Glucose before Thiamine for Wernicke Encephalopathy: A Literature Review

Schabelman, Esteban; Kuo, Dick

doi:10.1016/j.jemermed.2011.05.076

Cited by 62 publications

(37 citation statements)

References 28 publications

(48 reference statements)

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“…Hypoglycemia must be ruled out in a patient with altered mental status (AMS). Patient with AMS should be given intravenous thiamine; however, holding dextrose administration before thiamine administration should not be a priority in hypoglycemic patients because dextrose is readily taken up by cells compared to thiamine and there is no point of waiting for thiamine administration [12,13]. …”

Section: Discussionmentioning

confidence: 99%

Asystolic Cardiac Arrest of Unknown Duration in Profound Hypothermia and Polysubstance Overdose: A Case Report of Complete Recovery

et al. 2015

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Patient: Male, 20Final Diagnosis: Asystolic cardiac arrest in profound hypothermia and poly-substance overdoseSymptoms: Cardiac arrest • cardiac arrhythmiaMedication: —Clinical Procedure: Endotracheal intubation • hemodialysisSpecialty: Critical Care MedicineObjective:Unusual clinical courseBackground:Opioid addiction and overdose is a serious problem worldwide. Fatal overdoses from opioids are responsible for numerous deaths and are increasing, especially if taken in combination with other psychoactive substances. Combined with environmental exposure, opioid overdose can cause profound hypothermia. Opioid abuse and other drugs of abuse impair thermoregulation, leading to severe hypothermia. Both drug overdose and severe hypothermia can cause cardiac arrest.Case Report:We report a case of 20-year-old man with history of polysubstance abuse presenting with severe hypothermia and asystole of unknown duration with return of spontaneous circulation (ROSC) achieved after 28 minutes of cardiopulmonary resuscitation (CPR). Urine toxicology was positive for cocaine, heroin, and benzodiazepine, along with positive blood alcohol level. The patient was rewarmed using non-invasive techniques. Hospital course was complicated by acute renal failure (ARF), severe rhabdomyolysis, severe hyperkalemia, ST-elevation myocardial infarction (STEMI), shock liver, coagulopathy, and aspiration pneumonia.Conclusions:Survival with full cardiovascular and neurologic recovery after a cardiac arrest caused by drug overdose in the setting of severe hypothermia is still possible, even if the cardiac arrest is of unknown or prolonged duration. Patients with severe hypothermia experiencing cardiac arrest/hemodynamic instability can be rewarmed using non-invasive methods and may not necessarily need invasive rewarming techniques.

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Section: Discussionmentioning

confidence: 99%

Asystolic Cardiac Arrest of Unknown Duration in Profound Hypothermia and Polysubstance Overdose: A Case Report of Complete Recovery

et al. 2015

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“…Theoretically, administering a glucose load in the setting of inadequate thiamine stores may shut down the pyruvate to acetyl coenzyme A conversion, limiting glycolysis and the link to the Krebs cycle, which may precipitate the development of WE (27). For a thorough review, readers are referred to an excellent comprehensive literature review by Schabelman and Kuo (27).…”

Section: Thiaminementioning

confidence: 99%

“…The most cited reference for this phenomenon in humans appears to be a case series of four patients published in the early 1980s; however, as pointed out by some critics, none of these cases resulted in an acute conversion/worsening of WE following the acute administration of glucose (30,31). Case reports describing this phenomenon have generally involved at least 1-2 L of dextrose or more, and occurred 24 hours or more after the administration of glucose (27). Given the substantial harms of hypoglycemia and conflicting literature to date regarding the administration of thiamine prior to glucose, we do not suggest that glucose administration be delayed in a hypoglycemic patient with an AUD while awaiting the preparation and administration of thiamine.…”

Section: Thiaminementioning

confidence: 99%

Unpeeling the Evidence for the Banana Bag: Evidence-Based Recommendations for the Management of Alcohol-Associated Vitamin and Electrolyte Deficiencies in the ICU

Flannery

Adkins

Cook

2016

Critical Care Medicine

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Based on the published literature, for patients with a chronic alcohol use disorder admitted to the ICU with symptoms that may mimic or mask Wernicke's encephalopathy, we suggest abandoning the banana bag and utilizing the following formula for routine supplementation during the first day of admission: 200-500 mg IV thiamine every 8 hours, 64 mg/kg magnesium sulfate (approximately 4-5 g for most adult patients), and 400-1,000 μg IV folate. If alcoholic ketoacidosis is suspected, dextrose-containing fluids are recommended over normal saline.

