 100048, China
| | - Jingyan Li
- Translational Medicine Research Center, Fourth Medical Center and Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing 100048, China
| | - Huibin Huang
- Department of Critical Care Medicine, Beijing Tsinghua Chang Gung Hospital, Beijing 102218, China
| | - Guosheng Wu
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Feng Zhu
- Department of Critical Care Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Zhaofan Xia
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Chao Ren
- Translational Medicine Research Center, Fourth Medical Center and Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing 100048, China
| | - Yongming Yao
- Translational Medicine Research Center, Fourth Medical Center and Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing 100048, China
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26
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Crecraft C, Prittie J. Electrolyte Derangements, Hyperlactatemia, and Cardiac Abnormalities Secondary to Refeeding in Three Dogs: Case Report. J Am Anim Hosp Assoc 2021; 57:294-300. [PMID: 34606603 DOI: 10.5326/jaaha-ms-7132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 11/11/2022]
Abstract
Three dogs that presented to the emergency service in severely emaciated body conditions were admitted to the hospital for monitoring and refeeding. During their hospitalization, all three dogs developed electrolyte derangements or required supplementation to prevent hypophosphatemia and hypomagnesemia. Additionally, all dogs developed hyperlactatemia, which was suspected to be secondary to thiamine deficiency. Two dogs were reported to have cardiac abnormalities, including cardiac arrhythmias, systolic dysfunction, and spontaneous echogenic contrast. These cases highlight the complexity of refeeding syndrome and its associated complications that extend beyond electrolyte deficiencies.
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27
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Long B, Lentz S, Gottlieb M. Alcoholic Ketoacidosis: Etiologies, Evaluation, and Management. J Emerg Med 2021; 61:658-665. [PMID: 34711442 DOI: 10.1016/j.jemermed.2021.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/05/2021] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Alcoholic ketoacidosis (AKA) is defined by metabolic acidosis and ketosis in a patient with alcohol use. This is a common presentation in the emergency department (ED) and requires targeted therapies. OBJECTIVE This narrative review evaluates the pathogenesis, diagnosis, and management of AKA for emergency clinicians. DISCUSSION AKA is frequently evaluated and managed in the ED. The underlying pathophysiology is related to poor glycogen stores and elevated nicotinamide adenine dinucleotide and hydrogen. This results in metabolic acidosis with elevated beta-hydroxybutyrate levels. Patients with AKA most commonly present with a history of alcohol use (acute or chronic), poor oral intake, gastrointestinal symptoms, and ketoacidosis on laboratory assessment. Patients are generally dehydrated, and serum glucose can be low, normal, or mildly elevated. An anion gap metabolic acidosis with ketosis and electrolyte abnormalities are usually present on laboratory evaluation. Management includes fluid resuscitation, glucose and vitamin supplementation, electrolyte repletion, and evaluation for other conditions. CONCLUSIONS Emergency clinician knowledge of the evaluation and management of AKA is essential in caring for these patients.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Skyler Lentz
- Division of Emergency Medicine, Department of Surgery, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
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28
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Hussein AA, Sabry NA, Abdalla MS, Farid SF. A prospective, randomised clinical study comparing triple therapy regimen to hydrocortisone monotherapy in reducing mortality in septic shock patients. Int J Clin Pract 2021; 75:e14376. [PMID: 34003568 DOI: 10.1111/ijcp.14376] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/09/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES This prospective, comparative and randomised clinical study evaluated the effectiveness of triple therapy regimen (hydrocortisone, thiamine and vitamin C) versus hydrocortisone alone in reducing the mortality rate and preventing progressive organ dysfunction in septic shock patients. METHODS A total of 94 patients were randomly assigned to one of two groups: the first group received hydrocortisone 50 mg/6-h IV for 7 days or till intensive care unit (ICU) discharge, if sooner, followed by tapering. The second group received hydrocortisone 50 mg/6-h IV for 7 days or ICU discharge followed by tapering, vitamin C 1.5 g/6-h IV for 4 days or till ICU discharge and thiamine 200 mg/12-h IV for 4 days or till ICU discharge. RESULTS The triple therapy regimen showed a non-significant reduction in 28-day mortality compared to hydrocortisone alone (17 [36.2%] vs. 21 [44.7%]; P = .4005), but it was significantly lower than the control group regarding shock time and the duration of vasopressor use in days (4.000 [3.000-7.000]; 5.000 [4.000-8.000], [P = .0100]). The patients in the control group were likely to get 0.59 more in SCr level than those in the intervention group by a linear regression model which was significant (P < .05). Also, the number of patients who developed a fever after 216 hours was significantly higher in the control group (P value = .0299). CONCLUSION Vitamin C, thiamine, and hydrocortisone regimen for septic shock management showed non-significant efficacy in decreasing 28-day mortality when compared to hydrocortisone monotherapy. On the other hand, it showed significant efficacy in decreasing the shock time and duration on vasopressors.
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Affiliation(s)
| | - Nirmeen A Sabry
- Clinical pharmacy department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Maged S Abdalla
- Anaesthesia and Critical Care department, Faculty of Medicine (Kasr-el Ainy), Cairo University, Cairo, Egypt
| | - Samar F Farid
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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29
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Lange S, Mędrzycka-Dąbrowska W, Friganovic A, Oomen B, Krupa S. Delirium in Critical Illness Patients and the Potential Role of Thiamine Therapy in Prevention and Treatment: Findings from a Scoping Review with Implications for Evidence-Based Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168809. [PMID: 34444556 PMCID: PMC8392497 DOI: 10.3390/ijerph18168809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Thiamine is a water-soluble vitamin and is necessary for energy metabolism. Critically ill patients are at particular risk of developing thiamine deficiency and related complications. One of the complications that can occur is delirium. Delirium is a disorder that affects the body's response to treatment, length of stay in the ward, mortality, long-term cognitive impairment, and significantly increases treatment costs. In addition, studies show that delirium medication is more effective in preventing than in treating delirium. Given its low cost, availability, and minimal risk of side effects, thiamine supplementation could prove to be a relevant strategy in the prevention and treatment of delirium. METHODS PubMed, Cochrane Library, Ovid, and ClinicalTrials.gov databases were searched using relevant keywords that focus on the use of thiamine to prevent or treat delirium in critically ill patients. RESULTS Seven articles were included in the analysis. CONCLUSION The small number of studies and considerable heterogeneity prevent conclusions supporting the use of thiamine as an adjuvant in the prevention and treatment of delirium among critically ill patients. There is a need for high-quality, large-scale randomized clinical trials to confirm the beneficial effects of thiamine in the prevention and treatment of delirium.
