A Systematic Review of the Role of Thiamine Supplementation in Treatment of Refeeding Syndrome

Steiner, Lea; Hewlings, Susan

doi:10.1097/tin.0000000000000235

Cited by 4 publications

(2 citation statements)

References 32 publications

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“…The conditions that may generate deficiency are numerous [37]. The Wernicke-Korsackoff syndrome or symptoms are among the extreme manifestations, but delirium, congestive heart failure and oedema may be the presentation form [38]. A study in paediatric ICUs showed that the prevalence of thiamine deficiency based on blood levels is elevated by 11.1% and low levels may persist for 2--3 days [39].…”

Section: Thiamine B1mentioning

confidence: 99%

An update on essential micronutrients in critical illness

Berger

2023

Current Opinion in Critical Care

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Purpose of review Numerous micronutrients are involved in antioxidant and immune defence, while their blood concentrations are frequently low in critically ill patients: this has fuelled many supplementation trials. Numerous observational, randomized studies have been published, which are presented herein. Recent findings Micronutrient concentrations must be analysed considering the context of the inflammatory response in critical illness. Low levels do not always indicate a deficiency without objective micronutrients losses with biological fluids. Nevertheless, higher needs and deficiencies are frequent for some micronutrients, such as thiamine, vitamins C and D, selenium, zinc and iron, and have been acknowledged with identifying patients at risk, such as those requiring continuous renal replacement therapy (CRRT). The most important trials and progress in understanding have occurred with vitamin D (25(OH)D), iron and carnitine. Vitamin D blood levels less than 12 ng/ml are associated with poor clinical outcomes: supplementation in deficient ICU patients generates favourable metabolic changes and decreases mortality. Single high-dose 25(OH)D should not be delivered anymore, as boluses induce a negative feedback mechanism causing inhibition of this vitamin. Iron-deficient anaemia is frequent and can be treated safely with high-dose intravenous iron under the guidance of hepcidin to confirm deficiency diagnosis. Summary The needs in critical illness are higher than those of healthy individuals and must be covered to support immunity. Monitoring selected micronutrients is justified in patients requiring more prolonged ICU therapy. Actual results point towards combinations of essential micronutrients at doses below upper tolerable levels. Finally, the time of high-dose micronutrient monotherapy is probably over.

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Section: Thiamine B1mentioning

confidence: 99%

An update on essential micronutrients in critical illness

Berger

2023

Current Opinion in Critical Care

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“…Although all vitamin deficiencies can occur to varying degrees with inadequate intake, thiamine is of paramount importance when post-meal complications are considered. Thiamine is an essential coenzyme in carbohydrate metabolism and acts as the main cofactor of pyruvate dehydrogenases in glycolysis ( 49 ). Thiamine deficiency can lead to encephalopathy-like symptoms such as ataxia, eye disorders, amnesia, and coma in these patients ( 46 ).…”

Section: Pathophysiology and Clinical Manifestationsmentioning

confidence: 99%

Refeeding Syndrome in Pediatric Age, An Unknown Disease: A Narrative Review

Corsello,

Trovato,

Dipasquale

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Refeeding syndrome (RS) is characterized by electrolyte imbalances that can occur in malnourished and abruptly refed patients. Typical features of RS are hypophosphatemia, hypokalemia, hypomagnesemia and thiamine deficiency. It is a potentially life-threatening condition that can affect both adults and children, although there is scarce evidence in the pediatric literature. The sudden increase in food intake causes a shift in the body's metabolism and electrolyte balance, leading to symptoms such as weakness, seizures, and even heart failure. A proper management with progressive increase in nutrients is essential to prevent the onset of this condition and ensure the best possible outcomes. Moreover, an estimated incidence of up to 7.4% has been observed in pediatric intensive care unit patients receiving nutritional support, alone or as an adjunct. To prevent RS, it is important to carefully monitor feeding resumption, particularly in severely malnourished individuals. A proper strategy should start with small amounts of low-calorie fluids and gradually increasing the calorie content and amount of food over several days. Close monitoring of electrolyte levels is critical and prophylactic use of dietary supplements such as thiamine may be required to correct any imbalances that may occur. In this narrative review, we aim to provide a comprehensive understanding of RS in pediatric clinical practice and provide a possible management algorithm.

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