Anaphylaxis from administration of intravenous thiamine

Stephen, James M.; Grant, Robert P.; Yeh, Charlotte S.

doi:10.1016/0735-6757(92)90129-l

Cited by 36 publications

(8 citation statements)

References 10 publications

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“…Indeed, the dose of 250 mg/kg TTFD tended to produce adverse effects because death and a low body weight of some fetuses were observed following treatment (data not shown). In this context, intravenous administration of an excessive dose of thiamine causes anaphylaxis in humans (Stephen et al, 1992), and the LC 50 (a dose resulting in the death of 50% of exposed subjects) of an intravenous injection of thiamine is 100-125 mg/kg in mice (Zbinden, 1962). Considering these observations, it is highly likely that the TTFD dose used in the present study was sufficient to activate the TCA cycle in the fetal body.…”

Section: Discussionmentioning

confidence: 81%

α-Lipoic acid potentially targets AMP-activated protein kinase and energy production in the fetal brain to ameliorate dioxin-produced attenuation in fetal steroidogenesis

et al. 2017

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Our previous studies demonstrated that treating pregnant rats with dioxins, including 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), targets the pituitary expression of luteinizing hormone (LH) to attenuate testicular steroidogenesis in fetuses, resulting in the imprinting of sexual immaturity of the offspring after reaching maturity. Furthermore, we found that although TCDD disturbs the tricarboxylic acid (TCA) cycle in the fetal hypothalamus, maternal co-treatment with α-lipoic acid (α-LA), a cofactor of the TCA cycle, restores a TCDD-produced reduction in the LH-evoked steroidogenesis as well as the TCA cycle activity in fetuses. However, the mechanism underlying the beneficial effect of α-LA remains to be fully elucidated. To address this issue, we compared the effect of α-LA with that of thiamine, another cofactor of the TCA cycle. As with α-LA, supplying thiamine to dams exposed to TCDD alleviates the reduced level of not only hypothalamic ATP but also pituitary LH and testicular steroidogenic protein in fetuses. However, thiamine had a much weaker effect than α-LA. In agreement with ATP attenuation, TCDD activated AMP-activated protein kinase (AMPK), a negative regulator of LH production, whereas the supplementation of α-LA allowed recovery from this defect. Furthermore, α-LA restored the TCDD-produced reduction in the pituitary expression of the receptor for gonadotropin-releasing hormone (GnRH), an upstream regulator of LH synthesis. These results suggest that α-LA rescues TCDD-produced attenuation during fetal steroidogenesis due not only to facilitation of energy production through the TCA cycle but also through suppression of AMPK activation, and the pituitary GnRH receptor may serve as a mediator of these effects.

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Section: Discussionmentioning

confidence: 81%

α-Lipoic acid potentially targets AMP-activated protein kinase and energy production in the fetal brain to ameliorate dioxin-produced attenuation in fetal steroidogenesis

et al. 2017

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“…4 Similarly, cyanocobalamin has been implicated in embolia cutis medicamentosa (circumscribed skin necrosis following intramuscular injection). '… that this severe complication may be associated with technically proper ventrogluteal injection of a wide array of therapeutic drugs shows that intramuscular injections require valid indications'.…”

Section: Harmless?mentioning

confidence: 99%

The hollow needle: inappropriate injection in practice

Brokensha¹

1999

Aust Prescr

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SYNOPSISDoctors and needles seem to go together, but the hypodermic has only a relatively brief history. The curious tale of its enthusiastic adoption has much to teach us about contemporary practice. Our powerful medical culture seldom questions the role of injections, particularly of medicines that are often regarded as innocuous or harmless.Experience from developing cultures of the multiple factors motivating injections will inevitably illuminate our own. The misleading role of personal clinical experience in this context makes rational evidence-based practice difficult.The primacy of personal experience is a pitfall for doctors, but a potential benefit for patients. A greater understanding of the unjustly maligned placebo effect and the difference between controlling a clinical trial and healing the individual will assist practitioners to avoid both hollow and sharp practice.

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“…These guidelines may even be detrimental to patients in situations when glucose is delayed in order to administer thiamine. In addition, although uncommon, anaphylaxis from IV thiamine can occur, with life-threatening consequences 11,12…”

Section: Introductionmentioning

confidence: 99%

Comparison of Prehospital Glucose with or without IV Thiamine

Merlin¹,

Carluccio²,

Raswant³

et al. 2011

WestJEM

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Introduction:Loading of thiamine prior to glucose administration during hypoglycemia to prevent Wernicke’s encephalopathy is routine in the prehospital setting. To date no study has looked at the validity of this therapy.Methods:We evaluated a retrospective cohort of 242 patients who received intravenous glucose for hypoglycemia comparing those who received thiamine supplementation versus those who did not. Study endpoints were heart rate, blood pressure, Glasgow Coma Scale (GCS), reentry into the 911 system, and emergency department (ED) discharge rates.Results:There were no significant differences between the thiamine, and without-thiamine groups. All patients were discharged neurologically intact or were alert and oriented when refusing transport to the hospital. None of the 242 patients re-called 911 within the immediate 24-hour period or returned to the ED.Conclusion:To our knowledge this is the first study in the literature which evaluated the use of thiamine with glucose to prevent Wernicke’s encephalopathy in the prehospital setting. We found that routine administration of thiamine with glucose did not result in differences in respiratory rate, systolic blood pressure, GCS or ED hospital discharge rates. Until further research is done to validate our results emergency medical services leadership should consider whether the routine use of thiamine in the prehospital setting is appropriate for their system.

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Anaphylaxis from administration of intravenous thiamine

Cited by 36 publications

References 10 publications

α-Lipoic acid potentially targets AMP-activated protein kinase and energy production in the fetal brain to ameliorate dioxin-produced attenuation in fetal steroidogenesis

α-Lipoic acid potentially targets AMP-activated protein kinase and energy production in the fetal brain to ameliorate dioxin-produced attenuation in fetal steroidogenesis

The hollow needle: inappropriate injection in practice

Comparison of Prehospital Glucose with or without IV Thiamine

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