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Affiliation(s)
- Sandra Lange
- Department of Anesthesiology and Intensive Care, Hospitals Tczewskie SA, 83-110 Tczew, Poland;
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdańsk, Poland
- Correspondence:
| | - Adriano Friganovic
- Department of Anesthesiology and Intensive Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
- Department of Nursing, University of Applied Health Sciences, 10000 Zagreb, Croatia
| | - Ber Oomen
- European Specialist Nurses Organization (ESNO), 6821HR Arnhem, The Netherlands;
| | - Sabina Krupa
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, 35-310 Rzeszow, Poland;
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30
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Kripps KA, Baker PR, Thomas JA, Skillman HE, Bernstein L, Gaughan S, Burns C, Coughlin CR, McCandless SE, Larson AA, Kochar A, Stillman CF, Wymore EM, Hendricks EG, Woontner M, Van Hove JLK. REVIEW: Practical strategies to maintain anabolism by intravenous nutritional management in children with inborn metabolic diseases. Mol Genet Metab 2021; 133:231-241. [PMID: 33985889 DOI: 10.1016/j.ymgme.2021.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/31/2022]
Abstract
One of the most vital elements of management for patients with inborn errors of intermediary metabolism is the promotion of anabolism, the state in which the body builds new components, and avoidance of catabolism, the state in which the body breaks down its own stores for energy. Anabolism is maintained through the provision of a sufficient supply of substrates for energy, as well as critical building blocks of essential amino acids, essential fatty acids, and vitamins for synthetic function and growth. Patients with metabolic diseases are at risk for decompensation during prolonged fasting, which often occurs during illnesses in which enteral intake is compromised. During these times, intravenous nutrition must be supplied to fully meet the specific nutritional needs of the patient. We detail our approach to intravenous management for metabolic patients and its underlying rationale. This generally entails a combination of intravenous glucose and lipid as well as early introduction of protein and essential vitamins. We exemplify the utility of our approach in case studies, as well as scenarios and specific disorders which require a more careful administration of nutritional substrates or a modification of macronutrient ratios.
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Affiliation(s)
- Kimberly A Kripps
- Section of Clinical Genetics and Metabolism, Department of Pediatrics, University of Colorado, Aurora, CO, USA; Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Peter R Baker
- Section of Clinical Genetics and Metabolism, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Janet A Thomas
- Section of Clinical Genetics and Metabolism, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Heather E Skillman
- Department of Clinical Nutrition, Children's Hospital Colorado, Aurora, CO, USA
| | - Laurie Bernstein
- Section of Clinical Genetics and Metabolism, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Sommer Gaughan
- Section of Clinical Genetics and Metabolism, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Casey Burns
- Section of Clinical Genetics and Metabolism, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Curtis R Coughlin
- Section of Clinical Genetics and Metabolism, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Shawn E McCandless
- Section of Clinical Genetics and Metabolism, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Austin A Larson
- Section of Clinical Genetics and Metabolism, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Aaina Kochar
- Section of Clinical Genetics and Metabolism, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Chelsey F Stillman
- Section of Child Neurology, Department of Pediatrics, University of Colorado, Aurora, CO, USA; Neuroscience Institute, Children's Hospital Colorado, Aurora, CO, USA
| | - Erica M Wymore
- Section of Neonatology, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Ellie G Hendricks
- Department of Pharmacy, Children's Hospital Colorado, Aurora, CO, USA
| | - Michael Woontner
- Section of Clinical Genetics and Metabolism, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Johan L K Van Hove
- Section of Clinical Genetics and Metabolism, Department of Pediatrics, University of Colorado, Aurora, CO, USA.
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31
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Kanchanasurakit S, Suthumpoung P, Santimaleeworagun W, Nakaranurack C, Huynh NS, Srisawat C, Nunta M, Chirakan V, Saokaew S. Effectiveness of thiamine therapy in mortality rate in patients with septic shock: A systematic review and meta-analysis. Int J Crit Illn Inj Sci 2021; 11:86-94. [PMID: 34395210 PMCID: PMC8318170 DOI: 10.4103/ijciis.ijciis_159_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/26/2021] [Accepted: 02/26/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Septic shock is a serious condition leading to increased mortality. Despite previous report of no benefit, thiamine has emerged as potential therapy to reduce mortality in septic shock patients. This study aimed to investigate the effect of thiamine in mortality rate in patients with septic shock. Methods: Eight databases, including MEDLINE, EMBASE, Science Direct, Scopus, Cochrane, CINAHL, Open Grey, and Dart-Europe, were systematically searched from the inception of the database up to August 21, 2020. Studies evaluating the effectiveness of thiamine on mortality rate in septic shock patients compared between thiamine and placebo were included. We used random-effects model to analyze the mortality with risk ratio (RR) and 95% confidence interval (95% CI). The subgroup and sensitivity analysis were performed to examine the influence of variables. Publication bias was considered using funnel plot, Begg's test, and Egger's test. Results: A total of 3,658 studies were retrieved and reviewed. Five studies were included for meta-analysis. In random-effects meta-analysis of the randomized controlled trials, although not statistically significant, there was a trend which suggested that thiamine may reduce mortality rate in septic shock patients (RR, 0.96; 95% CI: 0.72–1.28, P = 0.774). The result of sensitivity and subgroup analyses also supported the suggestion that thiamine may decrease mortality in septic shock patients. The Begg's test (P = 0.624) and Egger's test (P = 0.777) revealed no publication bias. Conclusions: Although not statistically significant, thiamine may reduce mortality rate in septic shock patients. Further prospective studies with larger sample size are warranted.