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“…Duas proteínas (TcTIA6 e TcTIA7) envolvidas na biossíntese da tiamina codificadas pelo genoma do Theobroma cacao L Two proteins (TcTIA6 and TcTIA7) involved in the biosynthesis of thiamine coded by Theobroma cacao L. genome INTRODUÇÃO A vitamina B1, também conhecida como tiamina, é uma vitamina hidrossolúvel que atua como um cofator na descarboxilação do piruvato e do α-cetoglutarato, essencial para o metabolismo aeróbico (1,2). A tiamina é indispensável para o crescimento e desenvolvimento do organismo, atuando no sistema digestivo, cardiovascular, nervoso e ainda melhora o estado psicoemocional (3,4).…”

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DUAS PROTEÍNAS (TcTIA6 e TcTIA7) ENVOLVIDAS NA BIOSSÍNTESE DA TIAMINA CODIFICADAS PELO GENOMA do Theobroma cacao L

Santana

Silva

Bernardes

2017

Infarma

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Thiamine functions as a cofactor for activity of various enzymes that act on the metabolism of carbohydrates and amino acids. This study aimed to analyze through bioinformatic techniques the genes responsible for the biosynthesis of thiamine encoded by the genome of Theobroma cacao L. We found two genes, one in chromosome 6 and one in chromosome 7, being appointed as TcTIA6 and TcTIA7. The multiple alignment revealed a strong identity with the Arabidopsis thaliana protein and its direction is destined to the secretory route of the chloroplast. Conserved motifs in the C-terminal region were found, indicating participation in the DNA repair mechanism. Analyzing the dendrogram it was evident that the genes studied had a common ancestor with Gossypium raimondii. The analysis showed that the TcTIA6 and TcTIA7 proteins are probably bifunctional, since they are involved in the biosynthesis of thiamine and stability of the DNA molecule.Key Words: cacao, computational biology, genome, protein, thiamine RESUMO A tiamina funciona como um cofator para atividades de várias enzimas que atuam no metabolismo de carboidratos e aminoácidos. Este trabalho objetivou analisar através de técnicas de bioinformática os genes responsáveis pela biossíntese da tiamina codificadas pelo genoma do Theobroma cacao L. Foram encontrados dois genes, um no cromossomo 6 e outro no 7, sendo nomeados TcTIA6 e TcTIA7. O alinhamento múltiplo da TcTIA6 e TcTIA7 revelou alta identidade com a proteína da Arabidopis thaliana e seu direcionamento é destinado para a rota secretora do cloroplasto. Foram observados motifs conservados na região C-terminal, indicando participação no mecanismo de reparo de DNA. Analisando o dendrograma ficou evidenciado que os genes estudados tiveram um ancestral comum com Gossypium raimondii. As análises mostraram que as proteínas TcTIA6 e TcTIA7 provavelmente são bifuncionais, uma vez que estão envolvidas na biossíntese da tiamina e na estabilidade da molécula de DNA.

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Glucose before Thiamine for Wernicke Encephalopathy: A Literature Review

Cited by 62 publications

References 28 publications

Asystolic Cardiac Arrest of Unknown Duration in Profound Hypothermia and Polysubstance Overdose: A Case Report of Complete Recovery

Asystolic Cardiac Arrest of Unknown Duration in Profound Hypothermia and Polysubstance Overdose: A Case Report of Complete Recovery

Unpeeling the Evidence for the Banana Bag: Evidence-Based Recommendations for the Management of Alcohol-Associated Vitamin and Electrolyte Deficiencies in the ICU

DUAS PROTEÍNAS (TcTIA6 e TcTIA7) ENVOLVIDAS NA BIOSSÍNTESE DA TIAMINA CODIFICADAS PELO GENOMA do Theobroma cacao L

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