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Affiliation(s)
- Sukrit Kanchanasurakit
- Department of Pharmaceutical Care, Division of Pharmacy Practice, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,Department of Pharmacy, Division of Pharmaceutical Care, Phrae Hospital, Phrae, Thailand.,Center of Health Outcomes Research and Therapeutic Safety, School of Pharmaceutical Sciences, University of Phayao, Thailand.,Unit of Excellence on Clinical Outcomes Research and Integration, School of Pharmaceutical Sciences, University of Phayao, Thailand
| | - Pornsinee Suthumpoung
- Department of Pharmaceutical Care, Division of Pharmacy Practice, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Wichai Santimaleeworagun
- Pharmaceutical Initiative for Resistant Bacteria and Infectious Diseases Working Group, Faculty of Pharmacy, Silpakorn University, Nakorn Pathom, Thailand.,Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakorn Pathom, Thailand
| | - Chotirat Nakaranurack
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Nina S Huynh
- Department of Pharmacy Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Chansinee Srisawat
- Department of Pharmaceutical Care, Division of Pharmacy Practice, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Monnaree Nunta
- Department of Pharmacy, Chiangrai Prachanukroh Hospital, Chiangrai, Thailand
| | - Virakarn Chirakan
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Surasak Saokaew
- Department of Pharmaceutical Care, Division of Pharmacy Practice, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,Center of Health Outcomes Research and Therapeutic Safety, School of Pharmaceutical Sciences, University of Phayao, Thailand.,Unit of Excellence on Clinical Outcomes Research and Integration, School of Pharmaceutical Sciences, University of Phayao, Thailand.,Unit of Excellence on Herbal Medicine, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,Biomedicine Research Advancement Centre, School of Pharmacy, Monash University Malaysia, Malaysia.,Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor Darul Ehsan, Malaysia
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Serón Arbeloa C, Martínez de la Gándara A, León Cinto C, Flordelís Lasierra JL, Márquez Vácaro JA. Recommendations for specialized nutritional-metabolic management of the critical patient: Macronutrient and micronutrient requirements. Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva 2021; 44 Suppl 1:24-32. [PMID: 32532407 DOI: 10.1016/j.medin.2019.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/02/2019] [Accepted: 12/21/2019] [Indexed: 01/15/2023]
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Sedhai YR, Shrestha DB, Budhathoki P, Jha V, Mandal SK, Karki S, Baniya R, Cable CA, Kashiouris MG. Effect of thiamine supplementation in critically ill patients: A systematic review and meta-analysis. J Crit Care 2021; 65:104-115. [PMID: 34118501 DOI: 10.1016/j.jcrc.2021.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/31/2021] [Accepted: 05/26/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Several studies have previously shown the benefit of thiamine supplementation in critically ill patients. In order to fully appraise the available data, we performed a meta-analysis of 18 published studies. METHODS A thorough systematic search was conducted. The studies enrolling critically ill patients receiving thiamine supplementation was compared with the standard of care (SOC) group. Data was analyzed using RevMan 5.4. Clinical outcomes were pooled using Odds Ratio (OR) and mean differences. RESULT Eighteen studies (8 RCTs and 10 cohort studies) met the criteria for quantitative synthesis. In the analysis of RCTs, thiamine supplementation showed 42% lower odds of developing ICU delirium (OR 0.58, 95% CI, 0.34-0.98). A reduction in mortaliy was observed on performing fixed effect model analysis however, a level of statistical significance could not be reached on performing randon effect model analysis (OR, 0.78; 95% CI, 0.59 to 1.04). Further sub-group analysis of 13 studies in patients with sepsis, there was no difference in mortality between the two groups (OR, 0.83; 95% CI, 0.63 to 1.09). CONCLUSION Thiamine supplementation in critically ill patients showed a reduction in the incidence of ICU delirium among RCTs. However, there was no significant benefit in terms of overall mortality, and mortality in patients with sepsis. Further, large scale randomized prospective studies are warranted to investigate the role of thiamine supplementation in critically ill patients.
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Affiliation(s)
- Yub Raj Sedhai
- Department of Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA.
| | | | - Pravash Budhathoki
- Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA
| | - Vivek Jha
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal
| | - Sujit Kumar Mandal
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal; Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | | | - Ramkaji Baniya
- Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA
| | - Casey A Cable
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, VCU School of Medicine, Richmond, VA, USA
| | - Markos G Kashiouris
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, VCU School of Medicine, Richmond, VA, USA.
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The relation between acute changes in the systemic inflammatory response and circulating thiamine and magnesium concentrations after elective knee arthroplasty. Sci Rep 2021; 11:11271. [PMID: 34050237 PMCID: PMC8163855 DOI: 10.1038/s41598-021-90591-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 05/10/2021] [Indexed: 12/12/2022] Open
Abstract
Thiamine diphosphate (TDP) and magnesium are co-factors for key enzymes in human intermediary metabolism. However, their role in the systemic inflammatory response (SIR) is not clear. Therefore, the aim of the present study was to examine the relation between acute changes in the SIR and thiamine and magnesium dependent enzyme activity in patients undergoing elective knee arthroplasty (a standard reproducible surgical injury in apparently healthy individuals). Patients (n = 35) who underwent elective total knee arthroplasty had venous blood samples collected pre- and post-operatively for 3 days, for measurement of whole blood TDP, serum and erythrocyte magnesium, erythrocyte transketolase activity (ETKA), lactate dehydrogenase (LDH), glucose and lactate concentrations. Pre-operatively, TDP concentrations, erythrocyte magnesium concentrations, ETKA and plasma glucose were within normal limits for all patients. In contrast, 5 patients (14%) had low serum magnesium concentrations (< 0.75 mmol/L). On post-operative day1, both TDP concentrations (p < 0.001) and basal ETKA (p < 0.05) increased and serum magnesium concentrations decreased (p < 0.001). Erythrocyte magnesium concentrations correlated with serum magnesium concentrations (rs = 0.338, p < 0.05) and remained constant during SIR. Post-operatively 14 patients (40%) had low serum magnesium concentrations. On day1 serum magnesium concentrations were directly associated with LDH (p < 0.05), WCC (p < 0.05) and neutrophils (p < 0.01). Whole blood TDP and basal ETKA increased while serum magnesium concentrations decreased, indicating increased requirement for thiamine and magnesium dependent enzyme activity during SIR. Therefore, thiamine and magnesium represent potentially modifiable therapeutic targets that may modulate the host inflammatory response. Erythrocyte magnesium concentrations are likely to be reliable measures of status, whereas serum magnesium concentrations and whole blood TDP may not. ClinicalTrials.gov: NCT03554668.
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Refeeding syndrome occurs among older adults regardless of refeeding rates: A systematic review. Nutr Res 2021; 91:1-12. [PMID: 34130206 DOI: 10.1016/j.nutres.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 05/01/2021] [Accepted: 05/11/2021] [Indexed: 11/22/2022]
Abstract
Refeeding syndrome is a life-threatening clinical disorder that can occur when treating malnutrition. The aim was to examine the current knowledge of refeeding syndrome in patients ≥ 65 + years with special focus on the incidence of hypophosphatemia (HP) in relation to refeeding rate (kcal/kg/day), number of days until the lowest level of phosphate occurs (day of nadir), refeeding rates and adverse events, and death. Specifically, we hypothesized that higher energy provision would cause a higher incidence of HP. A search was conducted in the available databases. Two cohort studies, 1 case control, and a total of 12 case series/case reports, which accounted for 19 individual patient cases, were eligible. The incidence of HP (<0.5 mmol/L) was 15% and 25% in the 2 cohort studies and 4% in the case control study. The mean day of nadir was between days 2 and 3 in the cohort studies, day 11 in the case control study, and day 3 in the cases series/case reports. Importantly, a rapid drop in phosphate occurred receiving both 30 kcal/kg/day and 8 to 10 kcal/kg/day. The cohort studies reported high death rates-26% and 23%-using both 10 and 20 kcal/kg/day, respectively. Adverse events were noted in most all case series/case reports. Clinicians should be aware that HP may occur in up to 25% of older hospitalized adults, and importantly, it occurs even when refeeding cautiously. Hence, electrolytes should be closely monitored, especially between days 2 and 4, which is when the day of nadir occurs most frequently.
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Koekkoek WAC, Hettinga K, de Vries JHM, van Zanten ARH. Micronutrient deficiencies in critical illness. Clin Nutr 2021; 40:3780-3786. [PMID: 34130024 DOI: 10.1016/j.clnu.2021.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND & AIMS Low micronutrient levels in critical illness have been reported in multiple studies. Because of the antioxidant properties of various micronutrients, micronutrient deficiency may augment oxidative stress in critical illness. However, it remains unclear whether micronutrient concentrations in ICU patients are different from those in healthy age-matched controls. It is also unclear whether micronutrient deficiency develops, worsens, or resolves during ICU admission without supplementation. METHODS We prospectively studied a cohort of adult critically ill patients. Micronutrient levels, including selenium, β-carotene, vitamin C, E, B1 and B6 were measured repeatedly during the first week of ICU admission. We compared the micronutrient concentrations at ICU admission to those of healthy age-matched controls. In addition, associations between micronutrient concentrations with severity of illness, inflammation and micronutrient intake were investigated. RESULTS Micronutrient blood concentrations were obtained from 24 critically ill adults and 21 age-matched healthy controls. The mean micronutrient levels at admission in the ICU patients were: selenium 0.52 μmol/l, β-carotene 0.17 μmol/l, vitamin C 21.5 μmol/l, vitamin E 20.3 μmol/l, vitamin B1 129.5 nmol/l and vitamin B6 41.0 nmol/l. In the healthy controls micronutrient levels of selenium (0.90 μmol/l), β-carotene (0.50 μmol/l), vitamin C (45 μmol/l) and vitamin E (35.5 μmol/l) were significantly higher, while vitamin B1 (122 nmol/l) and B6 (44 nmol/l) were not significantly different between patients and controls. Selenium, vitamin B1 and vitamin B6 levels remained stable during ICU admission. Vitamin C levels dropped significantly until day 5 (p < 0.01). Vitamin E and β-carotene levels increased significantly on days 5-7 and day 7, respectively (p < 0.01). Micronutrient levels were not associated with severity of illness, CRP or micronutrient intake during the admission. CONCLUSIONS At admission, ICU patients already had lower plasma levels of selenium, β-carotene, vitamin C and vitamin E than healthy controls. Vitamin C levels dropped significantly during the first days of ICU admission, while β-carotene and vitamin E levels increased after 5-7 days. No association between micronutrient levels and severity of illness, C-reactive protein (CRP) or micronutrient intake was found. Progressive enteral tube feeding containing vitamins and trace elements does not normalize plasma levels in the first week of ICU stay. This was a hypothesis generating study and more investigation in a larger more diverse sample is needed.
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Affiliation(s)
- W A C Koekkoek
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, the Netherlands.
| | - K Hettinga
- Division of Human Nutrition and Health, Wageningen University & Research, HELIX (Building 124), Stippeneng 4, 6708 WE, Wageningen, the Netherlands.
| | - J H M de Vries
- Division of Human Nutrition and Health, Wageningen University & Research, HELIX (Building 124), Stippeneng 4, 6708 WE, Wageningen, the Netherlands.
| | - A R H van Zanten
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, the Netherlands; Division of Human Nutrition and Health, Wageningen University & Research, HELIX (Building 124), Stippeneng 4, 6708 WE, Wageningen, the Netherlands.
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Micronutrients in Sepsis and COVID-19: A Narrative Review on What We Have Learned and What We Want to Know in Future Trials. ACTA ACUST UNITED AC 2021; 57:medicina57050419. [PMID: 33925791 PMCID: PMC8146527 DOI: 10.3390/medicina57050419] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 12/14/2022]
Abstract
Sepsis remains the leading cause of mortality in hospitalized patients, contributing to 1 in every 2–3 deaths. From a pathophysiological view, in the recent definition, sepsis has been defined as the result of a complex interaction between host response and the infecting organism, resulting in life-threatening organ dysfunction, depending on microcirculatory derangement, cellular hypoxia/dysoxia driven by hypotension and, potentially, death. The high energy expenditure driven by a high metabolic state induced by the host response may rapidly lead to micronutrient depletion. This deficiency can result in alterations in normal energy homeostasis, free radical damage, and immune system derangement. In critically ill patients, micronutrients are still relegated to an ancillary role in the whole treatment, and always put in a second-line place or, frequently, neglected. Only some micronutrients have attracted the attention of a wider audience, and some trials, even large ones, have tested their use, with controversial results. The present review will address this topic, including the recent advancement in the study of vitamin D and protocols based on vitamin C and other micronutrients, to explore an update in the setting of sepsis, gain some new insights applicable to COVID-19 patients, and to contribute to a pathophysiological definition of the potential role of micronutrients that will be helpful in future dedicated trials.
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Hardy G, Wong T, Morrissey H, Anderson C, Moltu SJ, Poindexter B, Lapillonne A, Ball PA. Parenteral Provision of Micronutrients to Pediatric Patients: An International Expert Consensus Paper. JPEN J Parenter Enteral Nutr 2021; 44 Suppl 2:S5-S23. [PMID: 32767589 DOI: 10.1002/jpen.1990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/04/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Micronutrients (vitamins and trace elements) are essential to all nutrition. For children and neonates who are dependent upon nutrition support therapies for growth and development, the prescribed regimen must supply all essential components. This paper aims to facilitate interpretation of existing clinical guidelines into practical approaches for the provision of micronutrients in pediatric parenteral nutrition. METHODS An international, interdisciplinary expert panel was convened to review recent evidence-based guidelines and published literature to develop consensus-based recommendations on practical micronutrient provision in pediatric parenteral nutrition. RESULTS The guidelines and evidence have been interpreted as answers to 10 commonly asked questions around the practical principles for provision and monitoring of micronutrients in pediatric patients. CONCLUSION Micronutrients are an essential part of all parenteral nutrition and should be included in the pediatric nutrition therapy care plan.
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Affiliation(s)
- Gil Hardy
- Ipanema Research Trust, Auckland, New Zealand
| | - Theodoric Wong
- Consultant Pediatric Gastroenterologist, Women's and Children's Hospital, Birmingham, UK
| | - Hana Morrissey
- School of Pharmacy and Pharmaceutical Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
| | - Collin Anderson
- Pharmacy, Intermountain Healthcare Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Sissel J Moltu
- Department of Neonatology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Brenda Poindexter
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Centre, Cincinnati, Ohio, USA
| | | | - Patrick A Ball
- School of Pharmacy and Pharmaceutical Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
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Gonçalves SEAB, Gonçalves TJM, Guarnieri A, Risegato RC, Guimarães MP, de Freitas DC. Association between thiamine deficiency and hyperlactatemia among critically ill patients with diabetes infected by SARS-CoV-2. J Diabetes 2021; 13:413-419. [PMID: 33448683 PMCID: PMC8014215 DOI: 10.1111/1753-0407.13156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The present study aims to verify the association between diabetes and thiamine deficiency in critically ill patients infected by severe acute respiratory syndrome coronavirus 2. METHODS This is a descriptive cross-sectional study, whose demographic, anthropometric, and laboratory data (arterial lactate, bicarbonate, and plasma thiamine) were obtained in the first hours of admission to the intensive care unit. Patients with diabetes were compared with individuals without diabetes, and the correlation was performed between thiamine and lactate levels. Thiamine levels <28 μg/L were considered as thiamine deficiency. RESULTS Overall, 270 patients met the inclusion criteria; 51.1% were men, and the median age was 74 years (66.8-81). The median value of thiamine was 54.0 μg/L (38-72.3), and 15.6% had thiamine deficiency. Among patients with diabetes, 26.3% had thiamine deficiency, and 69.3% had hyperlactatemia. There was an association between thiamine deficiency and diabetes (odds ratio 4.28; 95% CI, 2.08-8.81; P < .001). There was a strong negative correlation between thiamine and arterial lactate in patients with diabetes (r = -0.711, P < .001) and a moderate negative correlation in critically ill patients without diabetes (r = -0.489, P < .001). CONCLUSIONS The prevalence of thiamine deficiency in critically ill patients due to coronavirus disease 2019 is higher in patients with diabetes. There is a negative correlation between thiamine and arterial lactate levels, which is higher in people with diabetes.
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Affiliation(s)
| | | | - Andreia Guarnieri
- Sancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
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Qian X, Zhang Z, Li F, Wu L. Intravenous thiamine for septic shock: A meta-analysis of randomized controlled trials. Am J Emerg Med 2020; 38:2718-2722. [PMID: 33036854 DOI: 10.1016/j.ajem.2020.08.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION The efficacy of intravenous thiamine to treat septic shock remains controversial. We conduct a systematic review and meta-analysis to explore the impact of intravenous thiamine on treatment efficacy of septic shock. METHODS We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through June 2020 and included randomized controlled trials (RCTs) assessing the effect of intravenous thiamine on septic shock. This meta-analysis was performed using the random-effect model. RESULTS Four RCTs were included in the meta-analysis. Overall, compared with control group in patients with septic shock, intravenous thiamine revealed no substantial impact on mortality (odd ratio [OR] = 0.87; 95% confidence interval [CI) = 0.62 to 1.21; P = 0.40), lactate change (standard mean difference [SMD] = 0.04; 95% CI = -0.28 to 0.35; P = 0.82), Sequential Organ Failure Assessment (SOFA) change (SMD = 0.02; 95% CI = -0.18 to 0.21; P = 0.87), intensive care unit (ICU) stay (SMD = -0.02; 95% CI = -0.33 to 0.30; P = 0.90) or renal replacement therapy (OR = 0.47; 95% CI = 0.07 to 3.15; P = 0.43). CONCLUSIONS Intravenous thiamine showed no benefit over placebo in treating patients with septic shock.
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Affiliation(s)
- Xiangfeng Qian
- Emergency Department, The first people's hospital of yuhang district, Hangzhou, Zhejiang, China
| | - Zhe Zhang
- Emergency Department, The first people's hospital of yuhang district, Hangzhou, Zhejiang, China
| | - Feng Li
- Emergency Department, The first people's hospital of yuhang district, Hangzhou, Zhejiang, China
| | - Longchuan Wu
- Emergency Department, The first people's hospital of yuhang district, Hangzhou, Zhejiang, China.
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Abstract
Critical illness commonly presents as a systemic inflammatory process. Through this inflammation, there is an enhanced production of reactive oxygen and nitrogen species combined with marked reductions in protective plasma antioxidant concentrations. This imbalance is referred to as oxidative stress and is commonly encountered in numerous disease states in the critically ill including sepsis, trauma, acute respiratory distress syndrome, and burns. Oxidative stress can lead to cellular, tissue and organ damage as well as increased morbidity and mortality in critically ill patients. Supplementation with exogenous micronutrients to restore balance and antioxidant concentrations in critically ill patients has been considered for several decades. It is proposed that antioxidant vitamins, such as vitamins A and C, may minimize oxidative stress and improve clinical outcomes. Vitamin B formulations may play a role in curtailing lactic acidosis and are recently being evaluated as an acute phase reactant. However, few large, randomized trials specifically investigating the role of vitamin supplementation in the critically ill patient population are available. This article seeks to review recently published literature surrounding the role of supplementation of vitamins A, B and C in critically ill patients.
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Affiliation(s)
- Melissa Chudow
- Department of Pharmacotherapeutics and Clinical Research, 466516University of South Florida Taneja College of Pharmacy, Tampa, FL, USA
| | - Beatrice Adams
- Medical and Burn ICU, Department of Pharmacy Services, 7829Tampa General Hospital, Tampa, FL, USA
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Blaauw R, Osland E, Sriram K, Ali A, Allard JP, Ball P, Chan LN, Jurewitsch B, Logan Coughlin K, Manzanares W, Menéndez AM, Mutiara R, Rosenfeld R, Sioson M, Visser J, Berger MM. Parenteral Provision of Micronutrients to Adult Patients: An Expert Consensus Paper. JPEN J Parenter Enteral Nutr 2020; 43 Suppl 1:S5-S23. [PMID: 30812055 DOI: 10.1002/jpen.1525] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/04/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Micronutrients, an umbrella term used to collectively describe vitamins and trace elements, are essential components of nutrition. Those requiring alternative forms of nutrition support are dependent on the prescribed nutrition regimen for their micronutrient provision. The purpose of this paper is to assist clinicians to bridge the gap between the available guidelines' recommendations and their practical application in the provision of micronutrients via the parenteral route to adult patients. METHODS Based on the available evidenced-based literature and existing guidelines, a panel of multidisciplinary healthcare professionals with significant experience in the provision of parenteral nutrition (PN) and intravenous micronutrients developed this international consensus paper. RESULTS The paper addresses 14 clinically relevant questions regarding the importance and use of micronutrients in various clinical conditions. Practical orientation on how micronutrients should be prescribed, administered, and monitored is provided. CONCLUSION Micronutrients are a critical component to nutrition provision and PN provided without them pose a considerable risk to nutrition status. Obstacles to their daily provision-including voluntary omission, partial provision, and supply issues-must be overcome to allow safe and responsible nutrition practice.
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Affiliation(s)
- Renée Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Emma Osland
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Krishnan Sriram
- US Department of Veterans Affairs, Regional Tele-ICU System (VISN 23), Hines, Illinois, USA
| | - Azmat Ali
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Johane P Allard
- Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Ball
- School of Pharmacy, University of Wolverhampton, Wolverhampton, UK
| | - Lingtak-Neander Chan
- Department of Pharmacy School of Pharmacy, and Graduate Program in Nutritional Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Brian Jurewitsch
- Specialized Complex Care Program, St. Michael's Hospital, Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Kathleen Logan Coughlin
- Center for Human Nutrition, Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - William Manzanares
- Department of Critical Care, Faculty of Medicine. Hospital de Clínicas, Universidad de la República (UdelaR), Montevideo, Uruguay
| | | | - Rina Mutiara
- Pharmacy Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ricardo Rosenfeld
- Nutrition Support Department, Casa de Saude Sao Jose, Associacao Congregacao de Santa Catarina, Rio de Janeiro, Brazil
| | - Marianna Sioson
- Section of Nutrition, Department of Medicine, The Medical City Hospital, Pasig City, Metro Manila, Philippines
| | - Janicke Visser
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Mette M Berger
- Faculty of Biology and Medicine, Service of Intensive Care Medicine & Burns, University of Lausanne Hospitals (CHUV), Lausanne, Switzerland
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Jovic TH, Ali SR, Ibrahim N, Jessop ZM, Tarassoli SP, Dobbs TD, Holford P, Thornton CA, Whitaker IS. Could Vitamins Help in the Fight Against COVID-19? Nutrients 2020; 12:E2550. [PMID: 32842513 PMCID: PMC7551685 DOI: 10.3390/nu12092550] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023] Open
Abstract
There are limited proven therapeutic options for the prevention and treatment of COVID-19. The role of vitamin and mineral supplementation or "immunonutrition" has previously been explored in a number of clinical trials in intensive care settings, and there are several hypotheses to support their routine use. The aim of this narrative review was to investigate whether vitamin supplementation is beneficial in COVID-19. A systematic search strategy with a narrative literature summary was designed, using the Medline, EMBASE, Cochrane Trials Register, WHO International Clinical Trial Registry, and Nexis media databases. The immune-mediating, antioxidant and antimicrobial roles of vitamins A to E were explored and their potential role in the fight against COVID-19 was evaluated. The major topics extracted for narrative synthesis were physiological and immunological roles of each vitamin, their role in respiratory infections, acute respiratory distress syndrome (ARDS), and COVID-19. Vitamins A to E highlighted potentially beneficial roles in the fight against COVID-19 via antioxidant effects, immunomodulation, enhancing natural barriers, and local paracrine signaling. Level 1 and 2 evidence supports the use of thiamine, vitamin C, and vitamin D in COVID-like respiratory diseases, ARDS, and sepsis. Although there are currently no published clinical trials due to the novelty of SARS-CoV-2 infection, there is pathophysiologic rationale for exploring the use of vitamins in this global pandemic, supported by early anecdotal reports from international groups. The final outcomes of ongoing trials of vitamin supplementation are awaited with interest.
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Affiliation(s)
- Thomas H Jovic
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea University, Swansea SA28PY, UK; (N.I.); (Z.M.J.); (S.P.T.); (T.D.D.)
- Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA66NL, UK
| | - Stephen R Ali
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea University, Swansea SA28PY, UK; (N.I.); (Z.M.J.); (S.P.T.); (T.D.D.)
- Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA66NL, UK
| | - Nader Ibrahim
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea University, Swansea SA28PY, UK; (N.I.); (Z.M.J.); (S.P.T.); (T.D.D.)
- Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA66NL, UK
| | - Zita M Jessop
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea University, Swansea SA28PY, UK; (N.I.); (Z.M.J.); (S.P.T.); (T.D.D.)
- Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA66NL, UK
| | - Sam P Tarassoli
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea University, Swansea SA28PY, UK; (N.I.); (Z.M.J.); (S.P.T.); (T.D.D.)
| | - Thomas D Dobbs
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea University, Swansea SA28PY, UK; (N.I.); (Z.M.J.); (S.P.T.); (T.D.D.)
- Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA66NL, UK
| | - Patrick Holford
- Institute for Optimum Nutrition, Ambassador House, Paradise Road, Richmond TW9 1SQ, UK;
| | - Catherine A Thornton
- Institute of Life Sciences 1, Swansea University Medical School, Swansea University, Swansea SA2 8PY, UK;
| | - Iain S Whitaker
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea University, Swansea SA28PY, UK; (N.I.); (Z.M.J.); (S.P.T.); (T.D.D.)
- Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA66NL, UK
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Miyamoto Y, Aso S, Iwagami M, Yasunaga H, Matsui H, Fushimi K, Hamasaki Y, Nangaku M, Doi K. Association Between IV Thiamine and Mortality in Patients With Septic Shock: A Nationwide Observational Study. Crit Care Med 2020; 48:1135-1139. [PMID: 32697483 DOI: 10.1097/ccm.0000000000004394] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To examine the effect of thiamine administration on mortality in patients with septic shock requiring norepinephrine. DESIGN Retrospective observational cohort study from July 2010 to March 2017. SETTING More than 1,000 acute care hospitals covering approximately 90% of all tertiary care emergency hospitals in Japan. PATIENTS Patients with septic shock requiring norepinephrine within 2 days of admission were retrospectively reviewed. INTERVENTIONS Patients who received greater than or equal to 100 mg of thiamine within 2 days of admission were included in the thiamine group and those who did not were included in the control group. MEASUREMENTS AND MAIN RESULTS We identified a total of 68,571 eligible patients, including 18,780 and 49,791 patients in the thiamine and control groups, respectively. In the thiamine group, 100 and 200 mg of thiamine per day were administered to 10,143 (54.0%) and 7,679 (40.9%) patients, respectively. The 28-day mortality were 19.2% (3,609/18,780) and 17.8% (8,845/49,791) in the thiamine and control groups, respectively. After adjusting for confounders by inverse probability of treatment weighting, no significant differences were observed between the two groups (risk difference, 0.2%; 95% CI, -0.5% to 0.9%). There were also no significant differences between the 100-mg thiamine group and the control group (risk difference, 0.6%; 95% CI, -0.3% to 1.4%) or between the 200-mg thiamine group and the control group (risk difference, -0.3%; 95% CI, -1.3% to 0.8%). CONCLUSIONS The findings of this nationwide database-based observational study did not support an association between thiamine administration early after admission and the 28-day mortality in patients with septic shock.
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Affiliation(s)
- Yoshihisa Miyamoto
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Shotaro Aso
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masao Iwagami
- Health Services Research and Development Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Health Services Research, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Yoshifumi Hamasaki
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Kent Doi
- Department of Acute Care Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
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Didisheim C, Ballhausen D, Choucair ML, Longchamp D, Natterer J, Ferry T, Perez MH, Amiet V. Severe Lactic Acidosis in a Critically Ill Child: Think About Thiamine! A Case Report. J Pediatr Intensive Care 2020; 10:307-310. [PMID: 34745706 DOI: 10.1055/s-0040-1713382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/14/2020] [Indexed: 10/23/2022] Open
Abstract
In this article, we presented a teenager, in maintenance chemotherapy for leukemia, who was admitted for digestive symptoms related to a parasitic infection and required nutritional support with parenteral nutrition. After 6 weeks, his condition worsened with refractory shock of presumed septic origin, necessitating extracorporeal membrane oxygenation. Despite hemodynamic stabilization, his lactic acidosis worsened until thiamine supplementation was started. Lactate normalized within 12 hours. Thiamine is an essential coenzyme in aerobic glycolysis, and deficiency leads to lactate accumulation through anaerobic glycolysis. Thiamine deficiency is uncommon in the pediatric population. However, it should be considered in patients at risk of nutritional deficiencies with lactic acidosis of unknown origin.
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Affiliation(s)
- Clémence Didisheim
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Diana Ballhausen
- Department of Metabolic Disease, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Marie-Louise Choucair
- Department of Pediatrics, Pediatric Hematology Oncology Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - David Longchamp
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Julia Natterer
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Thomas Ferry
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Marie-Hélène Perez
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Vivianne Amiet
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
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Herzog N, Jouquand F, Aries P, Giacardi C, Rouault M. [Latest treatments for septic shock and the current state of research]. REVUE DE L'INFIRMIÈRE 2020; 69:19-21. [PMID: 32600589 DOI: 10.1016/s1293-8505(20)30145-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The treatment of septic shock is a medical emergency. International guidelines advise immediate care and the first hour is generally critical. It is an emergency on both an etiological and symptomatic level.
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Affiliation(s)
- Nicolas Herzog
- Service de réanimation, hôpital d'instruction des armées Clermont-Tonnerre, 22, rue du Colonel-Fonferrier, 29240 Brest, France
| | - Fanny Jouquand
- Pharmacie hospitalière, hôpital d'instruction des armées Clermont-Tonnerre, 22, rue du Colonel-Fonferrier, 29240 Brest, France
| | - Philippe Aries
- Service de réanimation, hôpital d'instruction des armées Clermont-Tonnerre, 22, rue du Colonel-Fonferrier, 29240 Brest, France
| | - Christophe Giacardi
- Service de réanimation, hôpital d'instruction des armées Clermont-Tonnerre, 22, rue du Colonel-Fonferrier, 29240 Brest, France
| | - Médéric Rouault
- Service de réanimation, hôpital d'instruction des armées Clermont-Tonnerre, 22, rue du Colonel-Fonferrier, 29240 Brest, France.
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Marino LV, Valla FV, Beattie RM, Verbruggen SCAT. Micronutrient status during paediatric critical illness: A scoping review. Clin Nutr 2020; 39:3571-3593. [PMID: 32371094 PMCID: PMC7735376 DOI: 10.1016/j.clnu.2020.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/06/2020] [Accepted: 04/14/2020] [Indexed: 01/06/2023]
Abstract
Background No evidence based recommendations for micronutrient requirements during paediatric critical illness are available, other than those arising from recommended nutrient intakes (RNI) for healthy children and expert opinion. Objectives The objective of this review is to examine the available evidence from micronutrient status in critically ill children considering studies which describe 1) micronutrient levels, 2) associations between micronutrient levels and clinical outcome, and 3) impact on clinical outcome with micronutrient supplementation during PICU admission. Design Scoping review. Eligibility criteria Any study which used a qualitative and quantitative design considering causes and consequences of micronutrient levels or micronutrient supplementation during paediatric critical illness. Sources of evidence NICE Healthcare Databases Advanced Search website (https://hdas.nice.org.uk/) was used as a tool for multiple searches, with a content analysis and charting of data extracted. Results 711 records were identified, 35 were included in the review. Studies evaluated serum micronutrient status was determined on admission day in majority of patients. A content analysis identified (n = 49) initial codes, (n = 14) sub-categories and (n = 5) overarching themes during critical illness, which were identified as: i) low levels of micronutrients, ii) causes of aberrant micronutrient levels, iii) associations between micronutrients levels and outcome, iv) supplementation of micronutrients. Conclusion During critical illness, micronutrients should be provided in sufficient amounts to meet reference nutrient intakes for age. Although, there is insufficient data to recommend routine supplementations of micronutrients at higher doses during critical illness, the ‘absence of evidence should not imply evidence of absence’, and well designed prospective studies are urgently needed to elucidate paediatric micronutrient requirements during critical illness. The absence of reliable biomarkers make it challenging to determine whether low serum levels are reflective of a true deficiency or as a result redistribution, particularly during the acute phase of critical illness. As more children continue to survive a PICU admission, particularly those with complex diseases micronutrient supplementation research should also be inclusive of the recovery phase following critical illness.
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Affiliation(s)
- L V Marino
- Department of Dietetics/Speech & Language Therapy, NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust and School of Health Sciences, University of Southampton, Southampton, UK.
| | - F V Valla
- Paediatric Intensive Care Unit, Hôpital Femme Mère Enfant, CarMEN INSERM UMR 1060 Hospices Civils de Lyon, Lyon-Bron, France
| | - R M Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S C A T Verbruggen
- Intensive Care, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, the Netherlands
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Ehsanian R, Anderson S, Schneider B, Kennedy D, Mansourian V. Prevalence of Low Plasma Vitamin B1 in the Stroke Population Admitted to Acute Inpatient Rehabilitation. Nutrients 2020; 12:nu12041034. [PMID: 32290066 PMCID: PMC7230706 DOI: 10.3390/nu12041034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine the prevalence of vitamin B1 (VitB1) deficiency in the stroke population admitted to acute inpatient rehabilitation. DESIGN Retrospective cohort study. SETTING Acute inpatient rehabilitation facility at an academic medical center. PARTICIPANTS 119 consecutive stroke patients admitted to stroke service from 1 January 2018 to 31 December 2018. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Plasma VitB1 level. RESULTS There were 17 patients (14%; 95% CI 9-22%) with low VitB1 with a range of 2-3 nmol/L, an additional 58 (49%; CI 40-58%) patients had normal low VitB1 with a range of 4-9 nmol/L, twenty-five patients (21%; CI 15-29%) had normal high VitB1 with a range of 10-15 nmol/L, and nineteen patients (16%; CI 10-24%) had high VitB1 with a range of 16-43 nmol/L. CONCLUSIONS In this cohort of patients admitted to the stroke service at an acute rehabilitation facility, there is evidence of thiamine deficiency. Moreover, the data suggest that there is inadequate acute intake of VitB1. Given the role of thiamine deficiency in neurologic function, further study of the role of thiamine optimization in the acute stroke rehabilitation population is warranted.
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Affiliation(s)
- Reza Ehsanian
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
- Department of Neurosurgery, Stanford University, Palo Alto, CA 34304, USA
- Division of Physical Medicine and Rehabilitation, Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Sean Anderson
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
| | - Byron Schneider
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
| | - David Kennedy
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
| | - Vartgez Mansourian
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA; (R.E.); (S.A.); (B.S.); (D.K.)
- Correspondence: ; Tel.: +615-936-7708
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Moslemi R, Khalili H, Mohammadi M, Mehrabi Z, Mohebbi N. Thiamine for Prevention of Postoperative Delirium in Patients Undergoing Gastrointestinal Surgery: A Randomized Clinical Trial. J Res Pharm Pract 2020; 9:30-35. [PMID: 32489958 PMCID: PMC7235453 DOI: 10.4103/jrpp.jrpp_19_124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 12/23/2019] [Indexed: 12/04/2022] Open
Abstract
Objective: Postoperative delirium is a common complication after gastrointestinal surgery that is associated with adverse outcomes. Thiamine is an essential cofactor for the glycolysis, oxidative metabolism, production of neurotransmitters in the crebs cycle. In this study, efficacy of thiamine was assessed as a preventive strategy of delirium in patients undergoing gastrointestinal surgery. Methods: In this randomized clinical trial, 96 adult patients admitted to the intensive care unit (ICU) following gastrointestinal surgery were included. Patients were allocated to receive either 200 mg intravenous thiamine daily or an equal volume of 0.9% saline for 3 days. Delirium was evaluated twice daily based on the confusion assessment method-ICU. The incidence of postoperative delirium was considered as the primary outcome, and total analgesic use and ventilation days has been defined as secondary outcomes of the study. Findings: The incidence rate of delirium was significantly lower in the thiamine group than the placebo group on the first day (8.3% vs. 25%; Odds ratio: 0.27 [95% confidence interval (CI): 0.08–0.92]; P= 0.026) and on the second day (4.2% vs. 20.8%; or: 0.16 [95% CI: 0.03–0.81]; P= 0.014). No adverse effect related to thiamine was detected during the study course. Conclusion: Study results suggest that thiamine is a safe option for the prevention of postoperative delirium in patients after gastrointestinal surgery.
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Affiliation(s)
- Rohollah Moslemi
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Mohammadi
- Department of Intensive Care Unit, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Mehrabi
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Niayesh Mohebbi
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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